RSV: Prevention & Treatment for At-Risk Populations (Recording)

This webinar was recorded on January 20^th, 2026

Respiratory Syncytial Virus (RSV) remains a significant source of concern across vulnerable populations, including infants, older adults, and patients with chronic respiratory or immune conditions. As prevention and treatment options evolve, clinicians benefit from clear, up-to-date guidance that supports effective risk evaluation, patient counseling, and proactive seasonal planning. Join us as Dr. Juanita Mora highlights the latest evidence on RSV prevention and treatment, outlines current recommendations for high-risk populations, and shares practical insights to enhance clinical decision-making throughout RSV season.

Speaker:

Juanita Mora, MD

Dr. Juanita Mora is a board-certified allergist and immunologist and CEO of the Chicago Allergy Center. She serves as National Spokesperson for the American Lung Association and sits on its Board of Directors, where she advances lung health, asthma care, and health equity initiatives. Dr. Mora also co-chairs the Women’s Healthcare Committee of the American Academy of Allergy, Asthma & Immunology and contributes to national advocacy through the National Hispanic Medical Association.

She received her training at Rush University Medical Center, completing her Internal Medicine/Pediatrics residency, Allergy and Immunology fellowship, and a master’s in clinical research. Dr. Mora is recognized for her clinical leadership, media expertise, and extensive community outreach, particularly in underserved populations.

This Advances webinar is in partnership with the American College of Allergy, Asthma & Immunology. ACAAI offers CMEs for physicians for this webinar. If you are a member of ACAAI, you can obtain CME through the member portal for the Advances webinars.

Sponsored by the American College of Allergy, Asthma and Immunology

Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Ruthie Marker: Good afternoon, everyone. We’re going to get started shortly. I’m just going to let everyone come in that was in the waiting room, and we will start at the top of the hour.There are lots of people joining us today, lots of people eager to learn more about RSV, so it is going to be a great presentation, and it looks like we have a good group already, so I will go ahead and get started.Again, my name is Ruthie Marker. I am the Education Program Manager at the Allergy and Asthma Network. I’m delighted to welcome you to today’s… this afternoon’s CME-accredited webinar. We have an excellent program plan focusing on the latest strategies with RSV management. Before we get started today, I’d like to cover a few housekeeping details. Everyone will remain on mute during the webinar to minimize distractions. We will record the session and upload it to our website in about a week. You can also watch this recording, as well as previously recorded webinars at allergyasthanetwork.org. Our webinar is scheduled to last one hour. There will be a question and answer session at the end of the presentation. You’re welcome to submit any questions you have using the Q&A box located at the bottom of your screen. A team member will check the chat for any questions or help with any technical assistance you might need throughout the presentation. We will do our best to answer as many questions as possible before we finish for the day. This Advances webinar is brought to you in collaboration with the American College of Allergy, Asthma, and Immunology. The college offers continuing medical education credits for physicians and attendance credits for all others. You can create a free ACAI account to earn CME or attendance credits for Advances webinars via their member portal. All attendees will receive a certificate of attendance. Please note that no additional continuing education credits will be provided. A few days after the webinar, Zoom will email you supplemental resources with a link to download your certificate of attendance, as well as a copy of the slides and a link to the recording. So let’s go ahead and jump in. Today’s presentation is titled RSV, Prevention and Treatment for At-Risk Populations. RSV remains a significant source of concern across vulnerable populations, including infants, older adults. patients… in patients with chronic respiratory or immune conditions. As prevention and treatment options evolve, clinicians benefit from clear, up-to-date guidance that support effective risk evaluation, patient counseling, and proactive seasonal planning.

Today, Dr. Juanita Mora will evaluate and highlight the latest advances in RSV prevention for high-risk populations, and share tactical insights for enhance clinical decision-making throughout RSV season. Dr. Juanita Mora is a board-certified allergist and immunologist and CEO of the Chicago Allergy Center. She serves as a national spokesperson for the American Lung Association and sits on its board of directors. Where she advances lung health, asthma care, and health equity initiatives. Dr. Mora also co-chairs the Women’s Healthcare Committee of the American Academy of Allergy, Asthma, and Immunology, and contributes to the national advocacy through National Hispanic Medical Association. She received her training at Rush University Medical Center, completing her internal medicine and pediatric residency. Allergy and Immunology Fellowship, as well as a Master’s in clinical research. Dr. Mora is recognized for her clinical leadership and media expertise, and extensive community outreach, particularly in underserved populations. With that, thank you for being here, Dr. Mora. I will turn it over to you.

Juanita Mora: Thank you so much, Ruthie, for the beautiful introduction, and thank you, everyone, for being with us today to talk about RSVs. Such an important subject as we address it in our patient population, and it really is one of the actual diseases that is across the board and affects all populations. I’d like to talk about disclosures. No disclosures to identify, so next slide, Ruthie, please. Learning objectives. Today, we’re going to talk, first of all, about describing the epidemiology when it comes to RSV. We’re going to talk through transmission patterns, disease burden, populations at highest risk, and the impact of health inequities with RSV infection and outcomes in children and adults. Two, we’re going to evaluate current RSV prevention strategies, including vaccination and monoclonal antibody therapies. And distinguish appropriate candidates among adults, infants, and pregnant individuals based on evidence-based guidelines, because it’s not just the baby disease. Three, to recognize social, structural, and clinical factors that contribute to disparities in RSV risk and prevention uptake, and integrate these considerations into shared clinical decision making so that we make sure, especially to protect our most vulnerable communities. And four, to apply RSV prevention strategies in clinical practice as we see our patient populations. By appropriately identifying and recommending preventive therapies and assessing emerging evidence on whether early RSV prevention in infancy may influence long-term respiratory outcomes, including asthma development. And that’s a subject I’m super excited to talk about, as I’ll discuss some of the data coming out of Spain, France, and Chile, and it’s real-world data. So, with that, next slide, Ruthie.

Well, let’s talk RSV. Why is it so important that we talk about it? First of all, because RSV is a common respiratory virus that can infect people of all ages. And I want to highlight people of all ages, because people think of it as a baby disease, but now we know it can affect any age group, and especially puts people at high risk for RSV complications peak months, October through March, so we are right in season right now. And it’s so common that nearly 100% of children will have been infected with the virus by age 2. It’s the leading cause of hospitalizations in all infants, and it’s also spread from person to person so easily, with someone who is coughing, infected via secretions, and sneezing, or touching objects like doorknobs or toys that have virus on them. And this is especially relevant when we’re talking school setting, daycares, even homes where multiple generations are under the same roof. This is why it’s so important that we talk about RSV. Next slide, Ruthie.

So let’s look at RSV transmission. And it’s, like I said, so easily spread via respiratory droplets, from direct contact with infected secretions, or contact with contaminated fomites. So these are the doorknobs that people touch, surfaces that are frequently actually touched as well, too. And one thing we want to know and highlight is, if you have contact with an infant, you need to take extra care to keep the infant healthy. And that’s if you’re sick or anyone comes in contact with a baby that’s sick, that they wear a mask. You try to avoid people being sick, coming in contact with the baby as well, too. And let’s remember that most people, including infants, develop only mild symptoms like that of a common cold, but for some, RSV can be severe and even life-threatening. Especially when we look at babies and people who are older than 75 years of age, or 6-year-olds and older who have chronic medical conditions. All this beautiful mucus goes right into the lungs and can put people at risk for RSV pneumonia and even respiratory failure. So this is why it’s so important that we talk about it. Next slide, please.

Like I said, most people, including infants, it RSV… it starts as just a common cold. So people will begin with runny nose, maybe high fever, maybe a little cough in infants or adults, but this can become severe and life-threatening very fast. So. We have to be especially careful with those babies who are born prematurely, those who are very young, so the babies less than 6 months are going to be highest risk for RSV hospitalization, those that have chronic lung or heart disease, a weakened immune system, or neuromuscular disorders. We need to take extra care to keep the infants healthy, because these are high-risk infants for complications from RSV. Under this umbrella, I also like to mention babies who have cystic fibrosis babies who also have, basically, an immune system that’s compromised. And these are a lot of the patients that we see in clinic as well, too. So, risk factors that I always think about in babies for RSV, definitely those born premature, those with chronic medical conditions, such as heart disease, lung disease, weakened immune system, like I said, and cystic fibrosis, or any anything that makes their immune system weaker than most. These are the babies that you’re going to think about actually giving a second vaccination or a monoclonal antibody to these babies when they’re even a little older, 8 to 19 months of age, and we’re going to discuss this further. Next slide.

So, who else is at risk for RSV? We know that older adults greater than 60 years of age, and the CDC has identified risk factors for those greater than 60 years of age that make them good, actual candidates for RSV vaccination. And these are people who have diabetes, high blood pressure, cardiac disease, COPD or emphysema, asthma. Smokers fall into this category as well, too people with cancer because, again, they’re immunocompromised. In any underlying immunocompromised state, there are going to be very, very good candidates for RSV vaccination. Next slide.

So, when we look at RSV as a spectrum, it’s a cause of respiratory diseases in all ages. So, we know it affects the babies, we know it affects the kids, the older risks are at risk for severe infection, especially with associated complications. Due to age-related decline in immunity, which happens naturally. And then those adults with chronic medical conditions that predispose them to have a weakened immune system are going to be at greater risk for severe RSV infection. Next slide.

So, older adults and adults with certain medical conditions definitely are at increased risk of RSV. So, one is, just age alone puts them at high risk for RSV infection. So, older age identified by the CDC by those especially greater than 75 years of age. two comorbidities. So, adults aged greater than 60 years of age, with increased risk for severe RSV disease. And again, here are the chronic conditions that CDC has identified. Chronic kidney disease, COPD, asthma, severe obesity, coronary artery disease, diabetes, current smokers, those who have had strokes. And obesity as well, too, is considered a high-risk condition for RSV infection. And then those with a weakened immune system. Adults with weakened immune systems are particularly vulnerable. So those we’re going to identify, definitely, as those patients who might have underlying, for example, immune deficiencies, as we see in our practice. Next slide.

So, studies have shown that RSV infections can lead to exacerbations of underlying conditions. So, what we see in studies now is that RSV is a common factor in COPD and asthma exacerbations. So in a prospective study of adults aged 60 years and older hospitalized with RSV, 50% of patients with asthma had exacerbations. 80% of patients with COPD had exacerbations, and 38% of patients with CHF had exacerbations as well, too. So this is why these conditions are something that we need to think about when we think of conditions where we have to protect our patients against RSV complications, and Leading them to hospitalizations for asthma or COPD, which is very common in our patient population. Next slide.

When we look at emergency department referral and criteria for RSV in children and adults. This is what I like to call the anticipatory guidance that I like to give parents, I like to give on the news as well, too, and I love to give my patients as well, too. So, 3 big actual categories that I tell them, 3 key points that we need to watch out for that are the red flags. That people should go to the emergency department for. One, signs of labored breathing. When this baby or this older adult develops a dry cough that’s not getting better, they start using their muscles and their chest to try to breathe, because they can’t get that mucus out, they feel like they’re really choking, they’re unable to speak in full sentences, they turn blue in color, or any oximeter reading less than 92% of room air. I always tell parents also to look for babies for tugging of the neck muscles. That’s one of the signs as well, too, when it comes to retractions or having trouble breathing. Two signs of dehydration. I always ask parents to monitor for number of wet diapers in a day, making sure that this baby is continuing to stay hydrated, that they’re outputting as many wet diapers as possible, and pushing hydration, being it with their formula, being it with breast milk, being it with, little juices as well, too, to keep them hydrated and older adults, making sure that they’re just not lying in bed, fatigued and sleeping, not eating or drinking, because dehydration is the second leading cause of hospitalization when it comes to RSV. The third is a fever that does not respond to medication. So they call you and they tell you, you know, they’ve already done ibuprofen, they’ve done Tylenol as well, too, and they continue to have these fevers, 103, 104, 105, that are not, you know, responsive to medication. This is the third reason I send them to the emergency department. Next slide, Ruthie.

When we look at RSV, and this is why it’s so important that we discuss it, it places a substantial burden on U.S. healthcare, similar to influenza. So everyone knows, especially this season, we’ve gotten hit really hard with influenza, tons of hospitalizations, and we’re seeing a lot of pediatric deaths in the country due to influenza. But when we look to… link it to the burden that RSV places on the U.S. healthcare, very, very similar, which is why it’s so important that we talk. So, when it looks at deaths from RSV per year in patients greater than 65 years of age, RSV, we’re looking at 14,000 deaths per year versus 12 to 43,000 sometimes when it comes to influenza. When we’re looking at hospitalizations, 177,000 hospitalizations when it comes to RSV versus influenza that does 128,000 of true hospitalizations. And then when it looks at people who get infected, we’re looking at RSV, 2.2 million people infected a year due to RSV, And in influenza, it can range from 1.4 million to 5.1 million, depending on how bad the strains of influenza A and B that are going through. Currently, we are looking at very high numbers of influenza, and we’re starting to see RSV as well, too. So this is why it’s so important that we educate as many of our healthcare providers and healthcare teams to deal with RSV and try to do as much preventative therapy when it comes to protecting our patient population. Next slide, Ruthie.

Let’s look at RSV statistics in children in the U.S. So, each year in the U.S, an estimated 2.1 million kids go to the outpatient doctor for a visit due to RSV infection. This is when we look at kids less than 5 years of age. And an estimated 58,000 kids younger than 5 years of age are hospitalized due to RSV infection. And 1 to 2 out of every 100 children younger than 6 months of age with RSV infection may need to be hospitalized. And the sad number is 500 children drive from RSV each year. So this is why as much preventative therapy that we can do, and anticipatory guidance, especially to parents, is going to help to get kids, one, you know, parents to recognize the emergency red flags that can lead them into an emergency department or an urgent care a lot faster, and save these kids’ lives. And also, teach them as well, too, when… when is it okay to stay home, and when is it necessary to go to the hospital? Next slide.

Looking at RSV statistics in adults, each year in the United States, an estimated 177,000 adults are hospitalized due to RSV infection. 14,000 adults die from RSV each year, according to the CDC. And most adults who die from RSV are greater than 65 years of age, which is why it’s so important that we also try to do anticipatory guidance and prevention when it comes to our adult population, especially those Greater than 60 years of age with chronic medical conditions, and those with chronic, also greater than 65 years of age, period, because this is where we’re seeing the most deaths. Next slide with you, please.

Let’s look at racial and ethnic minority and socially, economically disadvantaged populations, and why they experience health inequities related to RSV infection. So, looking at this graph, one. when we look at American Indian, Hispanic, Black non-Hispanic, Asian non-Hispanic. What we’re looking at is that these populations, one, are more likely to have undiagnosed risk factors for severe RSV disease. Two, they have risk factors for severe RSV disease and are diagnosed with these risk factors at younger ages. 3. Experience severe RSV-related outcomes, such as hospitalizations and ICU admission. and four are more likely to not be vaccinated against RSV. Part of the reason that we’re seeing these, especially in these ethnic minority populations, is one poverty. So, having access to vaccinations, having access to medical insurance, and one thing that I’m seeing as a doctor in inner-city Chicago, dealing a lot with the Latino population, is due to the ICE rates now, less people are seeking care, and going to the doctor because they’re scared. So, for their children, for themselves as adults, many are not refilling their medications, so they’re not treating their asthma or COPD or emphysema, and they’re not getting the vaccinations because they’re losing medical insurance. So, part of the reason why they’re also not, getting the care that they need, so that’s going to put them at higher risk. for ICU admission and hospitalization when it comes to RSV infection. Next slide, Ruthie.

And as we talk about the RSV burden in Latino and African American communities, there’s many factors contributing to the disproportionate burden. One are multi-generational homes, because children bring home infection from daycare or school to grandparents, and infection spreads like wildfire, because it’s easier in that setting, right? Babies come from daycare, or kids come from school with RSV, and they infect the grandparents, which are higher risk for infection. 2. Higher prevalence of asthma as an underlying risk factor in inner-city African American and Latino children. 3. lack of education in identifying when to take a child or older adult to the emergency department. So this is where we talk about anticipatory guidance. 4. lack of medical access. Like I said, loss of medical insurance and medication coverage at this time is contributing to more disease burden when it comes to these populations. For lack of access to RSV vaccinations or treatments due to lack of medical insurances costs as well, too. Next slide, Ruthie.

So let’s now talk vaccinations, because vaccinations are going to be key in prevention. And I’m happy to say that 24-25 was the first year where we actually had vaccinations available, so, and so we’re going now into the second year where we have vaccinations available to help prevent the complications of RSV. When we talk the maternal RSV vaccination, it’s a bivalent protein-based vaccine, and it’s administered during 32 to 36 weeks of gestation, and typically given during the RSV season, so September through January is when we recommend it, and the CDC has given guidance for recommendations. Remember, this is a monoclon… this is an actual vaccine that provides good actual protection for the baby that lasts for about 6 months after birth, because it provides that passive protections to the infant. When subsequent pregnancy, so this is a good question. So with RSV vaccination, whether mommy has 1 baby, has 2 babies, 3 babies. Current recommendations, it’s only one maternal RSV vaccine, so one and done. When they looked at RSV antibodies, and they followed mommies for a second pregnancy or a third pregnancy in the studies, they’ve actually have not needed a new actual vaccination, so in that case, the current recommendation in subsequent pregnancies is to not repeat the maternal vaccination, but instead administer the RSV monoclonal antibody to the newborn infant. Next slide.

When we look at babies, and I think this is one of the most interesting, because they’re the highest population. of actually getting infected when it comes to, obviously the full population. We now have RSV monoclonal antibodies in infants. These are long-acting RSV monoclonal antibodies, and currently on the market is nirsimivab, and it’s indicated for all infants less than 8 months of age, so they can get it as soon as they’re born, entering their first RSV season. and children 8 to 19 months of age at increased risk for severe RSV. So again, these are the babies with chronic lung or heart disease, cystic fibrosis, any neuromuscular disorders, or anything that makes them immunocompromised, where they would be high risk, including prematurity. The mechanism of the monoclonal antibodies, remember, they’re not vaccines, they just provide a path passive immunity by supplying RSV-specific antibodies. The way I explain it to parents is they just provide that extra coat of protection that babies need so that if their little bodies encounter RSV, they’re going to be less likely to actually have any complications, and they have all the little soldiers to, to have protection against RSV infection. The duration of protection, a single dose provides protection for at least 5 months for that baby. Next slide.

So, as I mentioned earlier, when we look at preventative treatments for infants, 24-25 year was the first RSV season with widespread ability for both preventative option, resulting in a significant decrease in infant hospitalization. And this is the data, honestly, that I’m most excited to share, because I actually saw it in clinic, I saw the effects of it, and I saw less sick babies, and… and no one wants to see a sick baby, so this was very, very happy news. Next slide, Ruthie, so we can share it with them. So, looking at 24-25 hospitalization rates, the CDC analysis of RSV hospitality Hospitalization rates among two surveillance groups. from October 2024 through February 2025 found, one, that hospitalization rates were 45 and 52% lower for infants 0-2 months during peak RSVCs in December through February, and 28% and 43% lower for those 0 to 7 months old Compared to pre-pandemic or 2018 rates Of children hospitalized due to RSV, 75% were born at full term with no underlying conditions. And since 60% of eligible infants were born before the RSV season, October and November are important months for families to connect with their healthcare provider to discuss prevention. And so that’s a big message that I always give to a lot of the pediatricians. is, you know, as they’re seeing newborn babies who are born definitely before October and November, that they discuss with them the protection that they can get for RSV infection as the RSV season hits. Next slide.

So this is real-world data, and as an allergist, this is probably the highlight of, basically this talk, is RSV and asthma in pediatric populations. How will the institution of preventative treatment, the monoclonal antibody and the maternal vaccine, change the development of asthma in pediatric children? Will we drop the percentage of children with asthma and change the landscape? We know that morbidity and mortality in the last years in the United States has not changed when it comes to asthma, but will this change the landscape? So here’s what we’re doing. We’re following a cohort of babies in Spain and France and Chile. 2024 to present, and they will be followed for 5 years initially, and then they’re going to be followed longer. Because when we look at Spain, Spain was the only country that had enough doses for every baby born, and Spain gave it to 90% of babies born and saw an 82% effectiveness against hospitalization. Real-world data came out this week for Chile. Chile gave it to 95% of their babies and saw a 92% effectiveness against hospitalization. U.S, unfortunately, only had enough doses to give to 40% of babies in 24-25 year, because they underestimated the demand, so the company couldn’t keep up with the demand, which is why not enough babies got it. And this year, we expect no shortage, so there’s a lot of actual monoclonal antibody to protect these babies, so we should use it. But overall, we’re going to see and follow these kids in the cohort studies, and see, not only in the United States, but throughout the world. How will our landscape for asthma, basically do? Because we know that bad RSV is equivalent to bad asthma outcomes as older children and adults. Next slide.

now we get to talk about adults. As much as I love to talk about the kids, we also have to protect the adults as well, too, because… It’s so important, because they are also at risk for hospitalization. Looking at RSV vaccines in adults, we currently have 3 vaccines. One is the Moderna, which is an RSV vaccine for 60 and above. Pfizer vaccine for 60 and above as well, too, and then GSK, RSV vaccine for 60 and above. Currently, CDC recommends a single dose of RSV vaccine for all adults 75 years of age and older, and adults 60 to 74 years of age who are at increased risk for severe RSV disease. RSV does not mutate as often, so allowing RSV vaccines to provide more lasting protection. Current guidance recommends that older adults receive just a single dose of the RSV vaccine, so it’s one and done. Like I said before, they’ve looked at RSV antibodies, and during second year, they’ve maintained. During a third year, they still see them. They’re not as high, so we will see if eventually a second dose will be recommended, because it’s… they’re still following the RSV data. But at this point, it’s one and done, and like, because it doesn’t mutate, it can be given at any time of the year. It doesn’t just have to be given for adults during the RSV season. So this is the good advantage of the RSV vaccine. According to the CDC, conditions that increase risk for severe RSV include chronic cardiovascular disease, chronic lung or respiratory disease, chronic hematological conditions, and end-stage renal disease. Next slide, Ruthie. So these are the CDC guidelines for RSV recommendations when it comes to the adult populations. Remember, it’s a single dose, one and done for RSV vaccines. All adults aged 75 years or older, or adults 60 to 74 years of age who are at increased risk for severe RSV disease. And that’s where you see all the diseases that we’ve already covered, chronic cardiovascular Ocular disease, chronic lung disease, Diabetes, neurologic or neuromuscular disorders. hematological conditions. Severe obesity made the list as well, too. Moderate or severe immune compromise. Residents in a nursing home, which we need to think about, end-stage renal disease, chronic liver disease as well, too, and anything that puts them at high risk due to respiratory infections. Next slide, Ruthie.

So, as we talk RSV preventative measures, we know that we need to talk to parents and caregivers of children who are at increased risk for severe RSV disease, and give them anticipatory guidance to follow every day, especially during bad RSV season. Now, bad flu season, bad COVID season, the triple pandemic, right? So, one is avoiding close contact with sick people, and people who are sick, making sure that they mask. so that they don’t infect other people at home, especially in close quarters. Covering coughs and sneezes with the tissue. Washing hands with soap and water for at least 20 seconds so they can sing happy birthday and wash their hands. Three, cleaning frequently touched surface, so doorknobs. When it comes to frequently touched toys, frequently touched counters in schools, desks, etc, this is going to be important at decreasing the actual spread of infection. Staying home and avoiding close contact with others when you are sick. So, I tell parents, if kids are sick, please don’t send them to school, keep the germs at home. For parents who are sick, stay at home as well, too. Don’t go to work, and let’s keep our germs at home. And then avoiding sharing the cups, bottles, or toys as well, too. Brothers or sisters, it’s going to be important anticipatory guidance. Next slide.

When we’re looking at RSV treatment, supportive treatment is going to be important. One, teaching them to treat any fever and really relieve any pain that patients are having, whether adults or children. Two, hydration, hydration, hydration. Remember, it’s the secondary cause of hospitalization due to RSV is dehydration. So making sure that babies are well hydrated, older adults are well hydrated is going to be very important. Three, congestion relief is going to be important at getting all that mucus out as well, too. So that’s where you suggest the steam baths, the Mucinex as well, the humidifiers, everything, the long baths and running the hot showers, all that is really going to be helpful. The moist air, remember, this is the creepy cough. cough relief, but making sure when they’re wheezing that we give appropriate therapy as well, too. So I tend to listen to them in the office, and make sure if they have bad and rest. Rust is going to be very important in getting better and getting good sleep. Next slide.

Let’s talk medical treatments when it comes to RSV. So, a lot of it is going to be very much supportive therapy. So, people might require supplemental oxygen, especially when they desaturate, 2 IV fluids in cases of dehydration. 3. Rivavirin. This is FDA-approved antiviral medication, but its use is really generally limited to very sick, hospitalized patients with severe RSV infections. Especially those with compromised immune systems, due to questionable effectiveness and potential toxicity for healthcare workers. The American Academy of Pediatrics doesn’t typically recommend it for its general RSV treatment. And our favorites, bronchodilators. So, albutyl is going to be so key in making sure that these babies, these older adults, get some relief of their cough, especially when they’re having bronchospasm from the RSV infection in their lungs. Next slide, Ruthie.

When we’re talking key takeaways, key takeaways to talk about are, one. RSV holds a high health burden in the pediatric and adult population. It does not affect just children. 2. Prevented therapy with available RSV vaccinations in adults greater than age 60 years of age with chronic medical conditions and those greater than 74 years of age, and in pregnancy, 32 to 36 weeks of pregnancy is effective at preventing hospitalization and decreasing emergency department visits. Preventative therapy with monoclonal antibody in babies, newborns to 8 months of age, and those 8 months to 19 months of age who are high risk for RSV infection complications is effective at preventing hospitalization, pediatrician office visits, and emergency department visits. And we’re following that cohort study, following the pediatric population. 90% who receive monoclonal antibody. Will we change the prevalence of asthma and the landscape in the pediatric population? Such exciting, and we’ll have to come back and do a follow-up, Because these are such important takeaway plan… you know, points, and I hope that everyone learned a lot about RSV, because it’s something that we see every day in our clinics. Our patient population is high risk for RSV complications, both the adults and the kids, and I love doing anticipatory guidance when it comes to help preventing our kids, our adults, our babies from being hospitalized from RSV, because no one wants to see a sick baby, a sick kid, or a sick adult either. And, Ruthie, do we have any questions?

Ruthie Marker: We do, we do. I have been keeping up with them, in the chat, in the Q&A box, during the presentation, so we will, get right into it. Thank you so much, Dr. Mora, for the insightful information. You have definitely provided the audience with valuable information about management, so let’s start with some questions. The first one… How should clinicians approach shared decision making for RSV vaccination for those patients that are on the fence, kind of hesitant, about vaccinating?

Juanita Mora: It’s a great question. So, first is, I give patients three scenarios, right, Ruthie? One is the taker, right? The one that you’re like, look, Mrs. Smith, you have real… you have asthma, you are a wonderful candidate for RSV vaccination so you don’t get sick, plus you help your daughter take care of the grandchildren, and that grandma that says, yes, Dr. Murrah, we’ll do it. Second one is that patient that says. Well, I need… ugh, you know, I… I’ve heard of the RSV vaccination, Dr. Mora, but I want more information. So that’s where you can give them more of the data when it comes to the RSV vaccination, how it decreases hospitalizations, how it decreases emergency department visits, how it will not only help protect them, but help protect the babies in the home, and everyone else when it comes to adults. And the third one is the, Dr. Mora, I’m not interested in the vaccine, definitely not, will not do it. So this is the third patient that I called the doubter, right? And so, in that patient, I said, alright, Mr. Smith, so what we’re gonna do with you is, I’m gonna give you information to read. I understand that you don’t want this vaccine, but let me tell you a little bit more about RSV. And you can read on it, give them good resources, like, for example, RSV information that we have on our college website, Ruthpi, and then I tell them, as I gain more of their trust. then I re-approached the subject, because remember, RSV vaccination can be given at any time, so at the next follow-up, so Mr. Smith, what have you thought of the RSV information I gave you? So, as the trust builds up, we can have more of a conversation on it.

Ruthie Marker: Awesome, thank you so much. That is, great, great information. It kind of goes into, our next question, which is about, you know, you talk about those, high-risk populations, how are you deciding between, counseling a patient between RSV vaccination versus, Monoclonal antibody prophylaxis in, say, the older adults or high-risk populations like your mommies.

Juanita Mora: Oh, absolutely. So, it’s nice because as we see families as allergists, we tend to see the whole family here in the office. So, you get to know that… that mommy that’s coming in pregnant, and she’s coming in pregnant for just the follow-up for her other child who has asthma, right? And suddenly you notice she’s pregnant. So, I always take advantage of those moments, and I’m like, oh, when are you due? Have you heard about the RSV monoclon? antibody, it’ll really protect, you know, this little child already has asthma, so this baby, now we need to protect them. And so I go into the data. For the older adults, especially as I get to know them, and if I know that, you know, they have chronic kidney disease because I see their catheter, their dialysis catheter on them, or I know their history because they have bad emphysema, or I’ve known had smoking history in the past, I go through why RSV vaccination is so important as well, too. So I take every opportunity to really talk about vaccinations at every single visit, and I tend to do it for the flu, for COVID and RSV, because I’ve seen the devastation when it comes especially to the lower income or the high-risk populations. because they don’t have as many of the resources, so any chance I can get them, I’m going to talk vaccines. Awesome, thank you. One question that came through is about, insurance coverage. Have you encountered any struggles as you, you know, counsel patients, as far as any expected cost or insurance coverage barriers? Yeah, Ruthie, so what we’ve noticed is, initially, when the RSV vaccine came out, it was indicated for 75 years and older, and a lot of the insurance hadn’t gotten the memo that it was for greater than 60 years of age as well, too, or, or for anyone that we thought, you know, is immunocompromised and definitely a good candidate, even younger than that, right? We can use it depending on our criteria as well, too. So then, coverage was slow to come because the criteria needed to get into the insurance policies. Now, this second year, it’s been a lot smoother when it comes to getting people the RSV vaccination. And it can be as simple for us as allergist is writing a script and then sending them to the nearest Walgreens or CVS or their local pharmacy to get it, which is really nice. And the only place where I’ve actually had issues when it comes to the RSV vaccination in older adults is those who don’t have insurance, because then it’s running, like, $180, which sometimes can be a high economic burden, and right now, I’m you know, I’m trying to approach some of the companies to see if they’ll give a few free doses, so we can have them on hand for anyone who might be higher risk and not have the insurance coverage. For the babies, it’s really, really nicely well covered. Pediatricians are giving it. I gave it initially here in the office as well, too, because a lot of the pediatricians initially were a little nervous, right? Oh my gosh, it’s a monoclonal antibody, you know. what should we watch out for? But as we build confidence, it all gets better. And then mommies are getting it either at their primary care office or at OB. OB is also giving the mommy vaccination for RSV.

Ruthie Marker: So, that is… that’s so great to hear, especially with, you know, you don’t want to, like you mentioned, have… have those barriers trying to… to work towards, prevention, but also, you know, making care accessible and, you know, vaccines a little more accessible to everyone, so that’s great. Going along the lines of… RSV prevention, we have a question, from a clinician that says, how do you feel clinicians can better integrate RSV prevention into existing vaccination workflows without Overwhelming, overwhelming patients, with… with that decision.

Juanita Mora: Oh, I love that question, and I mean, I think, yeah, so sometimes we throw the kitchen sink at them, right? We’re giving them medications, we’re treating their asthma, we’re telling them about this new medication we’re going to start for their asthma, and suddenly you want to have the vaccine conversation, too. So, what I like to do is I sometimes break it up, and I form it into just regular conversation. So, you know, we’re gonna get your ass under good control, but part of it is also making sure that you have the vaccinations against the viruses. that most commonly get people with asthma sick. So, this is where I can kind of… key them in a little into the conversation, which I think is so important as well, too, so that way they don’t feel overwhelmed, and you can tell them it’s something to think about, we don’t have to make a decision right now. I know I’ve thrown a lot at you right now, but we will make sure that you, get the right information, and then you can always call me back after you’ve read what I’ve given you. digested everything, and what I will usually do is I’ll do a one-month follow-up, and especially in that patient that I feel feels a little overwhelmed, so that way I have that one-month window in which they digest everything, and then they come back, and they come back with questions.

Ruthie Marker: Okay, yeah. Yes, that is… you know, I myself, I recall when I was, you know, a pregnant mommy myself, and it’s like, you know, you don’t want to… you don’t want to overwhelm mommy when she’s at the OB, or, you know, having her follow up of all the things to do, so it’s great to approach it in that way, that it’s, you know. It doesn’t have to be so scary and so much information at once.

Juanita Mora: Oh, yeah, of course.

Ruthie Marker: Well, we have time for one more question, so I will get into it. Again, lots of great questions about high-risk, high-risk patients. So this question asks, for your high-risk adults. I have a lot of COPD, CHF, and immunocompromised patients. Is there evidence to support prioritizing an RSV vaccination other… over other respiratory vaccines if the patient isn’t willing to accept all of them?

Juanita Mora: Good question, because sometimes, one, they want to separate, two, they’re afraid of cost, right? They’re like, oh my gosh, they’re going to put the flu, the COVID-19, and the RSV all at once? And so, sometimes you kind of have to break… it… obviously, the data shows all of them can lead to COPD or asthma exacerbations, or even congestive heart failure exacerbations, as we saw from the data in the slides. So, one thing I do is… if they have not had any history of previous bad side effects when it comes to any of the respiratory vaccines, or they’ve never had an RSV vaccine, because it’s one and done. So one is, remember, the RSV’s not stational, right, when it comes to a vaccine, so you can give it any time. So you have time. So you might want to give it in the summer, you might want to give it, you know, like, early fall. And then, you can break it up and give the flu and COVID-19 together, like, later on in the season, before the bad respiratory season begins, because RSV vaccine, again, is one and done.

Ruthie Marker: Some… and that is, you know, like, even… Even just, like, as a patient myself, you know. clinician working in the hospital setting as a respiratory therapist, just to that education that, you know, like you’ve mentioned, RSV is really year-round. Like, yes, there are times you know, October to March when it’s heavier, but really, you know, really looking at it as a year-round, and then that benefit to the patient that, you know, you don’t have to do it all in the fall. So I think that that’s… that’s a great approach for that.

Juanita Mora: Excellent.

Ruthie Marker: Well, thank you again, Dr. Mora, for such an insightful and engaging presentation, and thank you, everyone, for joining us this afternoon. We really hope that this session has provided valuable tools and strategies to support your practice and management and treatment in your clinics. Soon, Zoom will email you a link to this recording, as well as supplemental resources. As always, your feedback is really important. For our second webinar of the year, please join us on February 19th at 1pm Eastern Time as Dr. Todd Marr presents depression and anxiety in patients with asthma. As always. We thank you so much for your participation. We look forward, for you joining us in upcoming webinars. I hope that y’all have a good rest of the day, and again, thank you, Dr. Mora, for being here.

Juanita Mora: Oh, you’re welcome, such a pleasure to be, and they can email me with any questions.

Ruthie Marker: Yes, feel free to share your email.

Juanita Mora: Sure, my email, JMORA2003 at gmail.com, or if you ever want to do a TikTok, or a Instagram Live, or anything together, we can totally do it, you guys!

Ruthie Marker: Thank you so much, everyone. Have a good rest of the day. Bye-bye.