Approach to prevention of respiratory syncytial virus disease in infants by passive immunization

Objective: To support family physicians in discussing respiratory syncytial virus (RSV) immunizations with patients.

Sources of information: Information was obtained through a literature review on the burden of RSV disease in infants; observational studies; randomized controlled trials; evidence presented by review agencies; product monographs; and National Advisory Committee on Immunization statements.

Main message: There are now 3 options available for preventing severe RSV disease in infants: the monoclonal antibody palivizumab, the long-acting monoclonal antibody nirsevimab, and the new RSVpreF vaccine administered during pregnancy. Only a small number of infants at high risk of severe RSV disease are eligible for palivizumab. Nirsevimab has received Health Canada authorization for all infants and RSVpreF has received authorization for all pregnant women and pregnant people. There are multiple considerations for the use of each product, including authorization; availability; timing of administration; health status and social determinants of health of the infant; efficacy and effectiveness; safety; patient preference; and cost. The National Advisory Committee on Immunization has recently issued guidance on the use of RSV immunization products for infants.

Conclusion: Family doctors should be aware of the indications, relative benefits, and recommendations for the 3 RSV immunization products to have informed discussions with patients, taking into account the preferences and circumstances of the pregnant woman or pregnant person or of the parent and infant.