Who should receive Respiratory Syncytial Virus (RSV) immunizations?

From the Guidelines

RSV immunizations are recommended for several specific groups, including infants and young children under 8 months of age who should receive nirsevimab (Beyfortus), a long-acting monoclonal antibody given as a single intramuscular injection before or during RSV season, as stated in the most recent guidelines 1.

Eligibility Criteria

The following groups are eligible for RSV immunizations:

• Infants and young children under 8 months of age who should receive nirsevimab (Beyfortus) 1
• Pregnant women between 32-36 weeks gestation who should receive the RSV vaccine (Abrysvo) to protect their newborns through maternal antibody transfer
• Adults aged 60 and older who should consider receiving either available RSV vaccine (Arexvy or Abrysvo) after discussing with their healthcare provider, particularly if they have underlying conditions
• Children with certain medical conditions like prematurity, chronic lung disease, congenital heart disease, or immunocompromised status who may need additional protection with palivizumab (Synagis), given monthly during RSV season 1

Special Considerations

• Infants with prolonged birth hospitalizations related to prematurity or other causes should receive nirsevimab shortly before or promptly after hospital discharge 1
• Providers can adjust administration schedules based on local epidemiology, and RSV seasonality in tropical climates or Alaska may differ from that of most of the continental United States 1
• Children with hemodynamically significant cyanotic or acyanotic CHD may benefit from palivizumab prophylaxis, and decisions regarding prophylaxis with palivizumab in children with CHD should be made on the basis of the degree of physiologic cardiovascular compromise 1

From the FDA Drug Label

SYNAGIS is a prescription medication that is used to help prevent a serious lung disease caused by Respiratory Syncytial Virus (RSV) in children: born prematurely (at or before 35 weeks) and who are 6 months of age or less at the beginning of RSV season, who have a chronic lung condition called bronchopulmonary dysplasia (BPD), that needed medical treatment within the last 6 months, and who are 24 months of age or less at the beginning of RSV season, born with certain types of heart disease and who are 24 months of age or less at the beginning of RSV season.

The following pediatric patients should receive Respiratory Syncytial Virus (RSV) immunizations with Synagis:

• Premature infants: born at or before 35 weeks gestational age and 6 months of age or less at the beginning of RSV season
• Children with bronchopulmonary dysplasia (BPD): who required medical treatment within the previous 6 months and are 24 months of age or less at the beginning of RSV season
• Children with hemodynamically significant congenital heart disease (CHD): and who are 24 months of age or less at the beginning of RSV season 2

From the Research

Eligibility for RSV Immunizations

The following groups are eligible for Respiratory Syncytial Virus (RSV) immunizations:

• Infants and young children with hemodynamically significant congenital heart disease, for whom palivizumab is appropriate 3, 4
• Children younger than 24 months with chronic lung disease (formerly called bronchopulmonary dysplasia) 3, 4
• Certain preterm infants, particularly those with a history of preterm birth and 2 or more risk factors 3, 4
• Infants who were 32 to 35 weeks of gestation at birth, for whom palivizumab has been shown to provide benefit 5

High-Risk Groups

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

• Prematurely born infants without chronic lung disease 5
• Infants with chronic lung disease (CLD), formerly designated bronchopulmonary dysplasia 5
• Children with congenital heart disease, although RSV-IGIV should not be used in children with hemodynamically significant heart disease 3, 4

Administration and Effectiveness

• Palivizumab is preferred for most high-risk infants and children because of ease of intramuscular administration 3, 4, 5
• Monthly administration of palivizumab during the RSV season results in a 45% to 55% decrease in the rate of hospitalization attributable to RSV 3, 4
• RSV-IGIV provides additional protection against other respiratory viral illnesses and may be preferred for selected high-risk children, including those receiving replacement intravenous immune globulin because of underlying immune deficiency or human immunodeficiency virus infection 5