RSV vaccination during pregnancy: guidance for parents-to-be

When the RSV season begins in the fall, many families become increasingly concerned about newborns, infants and young children. The respiratory syncytial virus (RSV) is one of the most common triggers of respiratory diseases in early childhood and can cause severe illness in the youngest children. At the same time, new prophylactic options are available: Vaccination during pregnancy, antibody administration for infants, hygiene rules in everyday life.

Find out what the RSV vaccination during pregnancy is all about, how the various vaccines and antibodies work, the recommendations of the Standing Committee on Vaccination (STIKO) and why individual advice from a doctor remains essential for every pregnant person.

What is respiratory syncytial virus (RSV)?

The respiratory syncytial virus, or RSV for short, is a virus that is found all over the world and primarily affects the respiratory tract. It belongs to the paramyxovirus family. The name "respiratory syncytial virus" refers to the fact that the virus causes cells in the lungs and lower respiratory tract to fuse together (syncytia).

For healthy adults, an RSV infection usually only causes a cold. However, in very young children, older people and people with underlying illnesses, the RSV virus can cause severe respiratory infections.

Structure and transmission of the respiratory syncytial virus

RSV is an enveloped virus. It has protein structures (glycoproteins) on its surface with which it docks onto mucosal cells in the nose, throat and lungs. These viruses are mainly transmitted by

• Droplets (e.g. when coughing or sneezing)
• close contact, for example when cuddling a baby or child with a cold
• Contaminated hands and surfaces (door handles, toys)

Just a few virus particles are enough to cause infection. This is what makes RSV so contagious, especially in communal facilities with many children.

Terms: RS virus, syncytial virus rsv and other names

Different formulations are used in everyday life: "RS virus", "syncytial virus rsv", "RSV infection" or just "RS" - sometimes even written as "rs" in Internet discussions.

It is important to note that it is always the same virus, the respiratory syncytial virus.

This variety of terms can be confusing. However, it is irrelevant for medical advice; the decisive factors are whether an infection is present, what the risk is and what prophylactic or treatment options are available.

Why RSV infections are particularly dangerous for newborns and infants

Newborns, infants and young children are particularly susceptible: their airways are narrow and their immune system is still immature. An RSV infection can severely inflame the bronchi and lungs and lead to serious illnesses such as bronchiolitis or pneumonia.

The following are particularly at risk

• Children in the first six months of life
• Premature babies
• Children with cardiovascular diseases
• Children with lung diseases or other underlying diseases

They are at risk of severe disease progression, sometimes requiring oxygen, intensive medical monitoring or even life-threatening.

Diseases of the respiratory tract and lungs

The respiratory syncytial virus mainly affects the lower respiratory tract:

• Inflammation of the small bronchi (bronchiolitis)
• Mucosal swelling and increased mucus production
• Constriction of the airways, the child has difficulty breathing

As a result, the course of the disease can rapidly become more severe. In very young infants in particular, even a slight swelling is enough to block the narrow airways.

Typical RSV symptoms in newborns, infants and young children

An RSV infection initially progresses like a normal upper respiratory tract infection:

• Cold, cough, possibly fever
• Difficulty drinking, restlessness or noticeable tiredness

If the lungs are more severely affected, various consequences can occur:

• Rapid breathing, abdominal or nasal breathing
• Whistling noises when exhaling
• bluish discoloration of the lips (sign of oxygen deficiency)

In such cases, prompt medical treatment is urgently needed.

The RSV season: when does the risk increase?

In Germany, most RSV infections occur in the winter months. According to the Robert Koch Institute, the RSV season typically runs from fall to spring, with a peak between October and March.

For parents-to-be, this means that if the birth of a newborn falls within this period, there is an increased risk that the baby will come into contact with RSV in the first few weeks of life. This is exactly where the idea of RSV vaccination during pregnancy comes in, or alternatively the passive immunization of the child after birth.

RSV vaccination during pregnancy - basic principles

RSV vaccination during pregnancy has a clear objective: after vaccination against RSV, the mother produces protective antibodies that are transferred to the newborn via the placenta.

This creates so-called nest protection, i.e. temporary protection for the child in the first few months of life, when its own immune system is not yet fully operational.

Important: In Germany, there is currently no general STIKO recommendation for RSV vaccination during pregnancy. Although the Standing Committee on Vaccination is reviewing the data, it does not yet consider it sufficient to recommend a general standard vaccination for pregnant women.

How the RSV vaccination works and nest protection is created

After vaccination, the pregnant woman forms specific antibodies against the syncytial virus (RSV). These are passed on to the newborn baby via the placenta, particularly in the third trimester (immunization of the child before birth).

Nest protection is not permanent, but it can reduce the risk of serious lung diseases, especially in the first 3-6 months of life.

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Timing of the RSV vaccination during pregnancy

The approved vaccine for pregnant women is recommended as a single dose between around the 24th and 36th week of pregnancy; according to some data, around five weeks before birth is optimal in order to transfer as many antibodies as possible to the newborn in good time.

In each individual case, the attending physician will discuss whether RSV vaccination during pregnancy is advisable, which risk factors are present (e.g. risk of premature birth, multiple pregnancy, chronic diseases of the mother such as diabetes mellitus or cardiovascular diseases) and whether other strategies, such as passive prophylaxis of the child, may be preferred.

What does the Standing Committee on Vaccination (STIKO) recommend?

The Standing Committee on Vaccination (STIKO) evaluates vaccines and makes recommendations for Germany. The current situation regarding RSV is as follows:

• For newborns and infants:
  • The STIKO recommends prophylaxis with nirsevimab (Beyfortus) for all infants in the first RSV season and for certain infants at increased risk.
• For adults:
  • The STIKO recommends the RSV vaccination with certain vaccinations for older people, e.g. people aged 75 and over and groups of people aged 60 and over with serious pre-existing conditions.
• For pregnant women:
  • The protein vaccine for RSV vaccination pregnancy has been approved, but according to the current state of data, the STIKO does not yet see enough data to recommend maternal RSV vaccination as a general standard vaccination. Decisions are currently made on an individual basis following medical advice.

For families, this means that there is a clear STIKO strategy in Germany for the prevention of severe RSV disease in infants, currently primarily with nirsevimab. The question of whether additional vaccination of pregnant women makes sense is weighed up by experts on an individual basis.

Risks, side effects and special risk factors of the RSV vaccination

Like any vaccination, the RSV vaccination during pregnancy can have side effects. In the studies to date, local reactions at the injection site, headache or muscle pain and occasionally fever were the main side effects. Serious adverse events were rare.

For the child itself, an RSV infection increases the risk of severe disease progression, especially if there are additional underlying illnesses or if it is a premature baby.

Crucial: The risk and protection are always weighed up individually, together with an experienced doctor.

RSV prevention in everyday life: hygiene rules and other protective measures

In addition to vaccination and antibody prophylaxis, prevention in everyday life plays an important role in avoiding infections:

• Consistent hand washing for all persons caring for the baby
• Cough and sneeze etiquette (cough or sneeze into the crook of your arm)
• People with an acute infection should avoid close contact with newborns and infants if possible
• Regular ventilation, especially during the RSV season
• Clean toys and frequently touched surfaces

Such hygiene rules not only help against RSV, but also against other respiratory infections. For particularly vulnerable groups of people (e.g. adults with serious underlying illnesses, very old people aged 75 and over, chronically ill adults), these measures are an important supplement to vaccinations.

Frequently asked questions from pregnant women and families

Is the RSV vaccination compulsory for me during pregnancy?
No. There is currently no obligation and no general STIKO recommendation. The decision is made voluntarily and after individual information, usually between the 32nd and 36th week of pregnancy.

What happens if I don't get vaccinated?
Then your baby can still receive passive immunization via nirsevimab (Beyfortus), depending on the data available and what is available. In many countries, this option is available for newborns in the first RSV season.

What if I have already had an RSV infection?
Past RSV infections do not provide lasting protection. Adults can also be infected several times and pass the virus on to infants or small children.

The information given here is intended as a guide. You should always discuss such questions with a doctor, where you will receive individual answers.

The role of home helps and care workers

For families with domestic help, babysitters or caregivers, their role in protecting against infection is particularly important:

• Domestic helpers and caregivers should be informed about RSV, respiratory diseases and the possibility of transmission.
• Consistent hygiene rules (washing hands, not coming to work with an acute infection) protect both the baby and other people in the household.
• When in contact with vulnerable children, such as infants, toddlers or children with serious illnesses, caregivers should pay close attention to their own cold symptoms.

Especially in households where several people look after the child, it makes sense to have a clear agreement so that everyone lives up to the same standard.

Conclusion: make well-informed decisions together with your doctor

The respiratory syncytial virus is only an annoying infection for most healthy adults. For newborns, infants and young children, however, it can cause severe respiratory infections of the lungs, sometimes with dramatic consequences. Modern medicine today offers several strategies:

• the optional RSV vaccination Pregnancy with protein vaccine (Abrysvo) to strengthen nest protection,
• passive immunization with nirsevimab (Beyfortus) in infants and young children at risk,
• supplementary vaccinations such as the COVID-19 vaccination with COVID-19 mRNA vaccines,
• consistent prevention through hygiene rules in everyday life.

At the same time, the data on maternal RSV vaccination is still in flux. Professional societies and experts are closely monitoring new studies, evaluating results and adapting recommendations.

The following applies to you as an expectant mother, father or caregiver:

• Seek medical advice, especially if you have risk factors such as underlying illnesses (e.g. diabetes mellitus, cardiovascular disease).
• Discuss the possibility of vaccination or antibody administration, both for yourself and for your child.
• Take your time and make an informed decision about which form of prophylaxis is best for your family.

This article can provide guidance, but is not a substitute for personal advice. You should always make the final decision about vaccination, treatment and other steps together with a trusted doctor.