What are the options for preventing severe RSV disease in infants?
To help protect infants and certain young children from severe RSV disease, the CDC recommends either maternal vaccination with Pfizer’s Abrysvo during weeks 32–36 of pregnancy or administration of a long-acting RSV antibody (nirsevimab or clesrovimab) to the infant after birth, or in October for those born prior to the start of RSV season. In addition, nirsevimab is advised for select high-risk children aged 8–19 months for second season protection.
When should maternal vaccination be given?
Weeks 32–36 of pregnancy, usually September–January. At this time the CDC does nt recommend another dose of RSV vaccine during subsequent pregnancies.
When should the infant RSV antibody be given?
In most of the U.S., infant RSV antibody is recommended between October and March. The best time to administer is just before the RSV season begins (typically October–November) or within the first week of life for infants born during October–March, ideally during the birth hospitalization.
Which infants should receive RSV monoclonal antibodies?
Infants <8 months old entering their first RSV season should receive RSV antibody unless mother received RSV vaccine at least 14 days (about 2 weeks)14 days (about 2 weeks) prior to the birth of the infant.
To prevent pertussis in young infants during the first few months of life, the CDC recommends all pregnant women to get a Tdap shot during the early part of the 3rd trimester of every pregnancy. All additional infant caregivers should be up to date with their pertussis vaccines. For patients exposed to someone with pertussis, post-exposure prophylaxis with antibiotics may be needed to prevent illness and transmission to others.
Which older children (8–19 months) need antibodies in their second RSV season?
Nirsevimab is recommended during their second RSV season for some children in high-risk groups: chronic lung disease of prematurity, severe immunocompromise, cystic fibrosis, American Indian/Alaska Native children.
Can both maternal vaccine and infant antibody be given?
Both are not usually needed. Consider both only if mother is immunocompromised, if there is poor antibody transfer, or if an infant is born <14 days after mother received RSV vaccine.
How long does protection last?
Maternal vaccine: ~6 months. Antibodies: one dose covers RSV season (~5 months+).
Timing during RSV season?
Most of U.S.: October–March. Adjust per local epidemiology in consultation with local health department.
What if maternal vaccination status is unknown?
If unverified, give infant antibody if eligible.
Co-administration with other vaccines?
Yes. Maternal vaccine and infant antibodies can be given with other vaccines no interval required.
Role of palivizumab?
Palivizumab is being phased out from the market. The manufacturer is discontinuing it in December 2025.
What systems are available to monitor respiratory trends in the U.S.?
Local health departments may maintain local/regional RSV surveillance data. The CDC maintains multiple systems to monitor and track seasonal trends, clinical risk factors, and rates of illness and hospitalization. Below highlight two of these systems:
- The RSV Hospitalization Surveillance Network (RSV-NET) is a population-based surveillance system for RSV-associated hospitalizations in the U.S. among children and adults.
- The National Respiratory and Enteric Virus Surveillance System (NREVSS) is a laboratory-based system that monitors seasons and circulation patterns of RSV and other viruses.
