Are Native Americans considered high risk for Respiratory Syncytial Virus (RSV) and eligible for a second dose of nirsevimab (Monoclonal antibody against RSV)?

Native Americans Are Considered High Risk for RSV and Eligible for a Second Dose of Nirsevimab

Yes, American Indian or Alaska Native (AI/AN) children are explicitly considered high risk for severe RSV disease and are eligible for a second dose of nirsevimab when entering their second RSV season (at 8-19 months of age). 1

Evidence Supporting High-Risk Designation

• Research shows that some AI/AN children experience significantly higher rates of severe RSV disease, with RSV-associated hospitalization rates 4-10 times higher than similar-aged children across multiple US sites 1
• Historical data documented bronchiolitis hospitalization rates of 91.3-96.3/1000 infants in Navajo populations, similar to rates seen in other high-risk groups like preterm infants and those with chronic lung disease 1
• Alaska Native infants in southwestern Alaska experience higher RSV hospitalization rates and a longer RSV season compared to the general US population 1
• Some AI/AN communities live in remote regions, making transportation of children with severe RSV more challenging, which compounds the risk 1

Eligibility Criteria for Second Dose of Nirsevimab

The Advisory Committee on Immunization Practices (ACIP) specifically includes AI/AN children in their recommendations for nirsevimab administration during the second RSV season:

• AI/AN children aged 8-19 months entering their second RSV season are explicitly listed as eligible for nirsevimab 1
• This recommendation appears in the official ACIP guidance box listing high-risk groups eligible for nirsevimab in their second RSV season 1

Administration Considerations

• The timing of nirsevimab administration should align with the local RSV season 1
• For AI/AN children in Alaska, where RSV seasonality is less predictable and often longer than the national average, providers should consult state or local guidance on timing 1
• Nirsevimab can be administered simultaneously with other routine childhood vaccines, following general best practices for immunization 1

Clinical Impact and Rationale

• RSV infection in infancy is associated with increased risk of chronic respiratory conditions, including wheezing, lower respiratory infections, and chronic productive cough that may persist to 5-8 years of age 2
• Native American populations have historically experienced disproportionately high morbidity and mortality from various infectious diseases 3
• Replacing palivizumab with nirsevimab for eligible children entering their second RSV season is expected to be cost-saving while maintaining protection 1
• A single dose of nirsevimab has demonstrated efficacy in protecting infants from medically attended RSV lower respiratory tract infections (79.5% relative risk reduction) and associated hospitalizations (77.3% relative risk reduction) 4

Important Considerations

• Nirsevimab is contraindicated in persons with a history of severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a product component 1
• When administering nirsevimab to children with increased risk for bleeding, providers should follow ACIP's general best practice guidelines for immunization 1
• Adverse reactions should be reported to MedWatch, as FDA has classified nirsevimab as a drug 1