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Respiratory illnesses in newborns are a major cause of concern, especially when they involve difficulty in breathing. Among the leading causes is Respiratory Syncytial Virus (RSV), a common and highly severe virus that affects the lungs and airways of infants and children under five. This virus often mimics symptoms of a common cold, such as a runny nose or low-grade fever. This similarity can create confusion for parents and health care providers alike, leading to delays in detection and intervention, which allows the illness to rapidly escalate.
For newborns and infants, whose immune systems are still developing, and airways are small, RSV can quickly become serious. Their tiny airways can get easily blocked by swelling and mucus, leading to lung infections like bronchiolitis or pneumonia. Each year, RSV leads to over 3.6 million hospitalisations and about 100 000 deaths in children under five years of age. As per WHO, most paediatric RSV deaths (97%) occur in low- and middle-income countries where there is limited access to supportive medical care. Even healthy, full-term babies can face complications, and in some cases, require intensive medical care.
In India, RSV cases spike during the monsoon and early winter, but the virus can circulate throughout the year. This makes timely protection critical. Medical advancements now offer a way to shield infants through immunisation strategies. While the RSVpreF maternal vaccine is not yet available in India, two monoclonal antibodies have emerged as key preventive options in India. Palivizumab, is administered monthly to high-risk infants such as those born prematurely or with underlying heart or lung conditions. Nirsevimab, on the other hand, is a long-acting monoclonal antibody offering protection with a single-dose. It is designed for all infants regardless of risk category and can be administered soon after birth, before hospital discharge, or during early routine check-ups.
Early immunization plays a vital role in protecting infants not just from immediate illness, but also from long-term respiratory complications. Severe RSV infections in the first year of life have been linked to increased risk of recurrent wheezing, asthma, ear infections, and reduced lung function well into adolescence. Infants are especially vulnerable because their immune systems are still developing, and their smaller airways are more easily blocked by inflammation caused by the virus.
By providing protection before exposure, through timely use of preventive monoclonal antibodies, we are better equipped to avoid serious outcomes for babies. Parents must understand the importance of stopping the virus before it can take hold, reducing the likelihood of hospitalisation and long-term health issues. For parents and health care providers alike, early immunisation isn’t just a seasonal precaution, it’s a critical investment in the child’s long-term respiratory health and overall well-being.
This article is authored by Dr Faisal B Nahdi, paediatrician, Rainbow Children’s Hospital, Hyderabad.
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