Immunizations for respiratory syncytial virus (RSV)
| Agent | Indications | Dosing | Adverse events | Estimated $ per dose |
|---|---|---|---|---|
| Monoclonal antibodies | ||||
| Palivizumab | First year of life: Infants born < 29 weeks’ gestation, or > 29 weeks with chronic lung disease, congenital heart disease, or other immunocompromising conditions Second year of life: Infants born < 32 weeks’ gestation who continue to need supplemental oxygen, chronic corticosteroids, or bronchodilator therapy, or those with immunocompromising conditions | 15 mg/kg monthly throughout RSV season | Minimal, low risk Fever, injection-site reactions including erythema, pain, or swelling, nervousness, and rhinitis | $2,100–$4,200 |
| Nirsevimab | Infants < 8 months old entering first season if: Mother did not receive RSV vaccine during pregnancy Mother’s RSV vaccination status is unknown Born within 14 days of the mother being vaccinated Infants 8–19 months old at increased risk of RSV,a entering second season | First RSV season (1 dose): < 5 kg: 50 mg ≥ 5 kg: 100 mg Second RSV season (1 dose): 200 mg | Minimal, low risk Fever, injection-site reactions including erythema, pain, or swelling, nervousness, and rhinitis | $519.75 |
| Vaccines | ||||
| RSVpreF | Adults 75 years of age and older Adults 60–74 years at increased risk of severe RSV diseaseb Pregnant women at 32 to 36 weeks’ gestationc | 0.5 mL (1 dose) | Fatigue, headache, injection-site pain, myalgia Rare inflammatory neurologic events | $295 |
| RSVPreF3 | Adults 75 years of age and older Adults 60–74 years at increased risk of severe RSV diseaseb | 0.5 mL (1 dose) | Fatigue, headache, injection-site pain, myalgia Rare inflammatory neurologic events | $280 |
| mRNA-1345 | Adults 75 years of age and older Adults 60–74 years at increased risk of severe RSV diseaseb | 0.5 mL (1 dose) | Fatigue, headache, injection-site pain, myalgia | Not yet available |
All doses are given intramuscularly. Prices are per Lexicomp, and CDC vaccine price list (https://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html).
↵aBorn premature with chronic lung disease, immunocompromising condition, or severe cystic fibrosis; American Indian or Alaskan native.
↵bThe CDC will publish considerations for chronic medical conditions and other risk factors for severe RSV disease for clinicians to use when implementing this risk-based recommendation.
↵cInfants whose mothers received maternal RSV vaccine during pregnancy are not recommended to receive nirsevimab, unless infant is born within 14 days of maternal vaccination, or the potential incremental benefit of administration is indicated based on clinical judgment.