News & Views — Implementing RSV Protection for Babies: Answering the Who? What? Where? When? Why? and How?
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Vaccine Update for Healthcare ProvidersPublished on
Vaccine Update for Healthcare ProvidersEditor’s note: This month’s article was co-authored by Drs. Lori Handy, Associate Director of the Vaccine Education Center, and Kathy Filograna, Regional Medical Director in the CHOP Primary Care Network. Drs. Filograna and Handy served on the working group for implementation of nirsevimab at Children’s Hospital of Philadelphia.
Have you implemented nirsevimab in your practice? Do you have questions about how to do so? While the science is clear that nirsevimab will reduce severe disease due to RSV in young infants, how to implement the recommendations from the Centers for Disease Control and Prevention (CDC) has been less clear, especially with the availability of a second tool that is recommended during pregnancy (Abrysvo™). So, this month, we thought it would be helpful to review key concepts and best practices for implementation to consider as we move into RSV season.
Nirsevimab is recommended for all infants younger than 8 months of age who are born during or entering their first RSV season and for infants and children between 8 and 19 months of age who are entering their second RSV season and at increased risk for severe disease. Other things to consider when determining whether an infant should get nirsevimab include:
Nirsevimab (Beyfortus™) is an RSV monoclonal antibody. One dose of nirsevimab can protect infants for five months, the length of an average RSV season.
When describing this product to parents and caregivers, do not commonly describe it as a vaccine or a treatment. It is not a vaccine because it does not cause the infant to generate their own immunity, and it is not a treatment because it is not treating an illness. You may consider referring to it as protection against RSV, a monoclonal antibody, or an immunization. The latter speaks to the use of passive immunity, meaning the recipient will have RSV-specific immunity, but it is not self-generated and, therefore, will not last long term. For more details about passive immunity, check the link in the resources section for the previous Vaccine Update article, “News & Views: Nirsevimab Means Brushing Up on Passive Immunity Talking Points.”
Any providers of the eligible patient population can administer nirsevimab, including birth hospitals, primary care practices, children’s hospitals and subspecialists. However, the logistics of obtaining a supply and getting reimbursed are complex, often leading to the quickest progress on implementation by primary care offices. If you are located in a setting other than a primary care office, these considerations may be helpful:
Administration will vary based on the seasonality of RSV in your area; however, for most providers, administration will begin in the fall and should continue through RSV season, which is typically about five months. Use local epidemiology, offered by your health department, for guidance. If you are in a setting where you see patients for well-child visits, you may determine that the best course for optimal coverage is through these regularly timed visits. However, if you do not see patients for this type of visit or you will not reach a significant portion of your patients, you may want to hold a nirsevimab clinic.
RSV impacts all newborns and young infants. One or two of every 100 children will be hospitalized with a lower respiratory tract infection caused by RSV in the first six months of life, and virtually all children are infected with RSV at least once by the time they are 24 months of age. We finally have an effective tool for protecting all infants from RSV. By giving babies antibodies that prevent RSV infection during the period when they are most susceptible, we can reduce the number who need to see a doctor, go to the emergency room, or be hospitalized with pneumonia or bronchiolitis caused by RSV.
While nirsevimab is not a vaccine, its administered like one. Most patients should receive a single intramuscular (IM) injection. Some patients in their second season will require two injections given at the same time. Nirsevimab can be given at the same time as all recommended vaccines. If the patient is getting two vaccines plus nirsevimab in the same leg, the doses should be separated by at least one inch, and you should ensure that your team has a consistent way to document the three doses in one limb. Likewise, in the same way that there is a Vaccine Information Statement (VIS) for vaccines, a patient information sheet for nirsevimab is also available (see “Resources” section at the end of this article). If you use an electronic health record (EHR), ensure that the nirsevimab dose can be recorded in your patients’ immunization records, so that central registries can still record receipt.
From the outset, many anticipated that there would be obstacles for implementation of nirsevimab. But we also know how hard it is to manage an influx of RSV-positive patients, so some upfront work to improve rates of receipt of nirsevimab will surely help your patients — and your team — in the long run. Because implementation challenges may disproportionately impact certain patient populations or geographic regions, we will all need to work together to quickly identify and resolve logistical barriers, so that all infants can be protected. Finally, make sure you and your team are comfortable with the science related to this new tool, so that you can communicate a clear, consistent and strong recommendation.
Contributed by: Charlotte A. Moser, MS, Paul A. Offit, MD
Categories: Vaccine Update October 2023, News and Views About Vaccines
Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.