Respiratory syncytial virus (RSV) is a common cause of respiratory infection among infants and young children; in fact, 90 percent of infants will experience RSV infection by their second year of life.1 What’s less known is that older adults and individuals with compromised immune systems are also vulnerable to RSV infections and associated complications.
According to the Centers for Disease Control and Prevention, “RSV activity has peaked in many areas of the country [as of January 2025]. Emergency department visits and hospitalizations are highest in children and hospitalizations are elevated among older adults in some areas.”2
Infection of the bronchioles (bronchiolitis) typically occurs with severe RSV disease in infants and young children and often necessitates hospitalization and supportive care.3, 4 It is common for RSV infection to occur at the same time as other viruses, and the presence of multiple respiratory viruses has been shown to further increase disease severity.5,6
It is estimated that RSV causes 58,000 to 80,000 hospitalizations and 100 to 300 deaths in children less than 5 years old and 60,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths in adults over 65 years old in the U.S. each year. Economic modeling suggests that RSV cases in U.S. adults over 60 years old are associated with $6.6 billion in annual costs.7
There are no medications approved by the Food and Drug Administration (FDA) for the treatment of active RSV infection. In “Evolving Strategies for Respiratory Syncytial Virus (RSV): A Review Article of Preventive Agents and Vaccines for RSV,” authors Edward Pudim III, PharmD, MPH, clinical consultant pharmacist at ForHealth Consulting, and Nick Howard, PharmD, formerly of Cencora, describe the pharmacology, efficacy, safety, and recommendations for the use of newly approved preventive agents and vaccines for RSV. This article was published in the Annals of Pharmacotherapy.
“Despite the significant burden RSV has on population health, there are no medications available for its treatment apart from symptomatic management with corticosteroids, diuretics, and supplemental oxygen. Thus, disease prevention plays an extremely significant role in reducing the impact of RSV on vulnerable populations,” the authors noted in the article.
New Approaches to RSV Prevention
Since there are no treatments for active RSV infection, preventative medicine is our best bet. Prior to 2023, the single preventive agent available for RSV infection, palivizumab, was only FDA-approved for use in young infants at high-risk of RSV infection. This injection is administered intramuscularly once a month during the RSV season.8
The FDA has since approved nirsevimab, a monoclonal antibody medication used to prevent RSV in infants and young children. Nirsevimab only needs to be given once per RSV season as opposed to the multiple times required for palivizumab.9
Three new vaccinations, Abrysvo, Arexvy, and mResvia, also aim to prevent RSV infection in adults at high risk of infection and in newborns via passive immunization by administration to pregnant women. All three vaccines are administered one time intramuscularly in the upper arm.
These new RSV preventive agents and vaccines offer less burdensome dosing and administration compared with palivizumab, show promising efficacy and safety data, and expand the populations eligible for RSV prevention. Updated clinical guidance supports immediate adoption of these agents in practice.
Professional medical associations and organizations recommend that healthy young infants and older adults at considerable risk of infection receive one of these new agents. Pregnant women are also recommended to receive an RSV vaccine to prevent infection of their newborn at birth through 6- months-old.
“Staying ahead of the pharmacy pipeline in infectious diseases is crucial; it empowers healthcare professionals to anticipate and optimize treatment strategies and ultimately improve patient outcomes,” said Tasmina Hydery, PharmD, MBA, BCGP, director, market access and healthcare consulting with Cencora.
At ForHealth Consulting, our highly experienced, multidisciplinary Clinical Pharmacy Services team—including pharmacists, physician advisors, and data and research professionals—understands today’s fast-changing healthcare environment, including responding to growing healthcare needs, such as the spread of viral infections like RSV.
In partnership with Cencora, our pharmacy experts develop Product Snapshots, product overviews which include pre-approval information, clinical trial summaries, and pharmacy and therapeutics considerations. RSV is one of many conditions covered within Product Snapshots, helping healthcare decision-makers to develop timely and accurate treatment plans. These are available on a complimentary basis via FormularyDecisions (a secure online platform that helps to facilitate informed decisions to support the product evaluation process).
At ForHealth Consulting, we help organizations achieve the highest-quality patient outcomes with our formulary and pipeline monitoring services. We ensure that our clients’ formularies are based on the latest clinical data and medical guidelines. These services enable new preventive therapy strategies for conditions like RSV, maximizing cost control and enhancing patient care.
- https://www.sciencedirect.com/science/article/pii/S2667009723000969#:
- https://www.cdc.gov/respiratory-viruses/data/index.html
- Centers for Disease Control and Prevention. Respiratory syncytial virus infection (RSV): symptoms and care. Updated September 6, 2023. Accessed May 15, 2024. https://www.cdc.gov/rsv/about/symptoms.html
- Ralston SL, Lieberthal AS, Meissner HC, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis [published correction appears in Pediatrics. 2015 Oct;136(4):782. doi:10.1542/peds.2015-2862]. Pediatrics. 2014;134(5): e1474-e1502. doi:10.1542/peds.2014-2742
- Jennings LC, Anderson TP, Werno AM, Beynon KA, Murdoch DR. Viral etiology of acute respiratory tract infections in children presenting to hospital: role of polymerase chain reaction and demonstration of multiple infections. Pediatr Infect Dis J. 2004;23(11):1003-1007. doi:10.1097/01. inf.0000143648.04673.6c
- Drews AL, Atmar RL, Glezen WP, Baxter BD, Piedra PA, Greenberg SB. Dual respiratory virus infections. Clin Infec Dis. 1997;25(6):1421-1429. doi:10.1086/516137
- https://pmc.ncbi.nlm.nih.gov/articles/PMC11326840/
- https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/infants-young-children.html
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2920777/