RSV in Panama: Prevention and Economic Burden

The Respiratory Syncytial Virus (RSV) continues to be a major public health challenge, responsible for severe lower respiratory tract infections, including moderate to severe bronchiolitis and pneumonia. In low- and middle-income countries, RSV is responsible for approximately 30% of hospitalizations due to severe respiratory infections in children under 5 years of age, causing the majority of deaths in this age group. "Ensuring equitable access to all newborns for these interventions will not only protect the most vulnerable but will also decrease the pressure on intensive care units and generate well-being for families and society," explains Dr. Ximena Norero, a Pediatrician and Infectologist at Dr. Jose Renán Esquivel Children's Hospital. From an economic point of view, an RSV hospitalization costs approximately $2,090 per event, a figure that rises to $11,087 when admission to the ICU is required. The global hospitalization rate in children under 12 months is 15.9 per 1,000 children, reaching 24.07 in infants under 3 months. The most vulnerable groups include premature newborns whose mothers could not be vaccinated because the vaccine was not yet indicated for that gestational week, infants under 6 months of unvaccinated mothers, babies whose mothers were vaccinated but were born before the maternal antibody transfer was completed (a process that requires at least 15 days after the vaccine is administered), mothers with placental insufficiency, and children with pre-existing heart or lung diseases. This supports the implementation of preventive strategies, such as maternal vaccination and the use of monoclonal antibodies in infants, to reduce the burden of severe disease in our country. Complementing these findings, a study conducted in Panama evaluated the health and economic impact of the main RSV prevention strategies, demonstrating that Nirsevimab complements the reduction in cases, hospitalizations, ICU admissions, and deaths. The majority of cases occur between June and December, especially in children under 6 months, who represent 43.1% of hospitalized episodes. Between 10% and 20% of hospitalized patients require intensive care, with an annual mortality rate close to 1.2%. This is compounded by indirect costs for families, including missed workdays, travel, and emotional stress, which affect social productivity, especially when the hospitalization period exceeds parental leave, as happens in more than 18% of cases. According to the authors of this study, the comprehensive genomic analysis of RSV in Panama demonstrates the high diversity and dynamics of its lineages, as well as the effectiveness of anti-F monoclonal antibodies against circulating strains. These results support prioritizing Nirsevimab as a key strategy to decrease the burden of RSV in Panama. Studies also show that viral circulation has been affected by global events, such as the COVID-19 pandemic, which interrupted RSV transmission in 2020 and caused an atypical resurgence in 2021, with year-round viral circulation and greater introduction of lineages in the metropolitan area. Furthermore, RSV infection can increase the risk of long-term respiratory complications, such as asthma or recurrent bronchiolitis, generating clinical and social impact even after initial recovery. Additionally, the analysis concludes that an annual Nirsevimab program could save up to 10 million dollars for the health system. The Respiratory Syncytial Virus (RSV) continues to be a major public health challenge, responsible for severe lower respiratory tract infections, including moderate to severe bronchiolitis and pneumonia. Between 2018 and 2024, the Gorgas Memorial Institute of Health Studies (IGCES) and the University of Panama, in collaboration with institutions from Uruguay, Spain, and the United States, conducted an exhaustive study on the genomic evolution of RSV in the country, analyzing 303 confirmed samples and studying in depth the genetic information of 115 cases to evaluate the effectiveness of certain treatments against the circulating variants.