From the Guidelines
The current recommendations for RSV vaccination include nirsevimab (Beyfortus) as a single dose for all infants under 8 months born during or entering their first RSV season, and for high-risk children aged 8-19 months entering their second RSV season. For adults, two vaccines are recommended: RSVPreF3 (Arexvy) for adults 60 years and older, and RSVPreF (Abrysvo) for both adults 60+ and pregnant women between 32-36 weeks gestation to protect newborns 1. For high-risk infants, palivizumab (Synagis) remains an option, administered monthly during RSV season 1. These vaccines work by targeting the RSV F protein, preventing viral entry into cells. The recommendations aim to protect vulnerable populations from RSV, which can cause severe respiratory illness in infants and older adults. Vaccination timing should align with the local RSV season, typically fall through spring in temperate climates. Side effects are generally mild and include injection site reactions, fatigue, and headache, with serious adverse events being rare. Key considerations for vaccination include:
- Infants under 8 months and high-risk children aged 8-19 months should receive nirsevimab (Beyfortus) as a single dose
- Adults 60 years and older should receive RSVPreF3 (Arexvy) or RSVPreF (Abrysvo)
- Pregnant women between 32-36 weeks gestation should receive RSVPreF (Abrysvo) to protect newborns
- High-risk infants may receive palivizumab (Synagis) monthly during RSV season
- Vaccination timing should align with local RSV seasonality, typically from September to January in most of the continental United States 1.
From the FDA Drug Label
SYNAGIS is a prescription medication that is used to help prevent a serious lung disease caused by Respiratory Syncytial Virus (RSV) in children: born prematurely (at or before 35 weeks) and who are 6 months of age or less at the beginning of RSV season, who have a chronic lung condition called bronchopulmonary dysplasia (BPD), that needed medical treatment within the last 6 months, and who are 24 months of age or less at the beginning of RSV season, born with certain types of heart disease and who are 24 months of age or less at the beginning of RSV season.
The current recommendations for RSV vaccination using Synagis are:
- Indications: Synagis is used to help prevent RSV disease in high-risk children, including those born prematurely, with bronchopulmonary dysplasia, or with certain types of heart disease.
- Administration: Synagis should be administered by a healthcare provider once a month during the RSV season by intramuscular injection.
- Dosage: The dosage of Synagis is 15 mg/kg per month, given as an intramuscular injection.
- RSV Season: The RSV season typically starts in the fall and ends in the spring, but may vary by region.
- Patient Selection: Synagis is recommended for children who are at high risk of RSV disease, including those who are 6 months of age or less at the beginning of RSV season and were born prematurely, or those who have a chronic lung condition or certain types of heart disease. 2
From the Research
Current Recommendations for RSV Vaccination
The current recommendations for Respiratory Syncytial Virus (RSV) vaccination are based on several studies and guidelines from reputable organizations.
- The American Academy of Pediatrics recommends the use of palivizumab, a monoclonal antibody, for high-risk infants, including those with chronic lung disease, congenital heart disease, and premature birth 3.
- A systematic review of evidence from the last 5 years recommends palivizumab for preterm infants, high-risk infants with chronic lung disease, and children with significant congenital heart disease, among other high-risk populations 4.
- The National Advisory Committee on Immunization (NACI) has updated its recommendations for the use of palivizumab, taking into consideration recent data on RSV burden of illness, effectiveness of palivizumab, and economic implications of its use 5.
- Palivizumab has been shown to be effective in reducing RSV-related hospitalization in high-risk populations, but its use is not without costs and potential adverse events 6, 7.
High-Risk Populations
High-risk populations that may benefit from palivizumab prophylaxis include:
- Preterm infants (<29 and ≤31 weeks gestational age) 4
- Infants with chronic lung disease or bronchopulmonary dysplasia 3, 4
- Children with significant congenital heart disease 4, 5
- Children with Down syndrome, pulmonary or neuromuscular disorders, immunocompromised, or cystic fibrosis 4