They are pulmonologists, infectiologists, oncologists, general practitioners... and share the same wish: that the elderly can be vaccinated against respiratory syncytial virus (RSV) as early as this year. Less known than influenza viruses, it would weigh just as much in terms of hospitalizations and deaths each winter.
Two specific vaccines were authorized in France, but they are not yet available in France, pending an opinion from the High Authority for Health, not before October 2024. "There is no reason to wait, now is the time to act!" write these health professionals in an article we publish. Here is their text.
"We need to make RSV vaccination available to at-risk individuals this year. A new winter is approaching with its share of seasonal respiratory viruses. The best known of these is the influenza virus, against which every year in October a vaccination campaign is launched among seniors, immunocompromised people and healthcare workers. Recently, we got acquainted with a newcomer, a coronavirus, SARS-CoV-2, responsible for Covid-19 with its potentially deadly respiratory forms. Although quickly countered by the unprecedented deployment of vaccines in record time, with international surveillance of potential adverse events unparalleled in history, it continues to rage, especially among the most fragile people. Recently, major progress has been made in the fight against a third virus, Respiratory Syncytial Virus or RSV.
This virus is well known to families because it is the one that causes bronchiolitis in infants, with sometimes impressive symptoms: cough, rapid wheezing, which can lead to a drop in oxygen levels in infants and hospitalizations for the most severe forms (about 450,000 infants affected each winter, including 73,000 emergency room visits and 26,000 hospitalizations during the winter of 2022-2023). Since mid-September 2023, we have a new preventive treatment for newborns, Nirsévimab (BEYFORTUS). It is a monoclonal antibody directed against RSV, administered preferentially before discharge from the maternity ward, and to all other infants during their first year of life and exposure to the RSV epidemic. This preventive treatment is fully covered by health insurance.
What is less known to the general public is that this same RSV virus causes respiratory infections in adults, most often benign, but potentially serious in the elderly and frail patients because immunocompromised, treated for cancer, or respiratory failure, including chronic obstructive pulmonary disease (COPD) of which more than 100,000 receive oxygen at home in France. Its dangerousness is potentially even higher than that of influenza, especially if we refer to recent French data with an estimated case fatality between 5 and 10% in case of hospitalization or 1 death every 10 to 20 hospitalizations (1-2). In France, it is estimated that there are 20,000 to 25,000 hospitalizations each year related to severe RSV infection in individuals over 65 years of age (2), a figure very close to that of influenza-related hospitalizations. These potentially serious infections represent a significant human and economic cost.
There are now several vaccines that have been shown to be effective in preventing RSV-related infections, more or less advanced in the registration and marketing process. One of them, Arexvy, developed by GSK, was granted marketing authorisation by the European Medicines Agency (EMA) in June 2023 on the basis of a clinical trial published in the New England Journal of Medicine, a leading medical journal (3). In this study, involving 25,000 subjects, the vaccine had a significant efficacy of 83% against infections and 94% on severe forms of pneumonia, with excellent tolerability.
This vaccine is available in France. It can be prescribed by doctors and dispensed by pharmacists. Unfortunately it is not covered by the Health Insurance, even for frail, elderly, respiratory failure, or immunocompromised patients. The very ones who are at risk of dying if they develop a severe form of RSV infection. With a cost of more than 200 euros, only the wealthiest will have access to it if they wish.
Why this situation? The High Authority for Health announced in September that in response to the referral from the Directorate General of Health of 4 May 2023, it would establish a vaccination strategy to prevent RSV infections in adults, with results expected by October 2024 (4). While waiting for these recommendations and the essential medico-economic evaluation, it is necessary that the Health Insurance covers this year in an exceptional way the cost of vaccination for the most fragile. To avoid thousands of hospitalizations with an obvious overload on the health system and of course potential deaths, we must maintain the responsiveness shown during the Covid crisis and focus on prevention. Doctors, pharmacists, liberal nurses, are ready to ensure this vaccination, as they are ready to ensure the anti-Covid vaccination with updated boosters from October 2 and against influenza from October 17.
Our patients have heard about this vaccination. They know it is effective and ask to be vaccinated. It is indeed a triple vaccination against Covid / flu / RSV that should be done this year. There is no reason to wait, now is the time to act! »
Dr Martin Amboise, general practitioner, SOS21 Dijon; Pr Claire Andrejak, pulmonologist, University Hospital of Amiens; Dr Jérôme Barrière, medical oncologist, Polyclinique Saint-Jean, Cagnes sur Mer; Pr Emmanuel Bergot, pneumo-oncologist, CHU Caen; Dr Rabia Boulahssass, geriatrician, Nice University Hospital; Pr Arnaud Bourdin, pulmonologist, Montpellier University Hospital; Dr Arnaud Boyer, pneumo-oncologist, Marseille; Pr Pierre-Régis Burgel, pulmonologist, Cochin Hospital, APHP, Paris; Pr Jacques Cadranel, pneumo-oncologist, APHP Hôpital Tenon, Paris; Pr Michel Carles, infectiologist, Nice University Hospital; Dr. Olivier Castelnau, pneumo-oncologist, Saint-Laurent du Var; Pr Francis Chabot, pulmonologist, Nancy University Hospital; Pr Pascal Chanez, pulmonologist, Marseille University Hospital; Dr Franck Clarot, radiologist, forensic pathologist, Rouen; Pr Sébastien Couraud, pulmonologist, Hospices civils de Lyon; Pr Francis Couturaud, pulmonologist, University Hospital of Brest; Dr Guillaume Coindard, general practitioner, Athis-Mons; Pr Bruno Crestani, pulmonologist, AP-HP. Nord, Paris, President of the Fondation du Souffle; Dr Éric Cua, infectiologist, Nice University Hospital; Pr Antoine Cuvelier, pulmonologist, Rouen University Hospital; Pr David Darmon, general medicine, Vice-President Health, Université Côte d'Azur, Nice; Pr Bruno Degano, pulmonologist, CHU Grenoble-Alpes; Dr Elisa Demonchy, infectiologist, Nice University Hospital; Dr Éric Denis, infectious disease specialist, Antibes Hospital Centre; Pr Alain Didier, pulmonologist, Toulouse University Hospital; Dr Olivier Do Castro, general practitioner, Saint Quentin; Dr Cédric Etienne, infectiologist, Centre Hospitalier de Grasse; Dr Jean-Jacques Fraslin, general practitioner, Bouguenais; Pr Frédéric Gagnadoux, pulmonologist, CHU of Angers; Pr Étienne Giroux Leprieur, pulmonologist, APHP-Hôpital Ambroise Paré, Paris; Pr Olivier Guérin, geriatrician, Nice University Hospital; Dr Jean-Paul Hamon, general practitioner, Clamart; Pr Bruno Hoen, infectiologist, CHRU of Besançon. High Council of Public Health. President of the Specialized Commission for Infectious Diseases/Emerging Diseases; Pr Karine Lacombe, infectious disease specialist, Saint-Antoine Hospital, Paris; Dr Olivier Le Rouzic, pulmonologist, Lille University Hospital; Pr Jacques Levraut, emergency physician, CHU of Nice; Pr Antoine Magnan, pulmonologist, Foch Hospital, Suresnes; Pr Bernard Maitre, pulmonologist, Créteil Intercommunal Hospital; Dr Rémi Malhomme, anaesthetist-resuscitator, CH d'Antibes; Pr Sylvain Marchand-Adam, pulmonologist, University Hospital of Tours; Dr Sabine Marco, pneumo-oncologist, Polyclinique Saint-Jean, Cagnes-sur-Mer; Dr Laurent Marcq, internist, Polyclinique Saint-Jean, Cagnes-sur-Mer; Pr Charles Marquette, pulmonologist, RespirERA University Hospital Institute, Nice University Hospital; Dr Olivier Martin, anaesthetist-resuscitator, CH d'Antibes; Dr Jérôme Marty, general practitioner, Fronton; Dr Véronique Mondain, infectiologist, Nice University Hospital; Dr Carl Mubarak, general practitioner, Roquefort-les-Pins; Dr Matthieu Piccoli, geriatrician, Broca Hospital, APHP, Paris; Pr Nicolas Roche, pulmonologist, APHP Centre, Cochin Hospital, Paris; Dr Michaël Rochoy, general practitioner, Outreau; Dr Leslie Rogeau, general practitioner, Vence; Pr Mathieu Salaun, pulmonologist, Rouen University Hospital; Pr Olivier Sanchez, pulmonologist, Georges Pompidou European Hospital, Paris; Pr Arnaud Scherpereel, pneumo-oncologist, Lille University Hospital; Dr Frédéric Schlemmer, pulmonologist, Henri Mondor Hospital, Créteil; Pr Thomas Similowski, pulmonologist, Hôpital de la Pitié Salpêtrière, Paris; Dr Richard Talbot, general practitioner, Saint-Hilaire du Harcouët; Dr Pierre-Marie Tardieux, emergency physician, Nice University Hospital; Pr François Vincent, pulmonologist, CHU of Limoges; Dr Franck Wilmart, general practitioner, Ambleny; Pr Gérard Zalcman, pulmonologist-thoracic oncologist, CHU Bichat-Claude Bernard, Paris; Dr Maeva Zysman, pulmonologist, Bordeaux University Hospital.
The signatories' links of interest are available on transparence.gouv.fr. Some of the signatories have links of interest with the laboratories mentioned in the text.