Who Should Receive Nirsevimab?
If an infant has been diagnosed with RSV this season, should they still receive nirsevimab?
Nirsevimab recommendations are the same regardless of prior RSV infection or RSV-associated hospitalization.
Should I administer nirsevimab to an infant who is born at the very end of the RSV season?
Yes. Optimal timing for administration is within 1 week after birth during the RSV season. Administering nirsevimab through the end of the season is important because the risk of severe disease is highest during the first few months of life.
If an infant’s mother has received maternal RSV vaccine, should the infant receive nirsevimab?
Maternal RSV vaccine was approved by the FDA on August 21, 2023. The CDC does not recommend nirsevimab for most infants born to a mother who received maternal RSV vaccine, except for infants where less than 14 days have elapsed between vaccination and birth.
Nirsevimab can be considered for infants born to a mother who received maternal RSV vaccine when, per the clinical judgement of the healthcare provider, the potential incremental benefit of administration is warranted, including but not limited to the following rare circumstances:
Infants born to pregnant people who may not mount an adequate immune response to vaccination or have conditions associated with reduced transplacental antibody transfer
Infants who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation leading to loss of maternal antibodies
Infants with substantial increased risk for severe RSV disease (eg, hemodynamically significant congenital heart disease, intensive care admission and requiring oxygen at discharge)
I have a healthy patient who was 7 months old in October. They present to the clinic in November, at 8 months of age. Can they receive nirsevimab at this visit?
No. CDC recommends that only those healthy infants younger than 8 months of age at the time of administration receive nirsevimab. In situations of limited availability of nirsevimab, CDC currently recommends prioritizing infants aged < 6 months.
Can a baby who is 9 months old but corrects to 6.5 months due to prematurity (delivery at 29 weeks gestational age) receive nirsevimab?
In accordance with CDC General Best Practice Guidelines for Immunization preterm infants (infants born before 37 weeks’ gestation), regardless of birth weight, should receive nirsevimab at their chronological age using the same guidance for full-term infants and young children.
Will infants born during the RSV season receive nirsevimab before they are discharged from the hospital?
It is recommended that infants born shortly before and during the RSV season receive nirsevimab within the first week of life, including in hospital settings. Infants with prolonged birth hospitalizations because of prematurity or other causes should receive nirsevimab shortly before or promptly after discharge. During the 23-24 RSV season, if a hospital has been unable to implement administration of nirsevimab, the infant should receive nirsevimab in an ambulatory setting as soon as available. Currently, few hospitals participate in the VFC program, and additional advocacy to support hospital participation is ongoing. Timely and well-coordinated communication between birth hospital and the medical home is important. Equitable access to nirsevimab will require those in a community to work together.
Which children should receive a dose of nirsevimab in their second RSV season?
In the context of limited supply of nirsevimab during the 2023-2024 season, CDC recommends suspending use of nirsevimab in palivizumab-eligible children aged 8-19 months, except for American Indian and Alaska Native children aged 8–19 months who are not palivizumab-eligible and who live in remote regions, where transporting children with severe RSV for escalation of medical care may be challenging, or in communities with known high rates of severe RSV among older infants and toddlers.
If a patient was born towards the end of March and did not receive nirsevimab, can they receive nirsevimab in October?
Yes. Per AAP’s guidance, healthy infants born at the end of their first RSV season who did NOT receive nirsevimab and are <8 months of age entering their second RSV season may receive one dose of nirsevimab. In the context of limited supply during the 2023-2024 RSV season, CDC recommends prioritizing available nirsevimab 100mg doses for infants at the highest risk for severe RSV disease: young infants (age <6 months) and infants with underlying conditions that place them at highest risk for severe RSV disease.
Why are infants 8-12 months old ineligible to receive nirsevimab (unless they are considered high-risk)?
The highest risk for severe RSV is in children under 6 months of age. Infants 8 months and older will be entering their second RSV season and have likely already experienced their first RSV infection and will not receive the full benefits of nirsevimab.
Should American Indian and Alaska Native infants and young children from birth – 19 months of age receive palivizumab if nirsevimab is unavailable?
If nirsevimab is unavailable, only those high-risk American Indian and Alaska Native infants and young children who meet current criteria for palivizumab should receive it. American Indian or Alaska Native heritage is not an indication for first or second season palivizumab.
What is the guidance for high risk infants who are 19-24 months of age, particularly given nirsevimab has been FDA approved for infants and toddlers 24 months of age and younger who are at high risk for severe RSV illness?
A dose of nirsevimab is recommended for some children aged 8 through 19 months who are at increased risk for severe RSV and who are entering their second RSV season (note this is inclusive of 19 months). Nirsevimab provides at least 5 months of protection and should be offered to eligible children when entering the RSV season.
Nirsevimab is not recommended for any child who is age 20 months and older. Children ages 20 months and older have likely already experienced two RSV seasons and been infected with RSV, and thus are less likely to benefit from nirsevimab.