RSV Immunization is administered much like vaccines. It should be administered through Intramuscular (IM) injection only and can be administered concomitantly with vaccines.
Routine Dosing
A single dose should be administered to all infants <8 months of age born during or entering their first RSV season (typically starting October 1 through March 31 in most of the continental US). For most babies whose mothers received RSVpreF at 32-36 weeks of pregnancy, where at least 14 days have elapsed between vaccine administration and birth, RSV immunization is not indicated. Please see the RSV Immunization Administration Visual Guide to guide your decision making about dosing.
In addition to mother’s vaccination status, eligibility is determined by age at the time of administration. Infants born during the RSV season should receive RSV immunization within 1 week of birth. This can be given either in the hospital before discharge or at the doctor’s office after discharge. Those with a prolonged hospital stay should get it shortly before or promptly after discharge. Safety data for use of RSV antibody in infants with a postmenstrual age (gestational age at birth plus chronologic age) of < 32 weeks or who weigh < 3.5 lb (<1.6 kg) are limited. Providers may consider administering RSV immunization to eligible hospitalized infants during their hospitalization, based on clinical judgment, considering the potential risks and benefits, as well as local RSV activity. For more information, see http://dx.doi.org/10.15585/mmwr.mm7432a3.
Providers, including regional medical centers and health systems, should consult with state or territorial health departments before systematically modifying the recommended months for RSV antibody administration for their eligible patient populations.
Dosing for Infants < 8 Months of Age
A single dose of clesrovimab or nirsevimab should be administered as follows:
- Infants weighing <5 kg: 50 mg dose of nirsevimab (purple plunger rod)
- Infants weighing ≥5 kg: 100 mg dose of nirsevimab (light blue plunger rod)
- Infants regardless of weight: 105 mg dose of clesrovimab (pink plunger rod)
Dosing for Children at High Risk During Second RSV Season
Children ages 8-19 months who remain vulnerable to severe RSV disease when entering their second RSV season should receive a single dose of 200 mg of nirsevimab, administered through 2 separate 100 mg IM injections.
This includes:
- Children with chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy or supplemental oxygen) any time during the 6-month period before the start of the second RSV season
- Children with severe immunocompromise
- Children with cystic fibrosis who have either manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) or have weight-for-length that is <10th percentile.
- American Indian and Alaska Native Children
- American Indian and Alaska Native Children are included in the high-risk category because they experience significantly higher rates of severe RSV disease and hospitalization, with children living in rural and reservation communities most impacted. Evidence supports that this increased risk is associated with social drivers of health.
Nirsevimab/Clesrovimab and Palivizumab
- Palivizumab is no longer routinely recommended for use by the AAP and it will be discontinued as of December 31, 2025. If palivizumab was administered in the 2024-25 respiratory virus season and the child is eligible for RSV prophylaxis in 2025-26, the child should receive nirsevimab in season 2.
Immunization Information Statement
It is recommended that an Immunization Information Statement be provided to families or caregivers when an infant or toddler receives nirsevimab. Consider offering this resource electronically, to review in-office, and/or to take home.
Reporting Adverse Events
Adverse events when giving nirsevimab alone should be reported to the FDA’s MedWatch Adverse Event Reporting Program.
If an adverse event occurs while co-administering RSV immunization with a vaccine, it should be reported to the Vaccine Adverse Event Reporting System.
Additional Information
In the rare event of product wastage (eg, family changed mind at last moment, syringe is dropped or damaged before administration, etc), it is recommended that you contact the Sanofi Customer Service at 800-VACCINE or via vaccineshoppe.com to discuss. Sanofi does not have a formal wastage policy in place for nirsevimab.
Contact the Merck Vaccine Customer Center at 877-VAX-MERCK or via the online contact form (must have a registered Merck account) for questions and concerns related to clesrovimab.
Last Updated
09/25/2025
Source
American Academy of Pediatrics