Infectious disease specialists Paul Loubet (CHU de Nîmes) et Benjamin Davido (Garches hospital) discuss new developments in vaccination strategies against influenza, RSV and COVID-19, as well as cases observed “out of season”.
TRANSCRIPTION
Benjamin Davido ― Hello everyone, welcome to Medscape. I have the pleasure of welcoming Professor Paul Loubet from Nîmes. Today we’re going to talk about fall and winter illness news, including COVID-19, the flu, and RSV.
Hello Paul, can you introduce yourself for those who don’t know you.
Paul Loubet ― Hello Benjamin, I am indeed an infectious disease specialist at Nîmes University Hospital and I specialize in vaccination and respiratory infections in adults.
Cases of “out of season” flu
Benjamin Davido ― My first question to have with your “feelings”. You work in the south of France, where life is good (at least better than in the north of Paris): have you started to see cases of flu, and if so are they hospital cases?
We see cases of flu that are outside of the usual flu circulation season.
Paul Loubet ― Yes, and interestingly enough just last week we had two cases of flu who were hospitalized; These are cases of influenza A, so I would not say that we are at the start of the epidemic which is expected a little later. If we look at the figures from Public Health France, we are not at all yet in an epidemic period in mainland France. Circulation is even close to 0. But it is quite interesting to see that now, as we are screening more and more widely for respiratory viruses, we are seeing cases of flu that are outside the usual flu circulation season and that was also the case this summer and particularly in August. In Nîmes we had several cases of influenza B in people who had not traveled, so it is an interesting observation. Finally, we have influenza viruses circulating and this is also the case with other respiratory viruses all year round.
Benjamin Davido ― So it’s not that unusual to get vaccinated early. For the 2024-2025 season, what vaccine is recommended?
Paul Loubet ― The vaccination season began like other years around mid-October, on October 15 to be exact. It is a vaccination which is coupled “flu and COVID-19” as it has been for the last 2 winters. We use a vaccine which is therefore quadrivalent, inactivated like other years, and which targets 2 strains of influenza A (H1N1 and H3N2) and 2 strains of influenza B. A novelty to highlight this year: it existed until now a vaccine which was more highly dosed was the Efflelda vaccine which was intended for people over 65 years old. This year, the vaccine is not available for these patients. We hope he returns next season.
And in fact, next season, one of the new features is that we will return to trivalent vaccines given that we have noticed that since 2020 there is one of the two strains of influenza B which is no longer circulating (flu B/Yamagata no longer circulates in the world) and therefore the WHO now advises a return to trivalent vaccines. From the winter of 2025-2026, in France, we will vaccinate again with vaccines covering two strains of influenza A and a single strain of influenza B.
Benjamin Davido ― On the subject of influenza, in the United States, I was pleasantly surprised to see that there was a nasal vaccine for influenza in children, which allows for an additional method of administration (but unfortunately we don’t have it yet in France).
RSV vaccination
Benjamin Davido ― We can quickly say a word about this big news in relation to RSV, because we talked a lot about Beyfortus in children, and now things are changing for adults and for pregnant women.
Paul Loubet ― Indeed, it is true that we can say that last year (2023) but also 2024 then 2025, are very important years with a lot of news, a lot of publications and above all a lot of recommendations. If we categorize into two populations to be protected at the moment, we have on the one hand the young child and on the other hand the so-called elderly people, that is to say those over 60 years old.
If we start with the children: we have from this season and this year, 2 strategies that we will leave to the choice of parents, which are:
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to administer a vaccine to pregnant women between 32 and 36 weeks of gestation. The goal is for the pregnant woman to develop antibodies which, through the transplacental route, will protect the fetus (that is to say, the child will be born with its mother’s antibodies which will gradually disappear after 3 to 6 months, but rather 6 months). And we know that in the first years of life, where the baby is really at high risk, he will be protected.
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the alternative is to offer Beyfortus, which is a long-acting anti-RSV monoclonal antibody. France was one of the first countries to use it during the previous winter (2023-2024) with very good acceptability from parents. Real-life data have been published in major journals, including the NEJMwith French teams who showed that the efficiency was around 80%. In fact, we find this effectiveness in phase 3 trials and it is particularly interesting.
So this year we will have, as in quite a few countries now, the choice of vaccination with the Abrysvo vaccine during pregnancy between 32 and 36 weeks of amenorrhea, and if this vaccination is not chosen or if it is not is not done, parents have the choice of having Beyfortus administered to children, either before leaving the maternity ward, or in town. And it’s true that this is clearly something that will probably change the circulation of RSV in this age group and perhaps in other age groups.
Benjamin Davido ― This is also good news because we will be able to respond to a demand that was strong, precisely for these antibodies in maternity.
Paul Loubet ― Exactly. We are waiting to see the first French data, and also Spanish data which will be very interesting. We will see what the use of this Beyfortus and maternal vaccination can achieve on a larger scale.
To protect adults over the age of 60, there are 3 vaccines (this is the new thing) which arrived a little late and which are Abrysvo, Arexvy and mRESVIA; they are slightly different in their vaccine platform or in their composition, but in practice all three have had authorization on the European market. In addition, in adults over 60 years of age, the three vaccines show very good effectiveness in phase 3 trials (compared to a placebo) of around 80% in the prevention of RSV lower respiratory infections. and above all, and this is what is interesting, they seem to show a duration of protection which would be at least 2 years.
This is truly a novelty, because these are the first vaccines to protect against HRV in adults, and the HAS decided this summer to restrict the recommendation a little and focus on the targeted people who are the over 75 years old and those over 65 years old with a chronic cardiac or respiratory pathology. That’s it for now. Afterwards, the question is possibly to later extend these recommendations to younger people but suffering from severe chronic cardiac or respiratory pathologies, or even to immunocompromised people in the broad sense, who for the moment have been somewhat left aside in these recommendations.
Don’t forget COVID-19
Benjamin Davido ― You make me think of the age criteria and these patients who have illnesses: what about this year with COVID-19? Because we seem to forget, even if we are no longer in a pandemic phase, that the virus is still circulating. What can we say about the cumulative burdens and outlook for this respiratory disease?
Paul Loubet ― It is certain that the virus is circulating, we have seen it clearly, there was a small wave at the beginning of the summer, rather at the end of June-beginning of July, then especially in September-October. In any case, we saw it clearly, all the people around us were sick. And then we especially saw a lot of people hospitalized, we saw cases of severe COVID going to intensive care, we saw prolonged COVID among the immunocompromised, and we saw a lot of elderly people who fell, who had difficulty fever and who are hospitalized for COVID not necessarily pneumonic, but in any case hospitalized due to COVID. So this remains a significant burden.
As you said, there isn’t really any seasonality yet. We know that there was something at the beginning of summer, something at the end of summer and at the beginning of spring, so it still remains important to vaccinate the people most at risk.
Benjamin Davido ― There is therefore real work to be done to raise awareness of all of these vaccines, with different schedules, and perhaps while waiting for combined vaccines.
All this is very clear, and it is still good news for vaccination which is not doing so badly after being scratched by the [polémiques autour des vaccins à ARN]. I thank you very much for all this insight and we’ll perhaps see you next year with other data which, I hope, will certainly be reassuring regarding the benefit of these vaccines.
