From the Guidelines
The RSV vaccine is recommended for adults aged 60 and older, pregnant women between 32-36 weeks gestation, and infants and high-risk children, with specific dosing and timing guidelines to prevent severe RSV disease and reduce hospitalization risk. For adults 60+, a single dose of either Arexvy or Abrysvo is recommended, especially before RSV season (typically fall through spring) 1. For pregnant women, a single dose of Abrysvo between 32-36 weeks gestation is advised to protect newborns through maternal antibody transfer 1. For infants, nirsevimab (Beyfortus) is recommended as a single dose during or before their first RSV season, with dosing based on weight (50mg for infants under 5kg, 100mg for those over 5kg) 1. High-risk infants, including those born prematurely or with certain heart or lung conditions, should receive priority protection. These vaccines work by stimulating the immune system to produce antibodies against RSV's F protein, which the virus uses to enter cells. Key considerations for vaccination timing include administering the vaccine between September and November, and it can be co-administered with the influenza vaccine 1. Protection is particularly important because RSV can cause severe respiratory illness, especially in vulnerable populations, and these preventive measures significantly reduce hospitalization risk. Some countries have specific recommendations for RSV vaccination in adults, including prioritizing those aged ≥75 years and those with risk factors such as chronic obstructive pulmonary disease, asthma, heart failure, and immunocompromise 1. Overall, the RSV vaccine is a crucial tool in preventing severe RSV disease and reducing hospitalization risk in vulnerable populations.
Key Recommendations
- Adults 60+: single dose of Arexvy or Abrysvo before RSV season
- Pregnant women: single dose of Abrysvo between 32-36 weeks gestation
- Infants: nirsevimab (Beyfortus) as a single dose during or before their first RSV season, with dosing based on weight
- High-risk infants: priority protection with nirsevimab (Beyfortus)
- Vaccination timing: between September and November, can be co-administered with influenza vaccine
Vulnerable Populations
- Adults aged 60 and older
- Pregnant women
- Infants and high-risk children
- Those with chronic obstructive pulmonary disease, asthma, heart failure, and immunocompromise
- Residents of nursing homes and other long-term care facilities
From the FDA Drug Label
5.4 Treatment of RSV Disease 8.4 Pediatric Use The FDA drug label does not answer the question.
From the Research
Recommendations for RSV Vaccine
The recommendations for the Respiratory Syncytial Virus (RSV) vaccine are based on several studies that have evaluated the effectiveness of palivizumab, a monoclonal antibody, in preventing severe RSV disease in high-risk infants.
- The American Academy of Pediatrics recommends the use of palivizumab for infants with chronic lung disease (CLD) or prematurely born infants without CLD 2.
- Palivizumab has been shown to reduce the risk of hospitalization due to RSV infection by 55% in high-risk pediatric patients 2, 3.
- 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 4.
- A systematic review of randomized controlled trials found that palivizumab reduces hospitalization due to RSV infection, results in little to no difference in mortality or adverse events, and may result in a large reduction in RSV infections 5.
High-Risk Groups
Certain groups of infants are at higher risk of severe RSV disease and may benefit from palivizumab prophylaxis, including:
- Prematurely born infants without chronic lung disease (CLD) 2, 3
- Infants with CLD, formerly designated bronchopulmonary dysplasia 2
- Infants with congenital heart disease, although palivizumab is not recommended for children with cyanotic congenital heart disease 2
Recent Developments
Recent studies have evaluated the effectiveness of new RSV prevention products, including maternal RSV vaccine and nirsevimab, a long-acting monoclonal antibody for infants aged 0-7 months and children aged 8-19 months 6.
- These products have been shown to reduce RSV-associated hospitalization rates among infants and young children, with estimated relative rate reductions of 43% and 28% compared to previous seasons 6.