Historically, the Yukon-Kuskokwim Delta has had high rates of the respiratory virus RSV in infants and young children. It’s been the highest in the United States, and the second-highest in the world, according to Brian Lefferts, the director of public health for the Yukon-Kuskokwim Health Corporation. He said that while RSV isn’t usually serious for adults, it can be devastating for young children.
“In some infants it can require not just hospitalization, but they could need to be intubated, they might have to be medevaced to Anchorage,” Lefferts said. “And […] some of those infections can lead to life-long complications.”
In 2023, YKHC was able to administer the first doses of a new immunization for RSV: a monoclonal antibody treatment called nirsevimab. It’s meant to help protect infants from severe illness or hospitalization because of the virus. And it worked incredibly well.
Since 2013, Lefferts said that the Y-K Delta has seen an average of 60 young children hospitalized each year because of RSV. In 2023, the first year the new treatment was available, that dropped to 19.
“And amongst those, only two of them were in children who received the antibody,” Lefferts said. “So that’s an effectiveness of 97% that we saw. [It’s] very, very effective at preventing hospitalizations, and we’re really hopeful that more people will be interested in taking advantage of it this year.”
Lefferts said that among all of the children who got sick with RSV last year, the immunization was also quite effective at preventing the need to seek medical care in the first place.
This year, Lefferts said that YKHC is once again putting an immense amount of resources into targeting its RSV immunization efforts. This week, the health care provider is chartering flights to 21 communities to distribute doses.
Lefferts said that YKHC has been calling eligible households to make sure they have an opportunity to receive the immunization – and there are around 1,500 children who are eligible to get it. That’s any child under 8 months old, and Alaska Native or high-risk children under 20 months old.
Three infants from the Y-K Delta have already been hospitalized because of RSV this year.
Nationwide, doses of nirsevimab are extremely limited. Lefferts said that the whole state of Alaska was only going to initially receive around 500 doses of the immunization this year. But the Centers for Disease Control and Prevention (CDC), recognizing the huge historical burden that the Y-K Delta has had because of RSV infections, sent an initial allocation of 800 doses of nirsevimab to the region, with a few hundred more on the way.
Kristina Morris, a pediatric nurse practitioner with YKHC, said that RSV immunizations are important not only for individuals, but for communities.
“It decreases the risk of serious infection,” Morris said. “Helps protect the lungs against infections that might help or might happen later on down the line. And then in decreasing each person that gets the infection, you decrease community spread. So even in people that may not benefit from getting nirsevimab, that decreases how many people get RSV and then pass it on to more people.”
And in a region where weather can prevent even the most urgent medical travel, Lefferts said that prevention is especially important.
“The alternative is it can be really, really bad,” Lefferts said. “I hear physicians and even parents just talk about how traumatizing it can be to watch an infant just struggling to breathe from an RSV infection. This is something that’s avoidable if we can just make sure we capitalize on the opportunity to take advantage of this opportunity to get protected.”
Lefferts and Morris also said that that the risk of side effects from the RSV immunization is very low, mostly confined to irritation around the injection site.
In addition to RSV immunizations, health care providers visiting villages around the region will also have updated vaccines for COVID-19, pertussis (also known as whooping cough), and the flu.
Morris said that it’s safe to get vaccines, even when you’re a bit sick.
“We do see that sometimes people will hold off on getting their vaccines [when they’re sick], and that’s really what’s really not indicated,” Morris said. “So it’s totally okay to get your shots if you have a fever, if you’re not being sent into Bethel for further evaluation or medevac out of your village, then really it’s okay to get shots.”
After the initial push for RSV and other immunizations this week, YKHC said that it will focus on stocking vaccine fridges throughout the region, and on sending out additional doses so that as many infants and families as possible can be protected.
