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Column originally published Dec 28, 2023

Seniors Should Get The New RSV Vaccine

Question: I am a fairly healthy senior. I managed to avoid catching Covid-19 infection during the pandemic. I just received the recent updated Covid-19 vaccine and the flu shot. Our youngest daughter delivered her first baby, our first granddaughter, prematurely. She is tiny, and had to stay in the hospital nursery for several weeks. She was discharged home recently. We were told that she is very susceptible to serious RSV infection. I have never heard of this virus before. The paediatrician suggested that we should get the new RSV vaccine because we are seniors, and we can protect our granddaughter from the virus. Please tell us more about this new vaccine.


Her paediatrician is correct, premature babies are very susceptible to serious RSV infection. It is important to prevent her from contracting this virus.

As paediatricians, we have known about RSV (Respiratory Syncytial Virus) for many decades. Almost every child got infected with RSV by the time they turn two years of age. RSV is a very contagious virus; it infects virtually everyone in daycare, and passes from children to their parents. We have seen outbreaks of RSV every year, from late fall to spring. Very few children can escape this virus.

In older children, RSV infection is usually mild. They can have a running nose and some cough; most of them get better within days. However, children under two can get a lot sicker. They usually have mild fever, lots of running nose, and a very congested cough. The younger the child is, the more severe is the cough. They can have difficulty breathing when their bronchial tubes are clogged up with mucus. Parents can see their chest sucked in between the ribs, and they have a wheezy noise when they breathe. This condition is called bronchiolitis.

Every winter, many children are admitted to the hospital with RSV bronchiolitis. Some require oxygen and medicine to open up their bronchial tubes. If they deteriorate, they may require intensive care, and a machine called ventilator to help them to breathe.

Premature babies are even more susceptible to serious RSV infection. This is partly because they have no immunity to the virus, and their bronchial tubes are extremely small. Some babies had died from severe RSV infection. In the last few decades, a special laboratory-produced antibody called Palivizumab has been used to prevent RSV infection in these very premature babies. It requires a monthly injection during RSV season. A new antibody called Nirsevimab was recently approved in Canada; it is effective for the whole RSV season following one injection.

Adults are infected with RSV from time to time, depending on their antibody level and exposure to the virus. Parents with young children are infected more frequently; this can boost their antibody level against RSV, so they mostly develop cold-like symptoms. Seniors who have less exposure to young children are infected less frequently; their immunity to RSV also wanes over the years. As a result, when they get infected with RSV, they can develop more serious illness including pneumonia and other complications partly because of their underlying medical conditions.

Earlier this year, Health Canada approved the first RSV vaccine called Arexvy for adults over 60 years of age. Scientists have discovered a protein in the virus that can induce immunity in our body. This vaccine uses a technology that has been well tested for several decades. It can prevent seniors from developing serious RSV infection for two years after a single dose of vaccine.

Although the vaccine is approved, the National Advisory Committee on Immunization (NACI) hasn’t developed guidelines for provinces on the use of Arexvy across Canada. All the provinces are still waiting for these guidelines before deciding whether to provide funding for this vaccine. However, physicians can prescribe it for seniors with underlying medical conditions, and for someone like yourself who wants to protect your premature granddaughter from RSV infection. Pharmacies can order the vaccine directly from the manufacturer. I suggest that you discuss this with your physician.