Baby Jace was born at 2 pounds, 2 ounces at 26 weeks, to Rhonesha Perkins. To her surprise, he was three months early. This was her second pregnancy, and she had relatively few complications. One day she went for a walk, she started having back pain, and the next thing she knew, she was in labor.
Since he was a premature baby, Jace spent 53 days in the neonatal intensive care unit. With no significant delays or issues, baby Jace was able to regulate his breath, eat, and grow. Shortly after going home, about four months passed when he got respiratory syncytial virus.
RSV is a common virus that causes cold-like symptoms, but it can be especially dangerous for premature infants and children under 2 years old.
For baby Jace, RSV could have easily been deadly.
But Perkins is a medical assistant in Fayetteville, North Carolina, and has worked in pediatrics for more than 10 years — she knew what to expect.
Some of his main symptoms were difficulty breathing, wheezing, fever, and a cough. As a result, he was treated with steroids and around-the-clock breathing treatments like albuterol. There were times that Perkins and her husband thought they might have to take baby Jace to the emergency room.
“I was legit scared,” she says. “In health care, you know the answers to everything until it comes to your children. You’re not looking at it from a medical standpoint; you’re looking at it from a parent’s standpoint.”
Most children get RSV. The typical season for this virus is between November to April. But for babies born prematurely, with low birth weight, or with lung or heart problems, the risk is more severe. According to the March of Dimes, preterm babies who get RSV are three times more likely to die from the virus than full-term babies.
As a practicing obstetrician caring for women of color, Dr. Hasra Snaggs, director, medical monitor, vaccine research development at Pfizer, and an obstetrician specialist has delivered mothers prematurely and recognized the impact of babies being born early.
“Unfortunately, Black women are 50 percent more likely to give birth to a premature baby than White or Hispanic women,” she says in an email interview. “RSV is of particular concern for Black mothers and infants.”
There is currently no vaccine to protect children from RSV. But, according to the Centers for Disease Control and Prevention, there is a medication that can help babies who are at high risk of RSV. The medicine palivizumab — or the common brand name Synagis — can be given to premature babies and children with certain heart and lung conditions. The Synagis injections are given every month during RSV season as a preventative measure.
However, all babies do not qualify for these injections, and full-term babies don’t need them. According to the Pediatric Clinic, Synagis is an antibody that helps fight RSV. Full-term babies get virus-fighting antibodies from their mothers during pregnancy — but premature babies usually do not get enough before birth.
Currently, most families with insurance can get the cost of the injection fully covered. And there are programs that can help lower the cost for low-income households. But out-of-pocket costs for a supply of 0.5 milliliters is about $1,926.
Perkins wasn’t able to get baby Jace the medication the first time he got RSV. During the following two RSV seasons, she was able to get him injections.
“He’s had RSV three times, pneumonia three times, and COVID three times,” she says. “I honestly feel like having the Synagis in his system helped him a lot the last few rounds.”
Why RSV Can Be Deadly For Babies
Dr. Freda Singletary is a pediatrician in rural North Carolina. “I’ve treated hundreds, if not thousands, of kids with RSV,” she says. The virus creates mucus in your airway; a baby with lung issues or born prematurely are not always able to clear the snot as easily. This creates shallow breathing and, if not treated properly, can lead to ear infections and asthma.
“We try to be proactive and be preventative,” she says. “We want you to come into the clinic, and we want to treat you. And make sure we’re doing everything we can to prevent (babies) having to go to the hospital and be intubated.”
Last year, children between the ages of 0-4 who had RSV were hospitalized at more than three times the rate in 2021. About 61 per 100,000 babies were hospitalized for RSV.
Low socioeconomic status can impact how quickly families can get their babies treatment, Singletary says. “The ones who really are being affected by social determinants are our youngest citizens.”
Singletary says in rural areas in North Carolina, some families may not have the money to get their babies an albuterol inhaler to help them breathe. Or parents may struggle to access resources like a nebulizer machine, a machine that turns liquid medication into a mist. Transportation has posed another challenge for families.
“Those are things for me as a pediatrician in a rural area that we really take into account,” Singletary says.
To curb this issue, the county Singletary lives in supports families by picking them up and taking them to and from doctors’ appointments. But she also encourages parents to treat their babies early. If they see signs of discomfort or infection, take the baby to get care.
“That’s really my biggest thing with RSV, is easing my parents’ anxiety,” Singletary says. “I try to help calm those nerves and those fears by explaining what we see with their baby.”
What Parents Need to Know
As a mom of two, Perkins realizes it takes a village to raise children. But sometimes, that village forgets how to respect boundaries. To protect baby Jace, she had to limit exposure to anyone with an inkling of illness. She reminds parents not to be afraid to set boundaries with loved ones.
“I’m not trying to be mean … but if something happens or that baby does get RSV, you’re not going to be the one taking care of him — it’s going to be me,” Perkins says. “Adults get RSV a lot. We go on through life like nothing’s happening, but we’re the superspreader.”
Dr. Iona Munjal, the senior director of clinical research & development at Pfizer and a pediatric infectious disease specialist, says virtually all children will get RSV. It is a leading cause of hospitalization in children less than 1 year of age. For children younger than 5, RSV accounted for about 2.1 million outpatient visits.
In May, the U.S. Food and Drug Administration’s (FDA) Vaccines and Related Biological Products Advisory Committee voted in favor of the use of Pfizer’s RSV vaccine for infants.
“Data from the Phase 3 clinical trial of the vaccine found that it was 81.8% effective in preventing medically attended severe RSV-associated illness in the first 3 months of life,” Munjal says in an email interview.
“If the vaccine is made available quickly through licensure, likely, the best preventative measure a mother could take to protect their infant from RSV is to get vaccinated each time she gets pregnant.”
The vaccine would help expecting mothers produce antibodies and pass them to the baby. This could allow the infant to be protected for that RSV season. This would be particularly helpful to Black moms.
As Snaggs explains, “Getting vaccinated during pregnancy is one thing moms can do to protect their infants early in life.”