Sort Out RSV Immunization Options for Inpatients

Hospitals are preparing for another cold and flu season involving respiratory syncytial virus (RSV).

RSV leads to common cold symptoms (fever, sneezing, coughing, etc).

But infants and older adults can have severe breathing complications that can require ICU care.

If your hospital provides inpatient RSV immunizations, differentiate product options and prevent errors to help protect patients.

Newborns and infants can get immunized using nirsevimab or clesrovimab monoclonal antibodies in their first RSV season.

Babies should ideally get a single dose during the first week after delivery if they’re born in October through March...depending on mom’s RSV vaccine status.

Don’t expect to commonly see palivizumab orders anymore for RSV immunization in kids...it’s being discontinued before 2026.

Unvaccinated pregnant patients should get Abrysvo between 32 and 36 weeks of pregnancy...between September and January...to pass on RSV antibodies to their newborn.

Alert your pharmacist if you see Arexvy and mResvia orders for pregnant patients...they are NOT approved in pregnancy.

Unvaccinated older adults should be immunized if they are 75 years and up...or 50 to 74 years with risk factors (COPD, diabetes, etc).

Know that these patients can get any of the adult RSV vaccines...Abrysvo, Arexvy, or mResvia...in late summer or early fall.

Highlight product differences to avoid storage and handling errors.

For example, point out that Abrysvo, Arexvy, clesrovimab, and nirsevimab are refrigerated...but only Abrysvo and Arexvy require reconstitution. And mResvia is frozen and does NOT need reconstitution.

Check your formulary and pharmacy policies before stocking any RSV vaccines or monoclonal antibodies on patient units.

For example, your hospital may allow clesrovimab or nirsevimab to be loaded in the NICU or nursery, since babies need a dose soon after birth.

On the other hand, Abrysvo generally doesn’t need to be stored in obstetric areas. Moms need to get their dose at least 14 days BEFORE delivery...but they are usually in labor when they are admitted.

Be aware that most patients can only get 1 lifetime RSV vaccine dose for now. Help your pharmacist check immunization records...including mothers’ records for newborns...to ensure patients don’t get extra doses.

Use our Preventing RSV chart to answer other common questions about RSV risk factors, who should be immunized, and more.

• Chart: Preventing RSV
• Chart: RSV Monoclonal Antibodies
• Chart: RSV Vaccines