What is RSV and why are infants especially at risk in India?
Respiratory Syncytial Virus, commonly known as RSV, is the leading cause of respiratory illness in children and infants worldwide. In India, RSV has also become a major issue for parents as well as pediatricians, particularly in the post-monsoon and winter seasons when cases surge.
Although the nation continues to establish complete surveillance information, existing studies in tertiary care facilities show that RSV contributes 30% to 50% of bronchiolitis and pneumonia incidents in children aged two years and below.
RSV is usually responsible for the symptoms of a cold in older children and adults. Nevertheless, in infants—especially those under six months of age, those who were premature at birth, or those with underlying health issues—the virus may cause severe lower respiratory tract infections, including bronchiolitis (inflammation of small airways) and pneumonia.
These two diseases usually require hospitalization, and hospitalization rates between 3 and 5 per 100 infants less than one year of age per year have been estimated in India.
The risks are not equal throughout the nation. Geographic and socioeconomic variations account for both the risk of and outcome of RSV infection. Children living in lower-income populations or in densely populated urban environments can have increased exposure from lesser access to healthcare, suboptimal ventilation, and slower diagnosis.
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Seeing the international burden of RSV, the World Health Organization (WHO) recently supported maternal RSV vaccination as a prevention approach. This entails immunizing pregnant women so that antibodies are passed on to the unborn child, providing immunity in the vulnerable early months of life. Although not yet included in India's Universal Immunization Programme (UIP), Indian health authorities, such as the Indian Academy of Pediatrics, are in the process of evaluating the vaccine's safety, effectiveness, and affordability in India.
Phased introduction in high-risk groups could be the initial step.
Apart from vaccines, monoclonal antibodies too have been promising in the prevention of RSV-related complications. These provide passive immunity in a single dose of injection. But the big constraint is cost. Without government incentives or being covered under public health schemes, these therapies could prove to be out of reach for the majority of Indian families.
Differential pricing models and collaborations with insurance companies will become paramount in order to expand access.
More encouragingly, Indian drug makers are not idle either. Bharat Biotech and Serum Institute of India have initiated RSV research programs and are likely to bank on their experience in the production of pediatric and maternal vaccines. Tie-ups with global firms can also open the way for local production of monoclonal antibodies, leading to costs savings as well as wider availability.
Experts put wide availability of RSV vaccines and antibodies in India at least 2 to 4 years down the road. Early access could start in corporate or private hospitals dealing with high-risk pregnancies. In the private sector, however, the incorporation of RSV prevention in the national immunization program will be crucial to making RSV vaccines and antibodies accessible and beneficial for all Indian infants—irrespective of birthplace.
Article courtesy: Dr. Shreya Dubey - Consultant - Neonatology & Paediatrics, CK Birla Hospital, Gurugram
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