Manitoba urged to protect all newborns against RSV with antibody shots Top doc says universal program being explored; only high-risk infants given shot By: Katrina Clarke Posted: 6:32 PM CST Thursday, Nov. 7, 2024 Last Modified: 7:10 PM CST Thursday, Nov. 7, 2024 Updates

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Health experts have called on the Manitoba government to offer RSV shots to newborns amid an increase in hospitalizations of babies who have the highly contagious virus.

Ontario, Quebec and Nunavut will offer the single-dose monoclonal antibody, called nirsevimab, to infants at no charge this fall.

In Manitoba, currently only high-risk babies, including some premature newborns, can get RSV (respiratory syncytial virus) shots. These are different from the shots offered in Ontario, Quebec and Nunavut and are more expensive. In addition, they must be administered once a month.

Data from Shared Health show the number of admissions of children under two years of age, who are hospitalized with RSV, hit a nine-year high in 2022-23, with 280 admissions at Children’s Hospital. It decreased to 199 admissions in 2023-24, which is still the third-highest rate in the nine-year period.

The average number of admissions for children under two over the past nine RSV seasons is 153.

Epidemiologist Colin Furness said “one of life’s worst things” is to watch a baby struggling to breathe. RSV affects the airways of the lungs and symptoms can include breathing difficulties, coughing, runny nose, fever and loss of appetite. It can lead to pneumonia or bronchiolitis.

Furness believes the RSV shot should be offered to all infants.

“Watching that kind of severe illness and thinking, ‘Wow, there’s a really easy way to avoid this,’ it makes it a really straightforward decision,” said Furness, an associate professor at the faculty of information at the University of Toronto.

He said it will be interesting to see how Manitoba and Ontario compare in terms of RSV hospitalizations this winter.

Ontario’s universal program launched after the National Advisory Committee on Immunization, updated its guidelines to recommend provinces and territories start “building towards a universal RSV immunization program for all infants.”

The body recommended the use of nirsevimab, sold under the brand name Beyfortus, which was approved by Health Canada in April 2023. It has been shown to reduce hospitalization associated with RSV by about 80 per cent and is effective for at least five months.

In Manitoba, only high-risk babies and children have access to an RSV medication called palivizumab. It lasts for about a month, which is why injections are needed regularly during RSV season. It has been found to reduce the risk of hospitalization by between 38 to 86 per cent in infants at risk of severe infection.

This year, Manitoba tried unsuccessfully to switch from palivizumab, which can cost between $5,000 to $9,000 a season, to nirsevimab, which has a list price of about $1,000, said Dr. Aaron Chiu, director of Manitoba’s RSV prophylaxis program. Doing so would have allowed the province to expand access beyond the 250 to 300 high-risk children under age four who receive it today, he said.

The plan hit a roadblock when the province couldn’t secure the shots, Chiu said.

Sanofi, the pharmaceutical company that sells nirsevimab, prioritized provinces that offer universal programs and Manitoba needed to be sure it had enough doses, he said. So it went with palivizumab.

In a statement, Sanofi spokesperson Alana Vineberg said: “Beyfortus will only be available through publicly funded programs this year.”

Dr. Brent Roussin, Manitoba’s chief public health officer, said the province looks to the national advisory committee for guidance on immunization, emphasizing the body only recommends “building towards” the universal program currently.

“We’re certainly looking at it,” Roussin said about a future universal program. Any such program rollout would require consideration of cost, resources, procurement and logistics of administration. He did not have an estimate of what it might cost.

Doctors Manitoba echoed Roussin’s comments, saying in a statement it supports the approach recommended by the national advisory committee.

As for the rising RSV hospitalizations in children, Roussin said two years ago was a particularly bad RSV season across Canada. “Immunity debt” after years of COVID-19 isolation may have played a role, he said.

This year, the RSV season in the southern hemisphere was “typical,” suggesting we might see the same, he said.

Local health experts would like to see change now.

“It is critical that Manitoba fund this shot,” said Barbara Porto, an assistant professor in the department of medical microbiology and infectious diseases at the University of Manitoba. “It’s crucial to protect infants throughout the winter… it’s a huge burden for the health-care system across Canada.”

Dr. Philippe Lagacé-Wiens, a medical microbiologist at St. Boniface Hospital, would like to see Manitoba offer a universal program. He noted Ontario also covers the cost of an RSV vaccine called RSVpreF for pregnant women who deliver around RSV season. The vaccine protects their babies.

In Manitoba, patients can pay out of pocket for RSVpreF at a rate of about $300, creating a “two-tier system,” Lagacé-Wiens said.

The national advisory committee recommends infants receive nirsevimab rather than have pregnant women receive RSVpreF.

katrina.clarke@freepress.mb.ca