Table 2.

Recommendations for nirsevimab immunoprophylaxis

*The recommended interval between the last dose of palivizumab and a dose of nirsevimab (in high risk infants) is 1 month (similar to the interval if the infant were to receive another dose of palivizumab)[5]
&The recommendations for nirsevimab for high-risk children apply to infants and children recommended to receive palivizumab[1]
To realize the full benefits of mAbs before each season, it is recommended that age-eligible infants be recalled at the start of the RSV season before they become ineligible based on age if nirsevimab is available
Administering nirsevimab through the end of the season is important because the risk of severe disease is highest during the first few months of life[31]
#Maternal vaccination efficacy is not established in
Women with high-risk pregnancies such as multiple pregnancy, pregnancy-induced or chronic diseases, evidence of placental insufficiency, or fetus/newborn with major congenital anomaly
Infants who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation, leading to loss of maternal antibodies
Infants with a substantially increased risk for severe RSV disease (e.g., hemodynamically significant congenital heart disease, intensive care admission, and requiring oxygen at discharge)
Infant born within 14 days of administering the maternal RSV vaccine[46]
High-risk infants hospitalized or still in NICU during the season should get the recommended schedule. Also, eligible infants at the beginning of the season and ready for discharge from NICU should receive the first dose up to 72 hours before discharge[28]
The mAb included palivizumab and nirsevimab does not interfere with the immune response to live or inactivated vaccines. The childhood immunization schedule should be followed for all children, regardless of mAb use[30]
	Age	Needle length	Injection site
IM injection, use a 22–25-gauge needle[5]	Newborns (1st 28 days)	⅝”	Anterolateral thigh muscle
	Infants (1–12 months)	1”	Anterolateral thigh muscle
	Toddlers (1–2 years)	1–1¼”	Anterolateral thigh muscle
		⅝–1”	Deltoid muscle of arm

RSV=Respiratory syncytial virus, CLD=Chronic lung disease, IM=Intramuscular, mAbs=Monoclonal antibodies, NICU=Neonatal intensive care unit