Back in September, the Children’s Hospital of Richmond at VCU staff was optimistic they’d receive enough shots of a new Beyfortus (nirsevimab) vaccine to arm babies against RSV for the season. RSV is the leading cause of infant hospitalization in the U.S.
But by the end of October, they’d only received 90 of the 50 milligram doses and 15 of the 15 milligram doses — out of the 200 doses CHOR requested. The 50 mg doses are designed for newborns, with the 15 mg doses for older babies around 4–6 months of age. CHoR staff estimated they’d need at least 3,000 doses total for a year.
“What we learned was that that initial order wasn't able to be met. And then we heard from the company that they would be unable to fulfill future orders as well,” Dr. Tiffany Kimbrough, a pediatrician with the hospital, told VPM News. “So whatever you got at the start of the season would be what you would have to get you through.”
For Kimbrough, that meant they wouldn’t be able to give the vaccine to all babies — and the majority of healthy babies would remain unvaccinated for respiratory syncytial virus.
“What we did was to shift into an allocation model to think about which are the babies who are at highest risk of RSV disease ending them up in the hospital, and try to protect those infants,” Kimbrough said.
That meant prioritizing babies with heart and lung disease, as well as those born prematurely. Kimbrough said they’ve given around 50 Beyfortus shots to babies leaving the NICU. The hospital has also been able to bring some newborns back to receive the vaccine through a separate allocation for Medicaid recipients through the Virginia Vaccines for Children Program (VVCP).
According to a spokesperson for the Virginia Department of Health, the VVCP has received a total of 6,160 50 mg doses and 2,770 100 mg doses across the state so far — but isn’t expected to receive more doses this winter.
In November, the Centers for Disease Control and Prevention expedited the release of 77,000 additional doses — but Kimbrough isn’t sure if CHOR will receive any additional doses from this new batch. If it does, it’s unclear when the vaccines would arrive.
“It takes months to make so we aren't expecting, unfortunately, any additional doses this season,” Kimbrough said. “But we're really hopeful that they'll have a better understanding of what the market demand is for us to be able to meet the needs next season, just given how many children really were hoping to get it this year.”
For those babies unable to get the vaccine this winter Dr. Drew Barber, a pediatric pulmonologist with VCU Health, said parents should keep an eye on how hard their babies are having to work to breathe, and if breathing work significantly changes they should visit a doctor.
“Retractions just mean that they are working harder to breathe, they're using other muscles to help get air in and so it looks like their skin is kind of sinking in underneath their ribcage or in their neck,” Barber said. “Or sometimes you'll see their nostrils flaring.”
For expecting mothers, another version of an RSV vaccine called Abrysvo (RSVpreF) is more readily available — and has been shown to significantly reduce infant hospitalizations when administered between 32 and 36 weeks gestation.
