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On September 22, 2023, the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP) recommended respiratory syncytial virus (RSV) vaccine for pregnant persons as a one-time dose at 32 through 36 weeks’ gestation using seasonal administration (meaning September through January in most of the continental United States) to prevent RSV-associated lower respiratory tract infection (LRTI) in infants aged less than 6 months.
On October 6, 2023, the CDC published Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus–Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023 in Morbidity and Mortality Weekly Report (MMWR).
The Pfizer bivalent RSVpreF vaccine (Abrysvo™), which is the same formulation and dose approved for use in adults 60 years and older, is recommended and approved as a single 0.5mL dose administered intramuscularly to pregnant persons who are 32 through 36 weeks’ gestation.
- Vaccine should be administered to pregnant persons September through January in most of the continental United States
- Vaccine can be administered with other recommended vaccines, such as tetanus, diphtheria, and pertussis (Tdap), influenza, and COVID-19 vaccines, without regard to timing, including simultaneous vaccination at different anatomic sites on the same day
- Additional data are needed to determine whether additional seasonal doses during subsequent pregnancies are indicated
Updated Clinical Guidance for Use of Nirsevimab (Infant Monoclonal Antibody) and Abrysvo (Maternal RSVpreF Vaccine):
- Either maternal RSVpreF vaccination (Abrysvo) during pregnancy at 32 through 36 weeks’ gestation OR nirsevimab immunization for infants aged less than 8 months who are born during or are entering their first RSV season is recommended to prevent RSV in infants, but administration of both products is not needed for most infants
- Providers who care for pregnant persons should discuss the advantages and disadvantages of both maternal RSVpreF vaccination (Abrysvo) and nirsevimab and consider patient preferences when determining whether to vaccinate the pregnant person or to rely on administration of nirsevimab to the infant. A list of advantages and disadvantages is outlined in the MMWR.
- Mothers of most infants born outside of RSV season (i.e., during April–September) will not have been vaccinated; therefore, nirsevimab is recommended for these infants at the onset of the RSV season if they are less than 8 months old
- At least 14 days are likely needed after maternal vaccination for development and transplacental transfer of maternal antibodies to protect the infant
- Nirsevimab is recommended for infants born less than 14 days after maternal RSVpreF vaccination (Abrysvo)
- Nirsevimab is recommended for infants aged less than 8 months born during or entering their first RSV season:
- Whose mother did not receive RSVpreF vaccine (Abrysvo)
- Whose mother’s receipt of RSVpreF vaccine (Abrysvo) is unknown OR
- Who were born less than 14 days after maternal vaccination
- Nirsevimab may be considered for infants born to vaccinated mothers in rare circumstances when, based on the clinical judgement of the health care provider, the potential incremental benefit of administration is warranted. These situations include but are not limited to:
- Infants born to mothers who might not have mounted an adequate immune response to vaccination (e.g., persons with immunocompromising conditions) or who have conditions associated with reduced transplacental antibody transfer (e.g., persons living with HIV infection)
- Infants who might have experienced loss of maternal antibodies such as those who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation
- Infants with substantially increased risk for severe RSV disease (e.g., hemodynamically significant congenital heart disease, or intensive care admission requiring oxygen at hospital discharge)
- Infants and children aged 8 through 19 months who are at increased risk for severe RSV disease and are entering their second RSV season are recommended to receive nirsevimab regardless of maternal RSVpreF vaccination (Abrysvo)
Additional RSV Vaccine Administration Resources for Pregnant Persons:
Healthcare Providers: RSV Vaccination for Pregnant People | CDC
Package Insert - ABRYSVO(fda.gov)
Thank you for all you do!
Oakland County Health Division, Immunization Action Plan
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