pediatrics
Respiratory Syncytial Virus (RSV) and Human Metapneumovirus Infections
Prevention of RSV and hMPV
Contact precautions (eg, hand washing, gloves, isolation) are important, particularly in hospitals. Two monoclonal antibodies used for RSV prophylaxis in infants and young children are available in the United States.Nirsevimabis preferred but may not be available to some infants because of supply limitations; if it is not available, eligible high-risk infants and children should receivepalivizumab. (See the Centers for Disease Control and Prevention's [CDC]interim recommendations regarding nirsevimab use amid supply limitations.)Nirsevimabis not needed for most infants if RSV vaccination (Respiratory Syncytial Virus Vaccine) was given in pregnancy. a long-acting monoclonal antibody, is recommended for the prevention of RSV in the following infants and young children ( Prevention references , All infants<8 months of age who are either born during or who are entering their first RSV season Children 8 months through 19 months of age who are at increased risk of severe RSV disease and who are entering their second RSV season Healthy newborns (ie, those who have no increased risk of severe RSV) should receive no more than 1 dose ofnirsevimab. Typically, this dose is given during an infant’s first RSV season. Those born at the end of their first RSV season should receive thisnirsevimabdose during their second RSV seasononlyif they are still<8 months of age and didnotreceivenirsevimabduring their first RSV season. Only children who meet high-risk criteria should receive more than 1 dose ofnirsevimab(1 dose in their first RSV season and 1 dose in their second RSV season). (See the CDC’sinterim recommendations regarding nirsevimab use amid supply limitations.) Children who receivenirsevimabshouldnotreceivepalivizumabin the same RSV season. High-risk children 8 to 19 months of age include the following: Children with chronic lung disease of prematurity who required medical support any time during the 6-month period before the start of the second RSV season Children who are severely immunocompromised Children with cystic fibrosis who have severe lung disease or whose weight-for-length is less than the 10th percentile Children who are American Indian or Alaska Native For eligible children,nirsevimabshould be given shortly before the RSV season (typically from October through the end of March in most of the continental United States). For infants who did not receive a dose at the start of the season, a dose may be given at any time during the season. Nirsevimabmay be given before the newborn leaves the hospital and simultaneously with other childhood vaccines. also a monoclonal antibody, decreases the frequency of hospitalization for RSV in high-risk infants ( Prevention references , Palivizumabis cost-effective only for infants at high risk of hospitalization, including those with the following characteristics: Born at<29 weeks gestation and are<1 year old at the start of RSV season <1 year old with chronic lung disease of prematurity (gestational age < 32 weeks and 0 days with the need for oxygen therapy for at least 28 days after birth) Chronic lung disease of prematurity in the second year of life and have received within 6 months of RSV season treatment with chronic corticosteroids or diuretics or have had a continued need for oxygen therapy <1 year old with hemodynamically significant congenital heart disease Prophylaxis withpalivizumabmay also be considered for Infants<1 year old who have anatomic pulmonary abnormalities or neuromuscular disorders that impair the ability to effectively clear the upper airways Children < 24 months old who have profound immunocompromise The first dose ofpalivizumabis given just before the usual onset of the RSV season. Subsequent doses are given at 1-month intervals for the duration of the RSV season (usually a total of 5 doses). Additional doses may be recommended during a prolonged RSV season or significant interseason RSV activity. (See also the American Academy of Pediatrics' reaffirmed2014 updated guidance for palivizumab prophylaxis for infants and young children who are at increased risk of hospitalization for RSV.) Infants who were initially givenpalivizumabshould be given a single dose ofnirsevimabif it is available before completion of the 5-dosepalivizumabseries. ) for the prevention of lower respiratory tract disease caused by RSV in people ≥ 60 years of age ( Prevention references , Several other maternal, pediatric, and adult RSV vaccines are in development in clinical trials. 1.Hammitt LL, Dagan R, Yuan Y, et al:Nirsevimabfor Prevention of RSV in Healthy Late-Preterm and Term Infants.N Engl J Med386(9):837-846, 2022. doi: 10.1056/NEJMoa2110275 2.Griffin MP, Yuan Y, Takas T, et al: Single-DoseNirsevimabfor Prevention of RSV in Preterm Infants.N Engl J Med383(5):415-425, 2020. doi: 10.1056/NEJMoa1913556 3.Simões EAF, Madhi SA, Muller WJ, et al: Efficacy ofnirsevimabagainst respiratory syncytial virus lower respiratory tract infections in preterm and term infants, and pharmacokinetic extrapolation to infants with congenital heart disease and chronic lung disease: A pooled analysis of randomised controlled trials.Lancet Child Adolesc Health7(3):180-189, 2023. doi: 10.1016/S2352-4642(22)00321-2 4.Garegnani L, Styrmisdóttir L, Roson Rodriguez P, et al:Palivizumabfor preventing severe respiratory syncytial virus (RSV) infection in children.Cochrane Database Syst Rev11(11):CD013757, 2021. doi: 10.1002/14651858.CD013757.pub2 5.The IMpact-RSV Study Group:Palivizumab, a humanized respiratory syncytial virus monoclonal antibody, reduces hospitalization from respiratory syncytial virus infection in high-risk infants.Pediatrics102(3):531–537, 1998. 6.Melgar M, Britton A, Roper LE, et al: Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023.MMWR Morb Mortal Wkly Rep72:793–801, 2023. doi: 10.15585/mmwr.mm7229a4 7.Papi A, Ison MG, Langley JM, et al: Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults.N Engl J Med388(7):595-608, 2023. doi: 10.1056/NEJMoa2209604 8.Walsh EE, Pérez Marc G, Zareba AM, et al: Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults.N Engl J Med388(16):1465-1477, 2023. doi: 10.1056/NEJMoa2213836 9.Kampmann B, Madhi SA, Munjal I, et al: Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants.N Engl J Med388(16):1451-1464, 2023. doi: 10.1056/NEJMoa2216480 10.American College of Obstetricians and Gynecologists (ACOG): Practice Advisory: Maternal Respiratory Syncytial Virus Vaccination. Accessed November 27, 2023. 