Introduction

As the winter season settles in, the state of Oregon faces an ongoing shortage of the RSV shot Beyfortus for newborns. This shortage poses a challenge to healthcare providers and families alike as they strive to protect infants from the respiratory syncytial virus (RSV). In this article, we will delve into the current situation, explore the demand for the RSV shot, and discuss the efforts being made to ensure that eligible newborns receive the necessary protection.

The Ongoing Shortage

The Oregon Health Authority (OHA) anticipates receiving shipments of approximately 1,600 additional doses of the RSV shot Beyfortus by the end of the year. However, this quantity is unlikely to meet the current demand, as around 40,000 babies are born in Oregon annually, and federal health officials recommend that all newborns receive protection against RSV.

Dr. Paul Ceislak, the medical director for immunizations at OHA, acknowledges the challenge, stating, “We’re not going to have enough to give to all the babies that might qualify for nirsevimab, unfortunately.” Nirsevimab is the recommended RSV shot for infants up to 8 months old, especially those whose mothers did not receive the new RSV vaccine during pregnancy.

Varying Dose Sizes and Supply Shortages

Nirvana comes in two different sizes: a 50 milligram dose for newborns and a 100 milligram dose for babies weighing 11 pounds and above, typically around 2 months or older. However, the vials for older infants have been particularly scarce. According to a representative from the drugmaker Sanofi, the demand for the 100 mg doses exceeded the company’s supply for the entire season just weeks after shipping began.

To address the shortage, the Centers for Disease Control and Prevention (CDC) issued an advisory recommending that clinicians prioritize the larger doses for babies 6 months and under, as well as those between 6-8 months with underlying health conditions that increase their risk for severe RSV.

Allocation and Prioritization Efforts

The state of Oregon has already exceeded its maximum allocation of the hard-to-find 100 mg doses for older infants. However, OHA is not issuing any guidelines or rationing recommendations. Their primary focus is ensuring that doses do not go unused. Thus, if a baby qualifies for Nirsevimab and the product is available, it is recommended to administer it.

To address the shortage, Oregon is expecting additional shipments of the smaller, 50 mg newborn dose. OHA plans to prioritize the distribution of these doses to federally-qualified health centers, tribes, and local public health authorities through the Vaccines for Children (VFC) program. This federal safety net program provides free shots to providers for children on Medicaid, uninsured children, and Alaska Native and American Indian children.

Notably, the CDC emphasizes that distributing Nirsevimab to Alaska Native and American Indian children should be a particular priority, as studies have shown that these children face a four to ten times higher risk of severe RSV compared to the general population.

Impact on Families and Providers

The ongoing shortage of the RSV shot has posed challenges for families and healthcare providers, especially as RSV season officially begins in Oregon. The percentage of positive lab tests for RSV has been rising since November, and Dr. Cieslak expects the number of cases to increase during the holidays, with a tapering off in the spring.

According to state immunization records, at least 4,306 infants in Oregon have received a dose of Nirsevimab so far this year. However, this number is likely an undercount as pediatricians are not always required to report doses they’ve purchased and given to patients with commercial insurance.

It is essential to note that families who cannot access the shot can still follow longstanding guidelines to protect newborns and young infants at the highest risk. This includes ensuring that family members who are sick wear masks or stay away from the baby whenever possible, regular handwashing, and cleaning frequently touched surfaces.

Private Market Shipments and Availability

While information regarding the impact of the shortage on families with commercial insurance is limited, state and federal rules prohibit the use of VFC shots for patients with commercial insurance. Kaiser Permanente Northwest has managed to order additional 50 mg vials of Nirsevimab from Sanofi for newborns but has a limited supply of the 100 mg doses, which may run out in the next two months.

Oregon Health & Science University (OHSU) is currently providing Nirsevimab at birth to all infants born in its hospitals until its supply of 50 mg doses is depleted. Salem Health, the only hospital in the state participating in the VFC program, offers the shot to all newborns at birth. However, many other hospitals have been unable to provide the shot to newborns due to the challenges of enrolling in the VFC program and the high cost of the shot.

Conclusion

As the demand for the RSV shot Beyfortus for newborns continues to outpace supply in Oregon, healthcare providers and families face the challenge of protecting infants from the respiratory syncytial virus. Efforts are being made to address the shortage, with additional shipments of the smaller dose expected. Priority is being given to federally-qualified health centers, tribes, and local public health authorities through the Vaccines for Children program. While the shortage poses difficulties, families can still follow guidelines to protect their newborns, and pregnant individuals can consider Pfizer’s maternal RSV vaccine as an option.