RSV Vaccine Schedule and Administration for Infants and Young Children
Nirsevimab (Beyfortus) is recommended as a single intramuscular injection 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 entering their second RSV season. 1
Recommended Schedule
- Nirsevimab should be administered shortly before or during the RSV season, which typically runs from fall through spring in most of the continental United States (approximately October through March) 1
- Only a single dose of nirsevimab is recommended for an entire RSV season - unlike previous monoclonal antibody treatments that required monthly dosing 1, 2
- Nirsevimab may be administered to eligible infants and children who have not yet received a dose at any time during the RSV season 1
- For infants with prolonged birth hospitalizations related to prematurity or other causes, nirsevimab should be administered shortly before or promptly after hospital discharge 1
Eligible Populations
- First RSV Season: All infants aged <8 months who are born during or entering their first RSV season 1
- Second RSV Season: Infants and children aged 8–19 months who are at increased risk for severe RSV disease, including: 1, 2
- Children with chronic lung disease of prematurity requiring medical support
- Children with severe immunocompromise
- Children with cystic fibrosis with severe lung disease or poor growth
- American Indian or Alaska Native children
Administration Considerations
- Nirsevimab can be co-administered with routine childhood vaccines - simultaneous administration is recommended in accordance with general best practices for immunization 1, 2
- For preterm infants, the chronologic age (not corrected age) should be used to determine timing and eligibility for nirsevimab administration 1
- In regions with different RSV seasonality patterns (Alaska, southern Florida, Guam, Hawaii, Puerto Rico, U.S.-affiliated Pacific Islands, and U.S. Virgin Islands), providers should follow local guidance on timing of administration 1, 3
Effectiveness and Impact
- Nirsevimab has been shown to effectively prevent severe RSV disease, with recent data showing significant reductions in RSV-associated hospitalizations among infants 4
- The largest estimated rate reductions (45-52%) were observed among infants aged 0-2 months during peak RSV transmission periods (December-February) 4
- Nirsevimab represents a significant advancement over palivizumab, which was only recommended for a small subset (<5%) of high-risk infants 1, 5
Precautions and Contraindications
- Nirsevimab is contraindicated in persons with a history of severe allergic reaction (e.g., anaphylaxis) to a previous dose or to a product component 1, 2
- When administering nirsevimab to children with increased risk for bleeding, providers should follow general best practice guidelines for immunization 1
- Nirsevimab is not recommended for prevention of hospital-acquired RSV infection as no evidence is available to support this use 1
Alternative Protection Options
- For infants whose mothers received RSV vaccine during pregnancy (administered at 32-36 weeks' gestation), maternal antibodies provide protection, though this likely wanes after approximately 3 months 3
- Either maternal RSV vaccination or infant nirsevimab administration is recommended for most infants, but both are not typically needed 3
- Nirsevimab is recommended for all infants born at <34 weeks gestation, regardless of maternal vaccination status 3