Cecilia, La. — Johanette Guidry and her family were getting ready for her son Owen’s first Christmas, when, the night before Christmas Eve, they realized the 4-year-old couldn’t breathe. Seeing her baby’s stomach cave in as he struggled to fill his lungs with air, the family rushed Owen to the hospital.
“It was absolutely terrifying,” remembers Guidry, who said she knew little of Respiratory Syncytial Virus, or RSV, and how it could affect small children.
RSV kills thousands of adults and hundreds of infants each year in the United States, and until this fall, there was no vaccine to prevent it or lessen the risk to patients who contract the virus. This season marks the first time a vaccine has been made widely available, but it’s unclear how many patients are willing to accept the potentially life-saving measure.
“I haven’t met many individuals who’ve had the vaccine yet,” said Dr. Julio Figueroa, chief of infectious diseases at LSU Health’s School of Medicine in New Orleans. The vaccine being in its first year of distribution and therefore not being on patients’ radar yet, along with other growing pains like questions over reimbursement likely played a role, Figueroa noted, along with vaccine fatigue or hesitancy.
That’s despite the severe outcomes an RSV infection can have for both infants and the elderly, the two groups most vulnerable to infection. Especially for elderly patients, an RSV infection can exacerbate existing health conditions, such as heart conditions or bacterial infections. “In older individuals, it’s sort of the thing that tips you over,” Figueroa said.
This season has been especially severe for respiratory illnesses outside of COVID-19, which have made a comeback following a significant dip while pandemic restrictions and disease prevention regiments were in place. Nationwide, flu hospitalizations are anticipated to return to pre-pandemic levels this season and RSV hospitalizations, which peaked in November last year, continued to climb through December.
According to the Louisiana Department of Health, the state is currently experiencing “very high” levels of influenza-like illness, an umbrella term used by the agency to describe upper respiratory illnesses with symptoms more severe than a common cold.
The department’s latest data snapshot sent out to physicians on Dec. 27 showed key data points like positive flu tests, hospitalizations and mortality all trending upwards. Influenza makes up the largest percentage of cases counted by the department, with RSV coming in second. Northwest and southeast Louisiana, as well as Acadiana, are currently experiencing the highest levels of severe respiratory illnesses statewide, according to LDH data.
While a flu vaccine has long been available, starting this season, patients for the first time have the option to protect themselves from the most severe outcomes of RSV as well. But, new vaccines and medications are often viewed with skepticism, Dr. Britni Hebert, a Lafayette-based internal and geriatric doctor, noted. “People, they need time to think about it and get used to it,” she said. That skepticism has only become more pronounced during the rollout of the coronavirus vaccines in recent years.
“Since the COVID pandemic, we’ve had an increase in reservation about vaccines in general,” Hebert said. Still, in light of an especially difficult season for respiratory illnesses, she’s hoping that adult patients will have conversations with their physicians to clear up any concerns they might have.
“Good information about medical decisions, and the reasons why we recommend what we do, are rarely found on social media through kind of wide internet searches,” Hebert noted. “Any stance on any medical decision, you can find someone who convincingly speaks to that stance. That doesn’t mean it’s right.”
The amount of information and misinformation shared online can be hard even for medical professionals to navigate, she added. Instead, she encourages those with access to a primary care physician to discuss the issue with a medical professional.
“That is the best way to come to an informed personal decision about any medical decision, vaccines included,” Hebert said.
A lack of access to primary care, however, has been a challenge nationwide, including in Louisiana. According to the advocacy group Access to Care, 95% of Louisiana residents live in areas identified as having a lack of primary care providers. While telehealth has been increasingly deployed to provide more access, especially in rural areas, challenges persist.
For those whose only access to medical guidance is online, Hebert advises relying on information provided on the website of their local health departments, which feature guidance on vaccines. “The majority of primary care doctors agree 100% with those recommendations,” she said. “That’s your safest place to start.”
Concerns people have about the safety of vaccines are valid, Hebert said, but they have to be put into perspective.
“Your drive to work is not zero risk. Ibuprofen kills 3,000 people per year. Antibiotics kill people every year. Nothing is zero risk,” she said. “We take the small risks that give us big benefits. And that balance between the risk and benefit is what makes a wise, healthy medical decision.”
According to Hebert, the main risks of the RSV vaccine are those commonly related to any vaccine. Allergic reactions, although rare, are possible. All vaccines activate the immune system, Hebert noted, which can lead to the development of a neurological disorder called Guillain-Barre Syndrome, in which the body’s immune system attacks the nerves.
But, Hebert points out, patients are much more likely to develop this rare illness following an infection with RSV, influenza or COVID-19 than they are as a result of taking a vaccine against those illnesses. By reducing the risk of infection or serious illness from one of those viruses, patients also reduce their overall risk of developing the disorder, she noted.
“We are actually protecting against this by getting the vaccine,” she said.
Assessing vaccine uptake in Louisiana is complex, and there is no data yet on how many Louisianians have chosen to get the new vaccine. Louisiana trails behind the national average on vaccination rates against influenza and COVID-19. Standard childhood vaccines have been slightly more accepted in Louisiana than they have nationwide, but the rate of parents using exemptions from vaccine requirements has increased recently.
Data on current RSV infections offers some hope that, at least for this season, the worst of it is behind us. Nationwide, test results from wastewater collection show that while flu infections continue to rise, RSV infections have been trending down over the last month, suggesting that the season may be tapering off. Average positive test rates in Louisiana have been trending down as well, according to data collected by the Centers for Disease Control and Prevention, although post-holiday illness might release in another uptick.
“We start kind of early with our RSV [season], so we might be on a downhill trend,” Figueroa said of Louisiana. “But it remains to be seen.”
Hebert is hopeful that in future RSV seasons, patients might be more open to trying the vaccine, as it becomes more established. Despite lingering hesitancy, she said she’s noticed some comfort around vaccines returning. “I think people are remembering what an opportunity vaccines are, that we get to protect our bodies against these diseases that used to disable and kill ancestors of ours,” she said.
In addition to the adult vaccine offered to elderly patients, there is also a vaccine for pregnant women, which can help prevent severe infections in their yet-to-be-born children. Had it been available when she was pregnant, Guidry said she’d gladly have taken it, especially after seeing the year-long health complications her son went through after his RSV infection.
“I understand the fear of giving your child something that maybe you haven’t done enough research on, you weren’t the person that created it,” she said. “But you also need to do everything that you can to protect them.”
For those looking to get the shot, RSV vaccines are available at primary care offices, pharmacies and local public health units.