respiratory syncytial virus vaccination

INFORMATION FOR PATIENTS

UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient education" and the keyword[s] of interest.)

●Beyond the Basics topic (see "Patient education: Bronchiolitis and RSV in infants and children (Beyond the Basics)")

SUMMARY AND RECOMMENDATIONS

●General measures – General measures to prevent RSV infection include hand washing, practicing cough hygiene, avoidance of tobacco and other smoke, and restricting participation in childcare during RSV season for high-risk infants (if possible). (See 'General measures' above.)

●Infection control in the health care setting – Measures for the prevention of health care-associated RSV infections include handwashing and appropriate use of gloves, masks, gowns, and eye protection for health care workers, isolation of patients in private rooms or in rooms with other RSV-infected patients (cohorting patients), and cohorting health care personnel. (See 'Infection control in the health care setting' above.)

●Immunoprophylaxis – Nirsevimab is a monoclonal antibody that targets the prefusion conformation of the RSV F glycoprotein. It has a long half-life and potent neutralizing activity. A dose of nirsevimab is expected to provide protection for at least five months such that only one dose is needed at the beginning of the RSV season. Nirsevimab should be used in place of palivizumab unless nirsevimab is not available (algorithm 1 and algorithm 2 and table 1). (See 'Immunoprophylaxis' above.)

•For all infants younger than eight months who are born during the RSV season or are entering their first RSV season, we recommend one dose of nirsevimab prophylaxis rather than no prophylaxis (Grade 1B), unless the birthing parent received RSV vaccination at least 14 days prior to birth. (See 'Infants <8 months' above.)

•Healthy infants less than eight months old should only receive a dose of nirsevimab upon entering their second RSV season if they did not receive nirsevimab during their first RSV season. (See 'All infants <8 months' above.)

•For infants and children who are 8 through 19 months of age with increased risk for severe RSV, we suggest a second dose of nirsevimab upon entry into their second RSV season (Grade 2C). (See 'Infants 8 through 19 months at increased risk for severe disease' above.)

•Limited supplies of nirsevimab may require prioritization of available supply.

•If nirsevimab is not available, palivizumab should be provided to patients for whom it has been previously recommended (table 2). (See 'Nirsevimab not available' above.)

●Nirsevimab dose and schedule

•Infant's first RSV season

-Weight <5 kg – One 50 mg intramuscular (IM) dose

-Weight ≥5 kg – One 100 mg IM dose

•Child's second RSV season

-One 200 mg IM dose

Nirsevimab is administered shortly before the RSV season begins (infants younger than 8 months and those 8 through 19 months at increased risk for severe RSV disease) or within one week of birth for a newborn infant delivered shortly before or during the RSV season.

●Nirsevimab not available (palivizumab prophylaxis) – Palivizumab, another monoclonal antibody that targets both the prefusion and postfusion conformation of the RSV F glycoprotein, was the only available immunoprophylaxis for severe RSV disease prior to the development of nirsevimab. Unlike nirsevimab, palivizumab requires monthly IM injections throughout the RSV season.

The eligibility criteria for palivizumab differ from those of nirsevimab and are outlined in the table (table 2). (See 'Nirsevimab not available' above.)

•Palivizumab dose and schedule

-15 mg/kg IM once per month (maximum of five doses)

-First dose administered shortly after birth or just before RSV season begins

-Interval between doses should not exceed 35 days

-Prophylaxis should be discontinued if infant hospitalized for breakthrough RSV infection

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REFERENCES

1. American Academy o