Respiratory Syncytial Virus (RSV) is a highly contagious virus that infects the respiratory tract. While it often presents with symptoms similar to the flu, its implications can be severe, especially for infants.

Until recently, only high-risk infants meeting specific criteria were eligible for the RSV vaccine – Synagis® (palivizumab). This vaccine was costly, ranging from $5,000 to $9,000 per infant per year and babies needed to get multiple injections (monthly doses from November to April). Accessibility was also an issue - particularly in northern Ontario and in racialized communities where the burden of RSV is higher.

Improved Access to RSV Vaccination and Prophylaxis in Ontario

The Ministry of Health expanded the RSV prevention program for the 2024-25 season to include ALL infants (and high-risk children up to 24 months of age). This expansion also included a change from the previous monoclonal antibody, Synagis® (palivizumab), to a new monoclonal antibody, Beyfortus® (nirsevimab). Unlike Synagis, Beyforus does not require multiple injections.

In addition, the Ministry of Health made the RSV vaccine, Abrysvo®, available to pregnant residents of Ontario from 32 to 36 weeks gestational age who will give birth near the start of or during the RSV season. When administered during pregnancy, RSV protection is provided to infants from birth to six months of age.

RSV Prevention Program Impact

According to Ontario Health models, if 90% of infants born “in-season” (October 2024 – March 2025), and 60% of infants born “out of season” (April 2024 to September 2024), receive Beyfortus®, we could see incredible system-wide impacts: 

  • 83% reduction of hospitalizations
  • 76% reduction of pediatric intensive care unit (PICU) admissions
  • 37% reduction in length of stay

This translates into 600 fewer PICU bed days and eliminates the need for thousands of episodes of medically attended care for infants suffering from RSV this season.

These projections only hold true if uptake is high. The BORN Information System allows tracking of real-world uptake, which is critical.

BORN’s Role in RSV Surveillance

New data elements related to RSV protection (summarized below) were integrated into the BORN Information System on October 31, 2024:

  • Prenatal vaccine (AbrysvoTM) administration and date
  • Infant RSV antibody (Beyfortus®) administration and date
  • Reason infant antibody was not given
  • High-risk criteria

System Benefits

Collecting the new data about infant RSV protection provided at birth (or during pregnancy) in the BIS will have a number of benefits:

  • Reporting: New RSV reports available in the BIS will help birthing hospitals and midwifery practice groups monitor the implementation of this new care standard and associated outcomes.
  • Quality Improvement: RSV data availability will allow organizations to identify areas of success and opportunities for improvements in local, regional and provincial programming.
  • Provincial Surveillance: The BORN RSV data will fuel province-wide surveillance of uptake and coverage for use by the Ministry of Health, ICES, Public Health Ontario, the Provincial Council for Maternal Child Health, Maternal Child Regional Networks, and others.
  • Centralized Information: Centralizing infant RSV protection information in the registry will allow for future functionality to share a newborn’s RSV protection status with clinicians in the circle of care to facilitate improved coverage and opportunities for protection.

RSV poses a significant health risk. Yemi’s story below provides a glimpse into one family’s grim experience with this virus. The availability of new protective products and improved data collection/surveillance, however, represent marked progress toward the goal of ensuring all infants in Ontario receive the protection they need.

 

Yemi’s Story

“I Love Watching Him Live”

For Mila Olumogba, something as ordinary as watching her 22-month-old son, Adeyemi (Yemi), fill a bucket with sand at the beach fills her with gratitude – “I just love watching him live”.  Life takes on new meaning you’ve seen it slipping away. Yemi was only 10 weeks old when he contracted Respiratory Syncytial Virus (RSV) and almost died.

“You’re Going to Be Here a While..."

In December 2022, Mila and her daughters were sick with RSV. Mila, tired and feverish, remembers it as one of the worst illnesses she’d ever had. Her husband and Yemi, who was born with a heart defect, initially seemed unaffected. But when Yemi developed a cough and struggled to breastfeed, Mila took him to CHEO, where he was tested for flu, COVID, and RSV. He was sent home with Tamiflu, an antiviral, but his symptoms worsened. Several days later, Mila returned to CHEO, where Yemi was diagnosed with RSV and put on high-flow oxygen. A pediatrician warned, "You’re going to be here a while," but Mila thought it might be just a few days.

Yemi’s condition deteriorated, and he was moved to the NICU. His case is not unique—49% of infants under six months hospitalized with RSV end up in intensive care. RSV-associated hospitalizations are highest in the first 3 to 6 months of life. Like Yemi, infants with risk factors such as heart conditions are particularly vulnerable. However, 80% of children hospitalized with RSV have no underlying risk factors at all.

“Strap In”

Doctors warned Mila and her husband to brace for a rough journey. “The docs basically said, ‘Strap in’. They said things were going to be tough for the next while - RSV gets worse before it gets better.” Days later, Mila was home making dinner for her two daughters when she got a call: Yemi was struggling to breathe and needed immediate intubation. Rushing to the hospital, she was relieved to know the procedure went well, but seeing Yemi on a ventilator was devastating. She and her husband sobbed seeing their tiny 10-week-old hooked up to a ventilator. 

Later, while grabbing food in the hospital cafeteria, Mila heard an announcement she’ll never forget: “Code Blue - all staff to ICU Room 9.” Yemi was in cardiac arrest. Mila and her husband were ushered into a room where they waited in agonizing silence “We just sat there waiting for someone to come in and tell us if our son was alive or dead”. Finally, the doctors delivered the news they’d hoped for - Yemi had been resuscitated.

Yemi in the intensive care unit

"The Beginning of Hell"

The adversity didn’t end with Yemi’s cardiac arrest. In fact, Mila says it was  the beginning of hell for the next month. Yemi spent 19 days at CHEO, including 12 days on a ventilator. After discharge, he faced weeks of painful opioid withdrawal, leaving Mila managing an intense medication schedule. "He wasn’t eating, he was angry, he was always crying," she recalls. She remembers the intense pressure and anxiety of administering medication correctly and using spreadsheets and alarms on her phone to tell her which drug to give and when.

Gratitude in Action

Today, Yemi is a healthy, energetic toddler. Mila’s gratitude to the CHEO team goes beyond words – she organizes annual fundraisers for CHEO and donates proceeds from her business - Colour Me Christmas – to pediatric hospitals. She’s also written a book - Dr. Santa & The Miracle Makers – about a little boy who ends up in the hospital over Christmas. Along with a host of holiday characters, the book profiles NICU healthcare providers and highlights their dedication and compassion.

150,000 Doses of Prevention

The expansion of Ontario’s RSV prevention program, alongside the introduction of the new monoclonal antibody Beyfortus®, brings hope that fewer families will face the trauma experienced by Yemi’s family. Beyfortus® has been shown to reduce hospital admissions related to RSV by 81-83% and has led to an 80% reduction in medically attended RSV respiratory infections in healthy infants (as per Government of Canada Immunization Guide).

Dr. Charles Hui, Chair of the Ministry of Health's RSV Advisory Group says, “Last season, 2,619 infants received Palivizumab (Synagis) under the high-risk program. This year, the expanded universal initiative aims to deliver 150,000 doses of Beyfortus® to infants throughout the province”.

To protect all infants, especially those at high risk like Yemi, collaboration is essential. Healthcare providers, parents, caregivers, researchers, and communities must work together—from sharing information and administering doses to gathering and reporting data. It takes a village not only to raise a child but to protect one as well.