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Respiratory Syncytial Virus (RSV): Information for Providers

Immunization Update

There are three new immunization products that protect against RSV in older adults, infants and young children.

Older adults: People ages 60 years and older may receive one dose of one of two new RSV vaccines: Arexvy and Abrysvo. Administration should be based on shared clinical decision-making.

Infants: There are two new products available for preventing RSV illness in infants:

  • Vaccine (Abrysvo) administered to pregnant people, or
  • Monoclonal antibodies (nirsevimab) administered to infants less than 8 months of age

In most cases, only one option is necessary to confer immunity to the infant and there is no preference for one over the other.

Young children: Monoclonal antibodies are recommended for children 8 to 19 months old who are at increased risk of severe RSV and entering their second RSV season.

Read more on RSV prevention.

Epidemiologic Information

Nationally, there has already been an increase in RSV activity across some parts of the United States. Historically, such regional increases have predicted the beginning of RSV season.

See CDC’s data on RSV National Trends and RSV State Trends.

For the latest NYC-level data on RSV, flu, and other respiratory viruses, see the NYC Weekly Influenza Surveillance Reports. For past data, see EpiQuery.


Testing

With multiple co-circulating respiratory viruses, diagnostic testing for influenza, COVID-19, and other respiratory viruses can help guide treatment and clinical management. Consider diagnostic testing for patients with suspected respiratory virus infections, particularly hospitalized patients, those with factors placing persons at high risk for severe outcomes from RSV, flu and COVID-19, and those with severe or progressive illness.

Several laboratory tests are available for confirming RSV infection, including:

  • Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), which is more sensitive than culture and antigen testing
  • Antigen testing, which is highly sensitive in infants and young children but not sensitive in older children and adults

Less commonly used tests include:

  • Viral culture
  • Serology, which is usually only used for research and surveillance studies

Providers should consult experienced laboratorians for more information on interpretation of results.


Treatment

Most cases of RSV will resolve without treatment. For supportive care, inform patients and parents to:

  • Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give aspirin to children.)
  • Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration.

Prevention

There are several options that protect against RSV in infants, young children and older adults, including three new immunization products.

Older Adults

There are two RSV vaccines for adults 60 years of age and older:

  • RSVPreF (Abrysvo™, manufactured by Pfizer)
  • RSVPreF3 (Arexvy, manufactured by GSK)

Per CDC recommendations, people 60 years of age and older may receive a single dose of RSV vaccine, using shared clinical decision-making.

Infants and Young Children

There are two main options to prevent RSV in infants:

  • Vaccination of the pregnant parent during pregnancy (Abrysvo), or
  • The monoclonal antibody product, nirsevimab (Beyfortus, manufactured by Sanofi and Astra-Zeneca), administered to the infant

There is no preference between the two options. When there have been at least 14 days between vaccine administration and birth — thus allowing enough transplacental antibody transfer — there is no recommendation to use both products, except in very limited circumstances, such as when there is concern that the pregnant parent did not mount an adequate immune response (for example, people living with HIV infection).

Health care providers of pregnant people should provide information on both options and consider patient preferences when determining whether to vaccinate the pregnant patient or rely on the administration of nirsevimab to the infant after birth. Nirsevimab should be administered to the infant if the vaccination status of the birthing parent is unknown.

Vaccine During Pregnancy

CDC recommends the new Abrysvo vaccine for pregnant people to prevent RSV in infants. The vaccine should be administered at 32 to 36 weeks of gestation and between September and January, in accordance with RSV seasonality in NYC.

Monoclonal Antibody Products

CDC recommends a new monoclonal antibody product, nirsevimab, to protect infants and young children against RSV. Although nirsevimab is not a vaccine, it provides passive immunity.

Administration of nirsevimab shortly before the start of the RSV season is recommended for infants less than 8 months of age and for children ages 8 to 19 months who are at increased risk of severe RSV. RSV season in NYC is defined as October through the end of March. Providers should target administration in the first week of life for infants born shortly before or during RSV season.

Another monoclonal antibody, palivizumab (Synagis), may still be given to high-risk infants and young children with certain underlying medical conditions who have not or cannot receive nirsevimab. Palivizumab is given in monthly intramuscular injections during the RSV season.


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