Ask the Experts: Respiratory syncytial virus (RSV): RSV Preventive Antibody Recommendations for Infants

Results (8)

ACIP recommends one dose of nirsevimab (Beyfortus, Sanofi) preventive antibody for all infants less than 8 months and 0 days of age who are born during or entering their first RSV season.

ACIP also recommends one dose of nirsevimab for specific groups of infants and children age 8 through 19 months who are entering their second RSV season and at increased risk for severe RSV disease.

Children 8 through 19 months at high risk and ineligible for palivizumab:

  • American Indian or Alaskan Native children entering their second RSV season. This is especially important for those who are in remote regions or in communities known to have increased rates of severe RSV disease in children.

Children age 8 through 19 months at high risk and eligible for palivizumab (Synagis, AstraZeneca):

  • Children with chronic lung disease of prematurity who require medical support during the six months before the start of their second RSV season
  • Children who are severely immunocompromised
  • Children with evidence of severe cystic fibrosis (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) or that have weight-for-length that is less than the 10th percentile

If nirsevimab is given to a child eligible for palivizumab, do not give palivizumab. If nirsevimab is unavailable, CDC recommends that palivizumab (a short-acting RSV monoclonal antibody) should be administered per AAP recommendations (see https://doi.org/10.1542/peds.2023-061803). Because palivizumab is effective for 30 days, if nirsevimab becomes available during the RSV season, do not administer nirsevimab within 30 days of a dose of palivizumab. Do not give palivizumab during the season after administering nirsevimab.

The full ACIP recommendation is available at www.cdc.gov/mmwr/volumes/72/wr/pdfs/mm7234a4-H.pdf.

Last reviewed: January 22, 2024

Infants and children 8 months through 19 months of age who meet one or more of the criteria listed below are recommended to receive one dose of nirsevimab (200 mg, administered as two 100-mg MFS injections given at the same time at different injection sites) just before or during their second RSV season:

  • Children with chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before the start of the second RSV season
  • Children with severe immunocompromise
  • Children with cystic fibrosis who have either 1) manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable), or 2) weight-for-length less than the 10th percentile
  • American Indian or Alaska Native (AI/AN) children

Nirsevimab is particularly important for AI/AN children who live in remote regions, where access to medical care may be challenging, or in areas where there are known high rates of severe disease among older infants and toddlers.

Last reviewed: January 22, 2024

The optimal timing for nirsevimab to be administered is shortly before the RSV season begins; however, nirsevimab may be administered to eligible infants and children who have not yet received a dose at any time during the season.

Nirsevimab should be administered to infants less than 8 months old and infants and children 8 through 19 months old during the months of October through March in most areas in the United States, unless otherwise advised by public health authorities. Adjustment of timing due to RSV activity outside this typical timeframe is most likely to be necessary in more tropical climates and in Alaska.

Last reviewed: January 22, 2024

Some American Indian or Alaska Native (AI/AN) children experience higher rates of severe RSV disease than the general population. A recent study found that the incidence of hospitalization due to RSV among some AI/AN children in their second year of life was four to ten times higher than that of similar-aged children in multiple study sites in the United States. Also, some AI/AN communities live in remote regions, making transportation of children with severe RSV to obtain medical care more challenging. Although the available data are limited and may not apply to all AI/AN children in all settings, ACIP recommends nirsevimab for AI/AN children entering their second RSV season.

Last reviewed: January 22, 2024

Palivizumab (Synagis, AstraZeneca) is another injectable monoclonal antibody recommended by the American Academy of Pediatrics (AAP) for use in certain infants and children with underlying medical conditions that put them at high risk of severe RSV infection. It is not long-acting and must be administered once monthly, up to 5 doses, through the RSV season. The cost of palivizumab is much higher than the cost of nirsevimab. Nirsevimab should be used for children eligible for either product.

Once a single dose of nirsevimab is given for the season, palivizumab is not needed for that season. In circumstances where nirsevimab is unavailable, a high-risk infant or toddler who is also eligible for palivizumab should receive palivizumab. If palivizumab is administered initially during a season and nirsevimab becomes available before 5 monthly doses of palivizumab have been given, discontinue palivizumab and administer one dose of nirsevimab (at least a month after the most recent dose of palivizumab).

AAP recommendations for use of palivizumab and nirsevimab are found at: https://publications.aap.org/redbook/resources/25379 and https://publications.aap.org/pediatrics/article/152/1/e2023061803/192153/Palivizumab-Prophylaxis-in-Infants-and-Young.

Last reviewed: January 22, 2024

If you are unable to obtain prenatal records or verify receipt of maternal RSV vaccine, CDC recommends that the baby receive nirsevimab, particularly if it is shortly before or during the RSV season. Don’t forget to check the state immunization information system (IIS) for the mother’s vaccination record. It is also important to attempt to verify from the birthing facility records whether this baby received nirsevimab prior to discharge to avoid giving a second dose.

Last reviewed: January 22, 2024

Yes. Infants born less than 14 days after the mother received RSV vaccine should receive nirsevimab. Infants born within 14 days after maternal vaccination may not have had sufficient time in utero to receive adequate protection from maternal RSV antibodies produced after vaccination. Infants born 14 days or more after maternal vaccination are not recommended to receive nirsevimab.

Last reviewed: January 22, 2024

In rare circumstances, nirsevimab may be considered for infants in their first RSV season who were born to RSV-vaccinated mothers. These situations may include:

  • infants born to mothers who have health conditions that might prevent an adequate maternal immune response to vaccination (an immunocompromising condition caused by disease or immunosuppressive treatment)
  • infants whose mothers have conditions associated with reduced transplacental antibody transfer (such as a mother living with HIV infection)
  • infants who might have lost maternal antibodies, such as those who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation (ECMO)
  • infants with substantially increased risk for severe RSV disease (such as hemodynamically significant congenital heart disease or intensive care admission requiring oxygen at hospital discharge).

Infants and children age 8–19 months who are at increased risk for severe RSV disease and are entering their second RSV season are recommended to receive nirsevimab regardless of history of maternal vaccination.

Last reviewed: January 22, 2024

This page was updated on .

Our Affiliated Sites

For the Public: VaccineInformation.org
For Coalitions: ImmunizationCoalitions.org
65+ Flu Defense
Protect vulnerable, older adult patients from influenza.
Give2MenACWY.org
Improve protection from meningococcal serogroups ACWY.
Mass Vaccination Resources
Access guidance documents, toolkits, and helpful resources.
NAIIS
Home of the National Adult and Influenza Immunization Summit.