What are the updated 2025 guidelines for respiratory syncytial virus (RSV) vaccination and monoclonal antibody use compared to the 2024 recommendations?

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Last updated: September 27, 2026 • View editorial policy

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Updated RSV Guidelines Since 2024

Yes, there are significant updates to RSV guidelines in 2025, most notably the addition of clesrovimab as a second monoclonal antibody option for infants and expanded recommendations for adult vaccination.

Key Changes for Infants and Children

New Monoclonal Antibody Option (June 2025)

On June 26,2025, ACIP recommended clesrovimab (Enflonsia, Merck) as a second long-acting monoclonal antibody option alongside nirsevimab for preventing RSV-associated lower respiratory tract infections in infants 1. This represents the most significant change since 2024.

The core recommendation remains that all infants aged <8 months born during or entering their first RSV season should be protected through one of three options:

  • Maternal RSV vaccination during pregnancy (32-36 weeks' gestation), OR
  • Infant monoclonal antibody administration (nirsevimab OR clesrovimab)

No single product is preferred—the choice should be guided by parent preference, product availability, and timing of birth relative to RSV season 1.

Efficacy Data Supporting the Update

The 2024-2025 RSV season provided the first full-season real-world effectiveness data showing:

  • RSV-associated hospitalization rates among infants aged 0-7 months were 43% and 28% lower compared to pre-COVID pandemic seasons 1
  • Both nirsevimab and maternal vaccination offer approximately 70-80% protection against RSV-associated hospitalizations 1

This real-world data validated the 2023 recommendations and supported expansion of options.

Key Changes for Adults (2025)

Expanded Adult Vaccination Recommendations

The 2025 adult immunization schedule includes important updates for RSV vaccination 2:

  • Adults ≥75 years: Universal vaccination now recommended (yellow designation) if not previously vaccinated
  • Adults 60-74 years: Vaccination recommended for those with risk factors or conditions increasing risk for severe RSV disease (purple designation)

This represents a shift from the previous shared clinical decision-making approach to more definitive age-based and risk-based recommendations.

Immunocompromised Adults (2025)

New IDSA guidelines issued a strong recommendation for age-appropriate RSV vaccination in adults and adolescents with compromised immunity 3. Key evidence:

  • 70% reduction (95% CI: 66-73%) in RSV-associated hospitalization among immunocompromised adults
  • 81% effectiveness (95% CI: 52-92%) against critical illness
  • Serious adverse events comparable to unvaccinated groups
  • Guillain-Barré syndrome remains rare (11 excess cases per million doses)

Timing should be individualized based on:

  • Treatment cycles
  • Transplant status
  • B-cell-depleting therapy schedules

Household members of immunocompromised patients should remain up-to-date with RSV vaccination when eligible 3.

Important Clinical Considerations

Common Pitfalls to Avoid

  1. Do not administer both maternal vaccine AND infant monoclonal antibody to most infants—this is not recommended and provides no additional benefit 1

  2. Maternal vaccination must be given ≥14 days before delivery to provide adequate protection to the infant 4, 5

  3. Infants born to mothers vaccinated <14 days before delivery should still receive monoclonal antibody 5

  4. High-risk infants should receive monoclonal antibodies regardless of maternal vaccination status 5—this includes:

    • Infants with chronic lung disease
    • Severe immunocompromise
    • Cystic fibrosis
    • Other conditions increasing RSV severity risk

Product Availability Considerations

The addition of clesrovimab addresses potential supply constraints experienced with nirsevimab during the 2023-2024 season. Providers should not delay protection waiting for a specific product—either monoclonal antibody is acceptable 1.

Coadministration

RSV vaccines can be coadministered with influenza and COVID-19 vaccines in adults 3. This simplifies vaccination visits during respiratory virus season.

What Hasn't Changed

The fundamental strategy established in 2023 remains: universal protection for all infants against RSV through either maternal vaccination or infant monoclonal antibody. The 2025 updates expand options and refine recommendations based on real-world effectiveness data rather than fundamentally altering the approach 1.

References

3
Research

IDSA 2025 Guidelines on the use of vaccines for the prevention of seasonal RSV infections in immunocompromised patients.

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.