What are the ACIP (Advisory Committee on Immunization Practices) recommendations for RSV (Respiratory Syncytial Virus) vaccine indications?

ACIP RSV Vaccine Indications

ACIP recommends nirsevimab for all infants aged <8 months who are born during or entering their first RSV season and for infants and children aged 8–19 months who are at increased risk for severe RSV disease and are entering their second RSV season. 1

Nirsevimab Recommendations for Infants

First RSV Season

• All infants aged <8 months who are born during or entering their first RSV season should receive nirsevimab 1
• Administered as a single intramuscular dose
• Timing: Shortly before or during RSV season (typically October through March in most of continental US)

Second RSV Season

Nirsevimab is recommended for infants and children aged 8–19 months who are at increased risk for severe RSV disease and entering their second RSV season, including:

• Children with chronic lung disease of prematurity requiring medical support within 6 months before the second RSV season
• Children with severe immunocompromise
• Children with cystic fibrosis with either:
  • Severe lung disease (previous hospitalization for pulmonary exacerbation in first year or persistent abnormalities on chest imaging)
  • Weight-for-length <10th percentile
• American Indian or Alaska Native children 1

Maternal RSV Vaccination Option

As an alternative to nirsevimab, ACIP recommends:

• RSVpreF vaccine (Abrysvo) for pregnant persons at 32 weeks 0 days–36 weeks 6 days gestation
• Administered during September–January in most of continental US
• Provides passive immunity to infants from birth 1, 2

Clinical Decision-Making Between Options

Either maternal RSVpreF vaccination or nirsevimab immunization is recommended to prevent RSV-associated lower respiratory tract infection, but both are not needed for most infants 1. Considerations include:

Maternal RSVpreF Advantages:

• Provides immediate protection from birth
• Generates polyclonal immune response potentially more resistant to mutations 2

Nirsevimab Advantages:

• Protection may last longer through the RSV season
• Can be given to all eligible infants regardless of maternal vaccination status
• Appropriate for infants born outside RSV season or <14 days after maternal vaccination 2

Administration Guidance

• Nirsevimab can be administered simultaneously with routine childhood vaccines
• Use chronologic (not corrected) age for preterm infants to determine timing and eligibility 1
• For pregnant persons, RSVpreF can be administered with other recommended vaccines (Tdap, influenza, COVID-19) without timing restrictions 1

Important Considerations

• RSV is the leading cause of hospitalization among US infants, with 50,000-80,000 RSV-associated hospitalizations and 100-300 deaths annually 1
• 79% of infants and children aged <2 years hospitalized with RSV have no underlying medical conditions 1
• Nirsevimab replaces palivizumab (which was only recommended for high-risk infants) and is expected to be cost-saving for eligible children entering their second RSV season 1

Contraindications and Precautions

• Nirsevimab is contraindicated in persons with history of severe allergic reaction to a previous dose or product component
• Follow ACIP's general best practice guidelines for immunization when administering to children with increased risk for bleeding 1

The introduction of nirsevimab and maternal RSV vaccination represents a significant advancement in preventing RSV-associated disease in infants, who previously had limited preventive options available.