Vaccine Blurbs Special Edition Issue 215: RSV Update


Washington State Department of Health | January 23, 2024

Updated Guidance for Healthcare Providers on Increased Supply of Nirsevimab

On October 23, 2023, the Centers for Disease Control and Prevention (CDC) issued Health Alert Network (HAN) Health Advisory 499 to provide guidance for prioritization of nirsevimab given limited supply. Nirsevimab (Beyfortus, Sanofi and AstraZeneca) is a long-acting monoclonal antibody immunization recommended for preventing RSV-associated lower respiratory tract disease in young children. Given the recent increase in nirsevimab supply and the manufacturers’ plan to release an additional 230,000 doses in January, CDC advises healthcare providers to return to recommendations put forward by CDC and the Advisory Committee on Immunization Practices (ACIP) on use of nirsevimab in young children. Infants and children recommended to receive nirsevimab should be immunized as quickly as possible. Healthcare providers should not reserve nirsevimab doses for infants born later in the season when RSV circulation and risk for exposure to RSV may be lower. RSV activity remains elevated nationwide and is continuing to increase in many parts of the country, though decreased activity has been observed in the Southeast.

Recommendations for Healthcare Providers

  1. In the setting of increasing supply, healthcare providers should administer a single dose of nirsevimab to all infants aged less than 8 months, as well as children aged 8 through 19 months at increased risk.
    1. Healthcare providers should continue to work with their state immunization program and the manufacturer to order available nirsevimab doses. CDC is working closely with jurisdictional partners to ensure adequate supply through the Vaccines for Children Program. 
    2. Neither RSV vaccine (Pfizer Abrysvo, GSK Arexvy) is approved for use in infants or young children. Healthcare providers should take care to use the correct product for the correct population.
    3. Although supply of nirsevimab is expected to increase, available supply may continue to vary locally and by healthcare facility. For healthcare providers who continue to have limited supply, nirsevimab should be prioritized to protect infants at the highest risk for severe RSV disease using the following principles: first by high-risk conditions and then by age, prioritizing the youngest infants first.   
  2. Pregnant people 32 through 36 weeks gestation should receive RSV vaccination through January.
    1. Pfizer Abrysvo is the only RSV vaccine recommended for use in pregnant people. GSK Arexvy is not recommended for use in pregnant people.
  3. Administration of both nirsevimab and RSV vaccination for pregnant people is not needed to protect most infants. 

Abrysvo Recommended for Pregnant Persons from September through January

The Advisory Committee on Immunization Practices (ACIP) recommends Abrysvo RSV vaccine for pregnant persons during September–January in most of the continental United States, which includes Washington State. In jurisdictions with RSV seasonality that differs from most of the continental United States, including Alaska, southern Florida, Guam, Hawaii, Puerto Rico, U.S.-affiliated Pacific Islands, and U.S. Virgin Islands, providers should follow state, local, or territorial guidance on timing of maternal RSVpreF vaccination.

The Childhood Vaccine Program will follow the ACIP recommendations and will no longer offer Abrysvo for pregnant teens after January 31, 2024.

During a call on January 17, CDC recommends that Abrysvo can be considered valid if given inadvertently to a pregnant person after January 31. Coverage may vary by private insurer or insurance plan if Abrysvo is given after January 31.

ACIP RSV Summary

The rationale for the recommendations includes:

  • Based on year-to-year seasonality, the most effective strategy is to designate September-January as the recommended months for RSV vaccination of pregnant persons.
  • The purpose of administering Abrysvo during these months is to offer protection to infants in their first months of life, when protection from maternal vaccination is at its highest during the RSV season.
  • Administering Abrysvo starting in September (1–2 months before the anticipated start of the RSV season) and continuing through January (2–3 months before the anticipated end of the RSV season) will maximize cost-effectiveness and benefits.
  • After January 31, in most of the continental US, infants will be born when RSV activity is expected to be lower, and there is less benefit relative to the cost of the vaccine.
  • Nirsevimab is still recommended for infants born between Feb-March.

RSV and Nirsevimab Administration Errors

Powerful tools have been available to protect newborns against severe disease this RSV season. Nirsevimab has provided invaluable protection for infants. In addition, Abrysvo between 32-36 weeks of pregnancy provides protection from severe RSV disease for the infant. It is important to be aware of vaccination errors that came about with bringing both of these products to the market at the same time. During a call with CDC on January 17, 2024, the following vaccination errors and steps to take to address these errors were discussed:

RSV administration errors table

Health care providers are encouraged to report these administration errors to VAERS even if there is no adverse health event related to the error. Inform the recipient of the error and determine how the error occurred and implement strategies to prevent it from happening again.

More information can be found here:

RSV and Nirsevimab Recommendations Webinar

RSV and Nirsevimab Recommendations Webinar 12:00 - 1:00 PM PT Thursday, February 1, 2024 Register here

The Washington State Department of Health will be hosting a RSV and Nirsevimab Recommendations Webinar on Thursday, February 1, from 12:00 - 1:00pm.

Presenters Dr. Killelea of Seattle Children's Hospital, and Dr. Frank Bell of Swedish Health, will:

  • Provide an overview of RSV.
  • Cover nirsevimab recommendations.
  • Share nirsevimab supply and ordering updates.
  • Discuss ways to talk with families about nirsevimab.

Continuing education will be available for nurses and medical assistants. The Department of Health will record the webinar and make it available after the live event. This webinar is designed for health care providers, local public health department staff, health educators, school staff, and anyone else interested in this topic.

We hope you will be able to join us!