Why RSV Protection for Infants in Canada Demands Awareness, Equity and Preparedness

Respiratory syncytial virus (RSV) is the leading cause of infant hospitalizations in Canada, yet many parents still see it as a mild seasonal illness.

87.6% of mothers expressed concern about their child getting RSV under six months of age, yet fewer than 30% were aware of existing protection options. Around 2% of infants in Canada are hospitalized with RSV in their first year, and in remote communities, the rate may rise from 5% to 17%.

To understand why RSV poses such serious risks to infants and how protection strategies are being implemented across Ontario, Xtalks spoke with Dr. Paul Roumeliotis (Dr. Paul), a pediatrician and public health leader in Eastern Ontario.

Why RSV Is So Dangerous for Infants

“RSV has a predilection for small airways, and for babies, their lungs are not fully formed,” said Dr. Paul. “In an adult, RSV just causes a cold – an upper respiratory tract infection. But in babies, for a variety of reasons – including the angle of their diaphragm and the way the elasticity of their lungs is formed – they are more susceptible to blockage of the small airways, or bronchioles.

Because babies’ lungs have a large amount of bronchial surface area relative to their size, even a small amount of swelling or secretion can block airflow. RSV inflames the small airways in a baby’s lungs, leading to mucus buildup and obstruction that makes breathing difficult. This is a condition known as bronchiolitis.

As babies grow, their lungs and diaphragms become stronger, making them less susceptible to RSV’s effects. But for premature infants or those with lung or heart conditions, RSV can be devastating. “It’s not surprising that RSV is the number one cause of admission to the hospital in children less than one year of age,” he said.

Severe RSV can cause coughing fits, wheezing, congestion, and breathing and/or feeding difficulties that sometimes require hospitalization for oxygen support and IV fluids.

He also noted that RSV can have longer-term consequences. “We believe that early-age onset of RSV disease may cause a child to be more susceptible to developing asthma in the future.”

Public Awareness and Parental Hesitancy

“There’s this concept that RSV is not very dangerous to kids. It just causes a cold,” Dr. Paul said.

Vaccine hesitancy has grown since the pandemic, highlighted Dr. Paul, adding to the misconception that RSV is harmless.

Public health efforts, he explained, have focused on sharing that most hospitalizations – about 80% – occur in otherwise healthy infants, and that awareness combined with protection can make a measurable difference.

Launching Protection Campaigns

To address this, Dr. Paul stressed the importance of knowing before you go. “It’s basically demystifying and informing parents of the potential severity of RSV and then, number two, talking about, hey, there is something we can do about it,” he said.

New immunization options have been shown to significantly reduce RSV infections in infants during their first year of life. In 2024, both Ontario and Quebec rolled out publicly funded protection programs, and this year most other provinces and territories have followed suit by implementing publicly funded all infant RSV programs, with the exception of Alberta, British Columbia, and New Brunswick.

Communicating Risk Without Fear

When it comes to discussing RSV risk, Dr. Paul said the key is balance. “You can’t sensationalize or scare people. You have to balance it and say, listen, we know that children’s lungs are very sensitive, and RSV can cause trouble in their lungs that could potentially put them in the hospital, which is something we don’t want to do,” he said.

He added that a personal approach matters: “You just can’t tell parents, ‘You need to take this.’ You have to say, ‘You know what? I’ve seen this. This is what happens, and we’ve got good news here, just like with other infectious diseases, now we can prevent this as well.’”

Trust, he said, is built through “non-threatening, relaxed, confident” communication and openness to questions.

Addressing Inequities in RSV Protection

“Equity is a fundamental tenet of public health,” said Dr. Paul. “Children living in underprivileged areas and remote areas have higher rates of bronchiolitis and higher rates of admission to hospital. That speaks to lack of access to care.”

Children in remote or underserved regions, such as parts of Northern Ontario, face higher rates of RSV-related hospitalizations due to limited access to care. To bridge these gaps, Ontario has prioritized preventive measures for vulnerable populations through its publicly funded program.

For remote communities, the RSV immunization products are flown in so they can be administered locally.

Health System Preparedness for RSV Season

Every year, the RSV season places pressure on hospitals already strained by influenza and COVID-19. “Before COVID, it really was flu and RSV,” said Dr. Paul. “Now we’re looking at a triple threat.”

Hospitals and public health units conduct tabletop exercises each year to ensure readiness and capacity, while public health teams work outside the hospital to raise vaccination coverage – particularly among infants and seniors, who make up the majority of RSV-related admissions.

Dr. Paul explained that preparations for the respiratory season begin as early as June or July, long before vaccines arrive. Public health teams coordinate with hospitals, primary care and long-term care facilities to plan fall clinics, logistics and communications campaigns.

“By the time we finish one flu season,” he said, “we’re already getting ready for the next.”

Integrating RSV Protection into Routine Care

According to Dr. Paul, RSV protection can easily fit into prenatal and early-childhood visits.

Just as parents safeguard their homes against visible dangers, he said, they can also protect against “invisible” ones like germs through timely vaccination. This includes vaccines offered during pregnancy, such as flu, whooping cough and now RSV, as part of a broader effort to keep both mothers and newborns healthy.

“Parents can discuss RSV prenatally as maternal vaccination is available between 32 and 36 weeks, and newborn immunization can also be provided in the hospital once their baby is born.”

A Veteran Pediatrician’s Perspective

Dr. Paul reflected on his decades-long career: “I started practicing in the 1980s. I’ve lived through infections that used to kill babies, literally kill children. And I had the displeasure of telling parents, your child died of, say, of meningitis.”

Reflecting on his decades of pediatric practice, Dr. Paul said that vaccines have eliminated many once-deadly childhood infections, from meningitis and epiglottitis to rotavirus, which previously caused severe diarrhea and dehydration in infants.

With the arrival of RSV protection, he added, another major cause of infant hospitalization is now addressable. “When people are given clear information,” he said, “most will choose to protect their children.”

His closing message to both parents and providers is simple: RSV is dangerous, but it’s preventable now. Learn more about RSV protection options and how to protect your family at the Praxus Health RSV Parent Information Hub.

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