The baby's nose is already running as soon as it is born. Shortly afterwards, the little one develops a fever, has to cough violently and finds it harder to breathe. Even newborn babies can contract the so-called Respiratory syncytial virus (RSV for short). Premature babies, infants and children with certain pre-existing conditions are particularly at risk of a severe course of infection. This is why the Standing Committee on Immunisation (STIKO) at the Robert Koch Institute has now recommended vaccination, all to protect newborns and infants in Germany against the virus with a one-off prophylaxis before their first RSV season.
The RS virus causes acute diseases of the upper and lower respiratory tract. Namely in each age! This nasty little virus can therefore infect very young children and trigger respiratory infections. Only in the first four to six weeks of life do mature newborns have a certain degree of protection against the virus due to antibodies transferred from the mother. Nest protectionif she has had an RSV infection during pregnancy. Children born prematurely, on the other hand, have a high risk of contracting a severe RSV infection in the first few weeks of life because their nest protection is significantly lower.
According to the Robert Koch Institute, which we have known well since the coronavirus pandemic at the latest, 50 to 70 per cent of all children have experienced at least one RSV infection in their first year of life - and almost all Children up to their second birthday.
In some sick babies, an RSV infection is "only" limited to the upper respiratory tract, which usually leads to milder courses of the disease. A runny nose, a non-productive cough, possibly a sore throat and, even in milder cases, usually a fever. More severe courses can develop if the infection spreads to the lower respiratory tract. There it can inflame the bronchioles, the trachea, the mucous membranes in the bronchi and also the child's lungs (bronchiolitis, tracheobronchitis, pneumonia).
This is very stressful and dangerous for the babies affected. This is because they are usually much less able to drink or take in food, they often have to cough terribly, sometimes even have difficulty breathing and are usually in a reduced general condition. Newborns and infants in their first six months of life are at a particularly high risk of contracting RSV. Most unfavourable RSV courses have been observed in previously healthy infants. It is not uncommon for affected children to have to be hospitalised and monitored.
Children with pre-existing conditions are also at high risk of developing problems. These include children with chronic diseases of the lungs or heart, complex congenital heart defects, congenital or acquired disorders of the immune system, neuromuscular diseases, various syndromes such as trisomy 21 or congenital malformations.
Overall, it must be noted: Newborns and infants are hospitalised most frequently in Germany due to RSV infection. No other illness causes hospitalisation as often as severe lower respiratory tract infections. This is precisely what the STIKO wants to change with its recommendation on RSV prophylaxis.
I would like to clarify a few important questions below:
How can the baby become infected with RSV? Transmission is mainly via droplet infection. Think of it like this: In a person infected with RSV, the virus colonises the mouth, throat and/or respiratory tract. When this person sneezes, coughs or speaks, tiny droplets of saliva swirl through the air and are inhaled by the baby. In other cases, the child ingests the droplets directly through the mucous membranes of its upper airways, for example by kissing the infected person.
This is why it is so important to observe hygiene rules - e.g. hygienic sneezing and coughing and, above all, regular Hand washing. It is assumed that transmission can also occur indirectly via contaminated hands and even objects and surfaces. The Robert Koch Institute has reported this: RS viruses on hands remain infectious for around 20 minutes and even for 45 minutes on paper towels or cotton clothing, for example. On plastic surfaces or disposable gloves, they can even last up to several hours.
Once the pathogen has entered the body, the first symptoms appear after an average of five days.
How is an RSV infection diagnosed in a baby? If the child is weak, pale and weak, has a fever and is breathing rapidly and laboured, an RSV infection may be present. In more severe cases, it can often be heard by a paediatrician when listening to a typical "crackling, rattling noise". A throat swab and a PCR test are sometimes carried out to clarify the diagnosis.
How is an RSV infection treated? As it is a virus, no antibiotics will help. Unfortunately, only the symptoms can be alleviated - e.g. by giving the child plenty of rest, sufficient fluid intake, fever-reducing measures if necessary and the administration of saline solution in the nose so that the baby can breathe and drink better. Decongestants Nose drops should not be given to an infant if possible. If the child shows abnormal breathing, it should always be taken to the paediatrician's practice. Babies with previous illnesses and premature babies should be seen by a paediatrician if they have a cough or fever.
When is "RSV season"? Like the flu, these infections usually occur in the autumn and winter months, i.e. from October to March. January and February are described as the "peak months" for infections.
Which vaccination does the STIKO recommend against RSV infection? The active substance is a ready-made antibody called nirsevimab (product name:Beyfortus®). It is administered once to the child and immediately protects newborns and infants against RSV diseases, particularly of the lower respiratory tract. This is known as "passive immunisation" because the child's immune system does not have to build up protection itself after the vaccination. A booster vaccination is also not necessary.
Nirsevimab is injected into the thigh as a single injection in a dose appropriate to the baby's weight.
When should I have my child immunised? The STIKO recommends the following times for RSV prophylaxis, regardless of the gestational age and risk factors of an infant:
- Babies born between April and September should receive prophylaxis in autumn (between September and November) - i.e. before their first RSV season.
- Newborns born during an RSV season (i.e. between October and March) should be vaccinated as soon as possible after birth. The Robert Koch Institute considers the time of discharge from the birth centre to be ideal or at the U2 screening examination (3rd to 10th day of life). "Any missed administration of nirsevimab should be made up as soon as possible within the child's first RSV season," says the RKI.
How safe is RSV prophylaxis with the antibody? Very safe, it is usually well tolerated by the little ones. Only the small injection site may show a little redness or swelling, as with other vaccinations, but this subsides quickly.
How long will the RSV prophylaxis protect my child? Throughout the RSV season, especially in the case of lower respiratory tract infections, before the disease becomes serious.
Why shouldn't my child be immunised before each RSV season? Quite simply because newborns and infants under six months of age have the highest risk of severe infection in their first RSV season. At an advanced age, they no longer benefit from the antibody, also because they have probably already had their first RSV infection and their immune system can respond to the virus itself.
Can my child fall ill again after an RSV infection? This is quite possible, there is no absolute protection against it. But even if the child's lower respiratory tract is also affected by the second RSV infection, in the vast majority of cases the course of the illness is significantly milder than the first time. And enforced hospitalisation is almost never necessary.
As a mum, can I protect my newborn baby against RSV by getting vaccinated against RSV during pregnancy? With this question, the so-called Nest protection which the mother gives her child for the first few weeks of life (surrogate immunity). If she were to receive an RSV vaccination during pregnancy, she could pass the corresponding antibodies on to her baby via the placenta.
However, the STIKO has not yet decided in favour of such an RSV vaccination during pregnancy. none recommendation. There is an RSV vaccine that has been authorised by the European Union for pregnant women. However, the STIKO still has far too little data on it.
And finally: Who is the STIKO anyway? The Standing Committee on Vaccination (STIKO) at the Robert Koch Institute is made up of independent experts. The committee has been developing recommendations on which vaccinations children and adults in Germany should receive since 1972. The STIKO weighs up the benefits and risks of a vaccination for the individual or a group of people as well as for society as a whole. STIKO's recommendations are always based on proven medical correlations and efficacy. The latest scientific findings are regularly consulted for this purpose.
