Member Spotlight: Joseph Domachowske

Joseph Domachowske, MD, FPIDS, is Professor Emeritus of Pediatrics at Upstate University Hospital and North America RSV Medical Director, Vaccines at Sanofi. He earned his medical degree at SUNY Upstate Medical University where he also completed his residency and his fellowship in pediatric infectious diseases. In January of this year, Dr. Domachowske retired from active teaching and took on his current position with Sanofi.

Why pediatric ID? That decision was a long time ago [laughs]. What I do remember is that I always wanted to do pediatrics. During my residency, I was considering pediatric endocrinology. I had some interest and skill set in microbiology and immunology, though those went more with the infectious disease path than it did with the endocrine path. And I like to solve puzzles. I like to help others when they’re struggling with deductive reasoning in determining what might be going on with patients. That appealed to me, the consultations and being the expert in the room.

Where have you taken your ID focus? I retired as professor emeritus from Upstate Medical University in January after 36 years of academic peds ID consultant. Things evolved and changed over the course of that part of my career. Initially, I was doing some basic science research before moving quickly into translational work and then becoming very involved in clinical trial work, which was always looking at ways to treat or prevent respiratory infections in young infants, especially with respiratory syncytial virus. One thing I learned along the way and tried to practice was act locally and regionally but think globally. We know that what we are doing always brings eyes toward us and that helps us bring things like RSV prevention to parts of the world where it can really make a big difference. I spent some time doing mission work in El Salvador and Ecuador and I really got to see how things play out over time.

More than 10 years ago, I had the absolute privilege of enrolling the first three infants in the world, ever, in a phase IB trial to receive nirsevimab, which is now a standard of care for all infants to protect against RSV. That experience and going through the clinical development, seeing it start to change the landscape of infant RSV in the U.S. and other parts of the world where it has been implemented led me to consider retiring but I realized I needed something else interesting to do. Sanofi had a medical director position open in their RSV franchise that I applied for. I spoke with both global Sanofi and U.S. Sanofi to decide together this would be a good transition for me as I retired from my academic position to move into a position where I can explore bringing RSV prevention to not just a community in Syracuse but to other parts of the country and the world. I’m very excited about this new opportunity. This new position has global responsibilities that allow me to take what I learned over the years from traveling to different places, like El Salvador and Ecuador, to see what it’s really like. We shouldn’t just make assumptions on how our work affects children. We should go and take a look for ourselves.

What is a recent development in pediatric ID that you are working on? The clinical development of nirsevimab tells the story of how my academic work has pushed toward changing the landscape of RSV and enabled my transition from retirement to my position with Sanofi. My niche beyond all infant protection is in immunocompromised and high-risk babies. Some of the research we produced includes Molecular and Phenotypic Characteristics of Respiratory Syncytial Virus (RSV) Infections in Medically Vulnerable Children: An Exploratory Analysis of a Phase 2/3 Randomised, Double-blind, Palivizumab-Controlled Trial of Nirsevimab (MEDLEY) and Safety and Pharmacokinetics of Nirsevimab in Immunocompromised Children.

I was also fortunate to act as guest editor of the Journal of the Pediatric Infectious Diseases Preventing Infant RSV Infection supplement in 2024. I had several authors submit manuscripts while I also contributed two of the papers: Understanding the Regulatory Pathways Used to Develop, Evaluate, Authorize, and Approve New Drugs and Vaccines in the United States and New and Emerging Passive Immunizations Strategies for the Prevention of RSV Infection During Infancy. That supplement really demonstrates what our collective efforts have led to for changing the landscape of infant RSV disease burden.

What do you enjoy most about being a PIDS member? What keeps you renewing your membership? It is never a question in my mind to renew. First, the Society offers me the camaraderie of my fellow peds ID experts. Though the group has grown in North America over time, when I started in the 1990s, we all knew each other. I still know many-to-most of the folks who identify as peds ID specialists. That camaraderie is amazing. I would also highlight the outstanding leadership of Deb Palazzi and the people before her as well as that of the leaders of the journal—they are all incredible. When I went through as guest editor of the RSV supplement one thing that impressed me more than most was the level of detail and holding to the truth and the science with the requested revisions that were made along the way. The JPIDS editors are so careful and so good at what they do under the leadership of Ravi Jhaveri, as editor-in-chief, and Andrew Handel, as supplements associate editor, who happens to also have been one of my medical students and research assistants! I have the highest regard for all of our PIDS leaders.