What are the indications for Respiratory Syncytial Virus (RSV) vaccine?

From the Guidelines

Respiratory syncytial virus (RSV) vaccines are primarily indicated for adults aged 60 years and older, pregnant women between 32-36 weeks gestation, and infants and young children, particularly those with chronic cardiovascular disease, chronic lung or respiratory disease, and other high-risk conditions, as outlined in the updated recommendations of the Advisory Committee on Immunization Practices - United States, 2024 1. The indications for RSV vaccine are based on the risk of severe RSV disease, which can cause significant morbidity and mortality in vulnerable populations.

• Adults aged 60 years and older, especially those with chronic conditions such as heart disease, lung disease, and diabetes, are at increased risk for severe RSV disease and should receive a single dose of an FDA-approved RSV vaccine, such as Arexvy (GSK) or Abrysvo (Pfizer) 1.
• Pregnant women between 32-36 weeks gestation should receive a single dose of Abrysvo to provide passive immunity to infants during their first 6 months of life 1.
• Infants and young children, particularly those with high-risk conditions such as premature birth, congenital heart disease, and chronic lung disease, should receive nirsevimab (Beyfortus) as a single dose of 50mg for infants under 5kg or 100mg for those over 5kg, providing protection for about 5 months 1. The updated recommendations emphasize the importance of vaccinating adults aged 75 years and older, as well as adults aged 60-74 years with increased risk for severe RSV disease, to maximize RSV vaccination coverage and reduce hospitalizations and serious complications 1. Key factors for severe RSV disease include chronic cardiovascular disease, chronic lung or respiratory disease, end-stage renal disease, diabetes mellitus, neurologic or neuromuscular conditions, and moderate or severe immune compromise, among others 1. Healthcare providers should use their clinical judgment to determine which patients are at increased risk for severe RSV disease and recommend vaccination accordingly, taking into account local epidemiology and community incidence of RSV-associated hospitalization 1.

From the FDA Drug Label

Synagis is indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients: with a history of premature birth (less than or equal to 35 weeks gestational age) and who are 6 months of age or younger at the beginning of RSV season, with bronchopulmonary dysplasia (BPD) that required medical treatment within the previous 6 months and who are 24 months of age or younger at the beginning of RSV season, with hemodynamically significant congenital heart disease (CHD) and who are 24 months of age or younger at the beginning of RSV season

The indications for Respiratory Syncytial Virus (RSV) vaccine, specifically Palivizumab, are for the prevention of serious lower respiratory tract disease caused by RSV in pediatric patients with:

• Premature birth (less than or equal to 35 weeks gestational age) and 6 months of age or younger at the beginning of RSV season
• Bronchopulmonary dysplasia (BPD) that required medical treatment within the previous 6 months and 24 months of age or younger at the beginning of RSV season
• Hemodynamically significant congenital heart disease (CHD) and 24 months of age or younger at the beginning of RSV season 2 2

From the Research

Indications for Respiratory Syncytial Virus (RSV) Vaccine

The indications for RSV vaccine, or more specifically, RSV immunoprophylaxis, are as follows:

• High-risk infants, including those with chronic lung disease (formerly called bronchopulmonary dysplasia) and certain preterm infants 3, 4, 5, 6
• Infants and young children with hemodynamically significant congenital heart disease 3, 4, 5, 7
• Preterm infants with a history of preterm birth and chronic lung disease who are most likely to benefit from immunoprophylaxis 3
• Children younger than 24 months with chronic lung disease 3
• Infants born after 32 to 35 weeks' gestation with 2 or more risk factors 3

High-Risk Groups

High-risk groups that may benefit from RSV immunoprophylaxis include:

• Preterm infants with or without bronchopulmonary dysplasia (BPD) 4
• Infants with cyanotic congenital heart disease (CHD), although RSV-IGIV is not recommended for this group 4
• Children with hemodynamically significant congenital heart disease 3, 4, 5, 7

Recommended Prophylaxis

The recommended prophylaxis for RSV infection includes:

• Palivizumab, a humanized RSV monoclonal antibody, which is preferred for most high-risk infants and children due to its ease of intramuscular administration 3, 4, 5, 6, 7
• Monthly administration of palivizumab during the RSV season, which results in a 45% to 55% decrease in the rate of hospitalization attributable to RSV 3