RSV Advisory for Healthcare Providers

RSV Increasing in Southeast United States and New RSV Prevention Tools

Posted Sept. 8, 2023. Past health advisories and alerts are archived for historical purposes and are not maintained or updated.

The Centers for Disease Control and Prevention (CDC) wants to notify clinicians and caregivers about increases in respiratory syncytial virus (RSV) activity across some parts of the Southeastern United States in recent weeks, suggesting a continued shift toward seasonal RSV trends observed prior to the COVID-19 pandemic. Historically, such regional increases have predicted the beginning of RSV season nationally, with increased RSV activity spreading north and west over the following 2–3 months. RSV can cause severe disease in infants, young children, and older adults.

In anticipation of the onset of the 2023-2024 RSV season, CDC encourages clinicians to prepare to implement new RSV prevention options.

  • Monoclonal antibody products, including a new, long-acting product, nirsevimab (Beyfortus™, Sanofi and AstraZeneca), are available to protect infants and some young children at higher risk for severe RSV disease. For all infants ages <8 months, and infants and children ages 8–19 months who are at increased risk of severe RSV, clinicians should start to offer nirsevimab when it becomes available (expected by early October).
  • Also, two new vaccines are available to protect older adults from severe RSV disease.
    • For adults ages 60 years and older, clinicians should offer a single dose of an RSV vaccine, either RSVPreF3 (Arexvy, GSK) or RSVpreF (Abrysvo™, Pfizer), based on shared clinical decision-making between the healthcare provider and the patient. Clinicians should also talk to their patients about other vaccines available this fall to help prevent respiratory infections.
    • Clinicians should consider testing symptomatic patients with high-risk conditions for COVID-19, influenza, and RSV to inform treatment decisions.
    • Healthcare personnel, childcare providers, and staff at long-term care facilities should stay home and not go to work when they have fever or symptoms of respiratory infection to reduce the spread of respiratory infections including RSV.

Background

RSV is an RNA virus, and transmission occurs primarily via respiratory droplets when a person coughs or sneezes, or through direct contact with a contaminated surface. Infants, young children, and older adults, especially those with chronic medical conditions, are at increased risk of severe disease from RSV infection. CDC estimates that every year RSV causes approximately 58,000 - 80,000 hospitalizations and 100 - 300 deaths in children ages <5 years, as well as 60,000 - 160,000 hospitalizations and 6,000 - 10,000 deaths among adults ages 65 years and older.

Recommendations for Clinicians

A clinician’s recommendation is one of the most important factors in whether patients choose to accept a prevention product or vaccine. These new prevention tools can prevent severe RSV disease:

  • Monoclonal antibodies for infants and young children: Clinicians should start to offer nirsevimab when it becomes available (expected by early October) for all infants ages <8 months, and for infants and for children ages 8–19 months who are at increased risk for severe RSV disease (see specific recommendations below).
    CDC recommends nirsevimab for the following groups:
  • All infants ages <8 months born during or entering their first RSV season should receive 1 dose of nirsevimab.
    • Infants born shortly before or during the RSV season should receive nirsevimab within their first week of life.
    • Infants not born shortly before or during this RSV season should receive nirsevimab shortly before the start of their first RSV season or as early as feasible during the season.
  • Infants and children ages 8–19 months who are at increased risk for severe RSV disease, such as those who are severely immunocompromised, should receive 1 dose of nirsevimab shortly before entering or during their second RSV season.

Dosage of nirsevimab:

  • All infants ages <8 months:
    • 50 mg dose administered as a single injection for infants weighing <5 kg [<11 lb]
    • 100 mg dose administered as a single injection for infants weighing ≥5 kg [≥ 11 lb]
  • Infants and children ages 8–19 months who are at increased risk for severe RSV disease:
    • 200 mg dose administered as two 100 mg injections

Another prevention product, palivizumab (Synagis®, SobiTM), is available for children <24 months of age with certain conditions that place them at increased risk for severe RSV disease. Where nirsevimab is not available during this RSV season, the American Academy of Pediatrics (AAP) recommends that eligible infants and older babies should continue to receive palivizumab until nirsevimab becomes available.

  • RSV vaccines for older adults: CDC recommends that adults ages 60 years and older may receive a single dose of RSV vaccine (either product) using shared clinical decision-making to prevent RSV-associated lower respiratory tract disease. Clinicians should discuss RSV vaccination with adults ages 60 years and older. Vaccination should be prioritized in adults ages 60 years and older who are most likely to benefit, including those with certain chronic medical conditions associated with increased risk of severe RSV disease, such as heart disease (e.g., heart failure, coronary artery disease), lung disease (e.g., chronic obstructive pulmonary disease [COPD], asthma), and immunocompromising conditions. Adults with advanced age and those living in nursing homes or other long-term care facilities are also at increased risk of severe RSV disease and may benefit from RSV vaccination.
  • Healthcare providers should also talk to their patients about other vaccines (e.g., COVID-19, influenza) available this fall to help prevent respiratory illness.
  • Healthcare providers can co-administer the vaccines for which a patient is eligible in the same visit, including RSV, COVID-19, and influenza vaccines. When deciding whether to co-administer other vaccines with RSV vaccine at the same visit, providers can consider whether the patient is up to date with currently recommended vaccines, the feasibility of their returning for additional vaccine doses, their risk of acquiring vaccine-preventable disease, the vaccine reactogenicity profiles, and patient preferences.
  • Clinicians should consider testing patients with symptoms of acute respiratory illness and high risk conditions for respiratory pathogens to inform patient management. Although treatment for RSV is supportive, diagnostic testing can help identify patients who might benefit from medications to treat other respiratory pathogens, such as COVID-19 and influenza. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) is the preferred method for testing for respiratory viruses.
  • Healthcare personnel, childcare providers, and staff of long-term care facilities should stay home and not go to work when they have fever or symptoms of respiratory infection.

Recommendations for the Public

  1. Expectant parents, parents of infants under the age of 8 months, and parents with older babies (through age 19 months) at increased risk of severe RSV disease should talk with their healthcare providers about using monoclonal (preventive) antibodies to protect against RSV this season. Infants under the age of 8 months should receive preventive antibodies to protect against RSV this season.
  2. Adults ages 60 years and older should talk to their healthcare provider about whether RSV vaccination is appropriate for them.
  3. Stay home and away from others when you are sick. If you are at increased risk of severe illness, contact your healthcare provider to see if you would benefit from early diagnostic testing. Treatments for influenza and COVID-19 are available that, if given within days of symptoms starting, can reduce your risk of hospitalization and death.

For More Information