Table 3.

Immunoprophylaxis technical considerations[5]

Type of mAbs	Action	Recommendation	Comments
All short and long-acting	Immunoprophylaxis to be included in the National program immunization enrolment	For all infants except high-risk infants	Immunoprophylaxis for high-risk infants should be administered in specialized clinics
	mAbs be co-administered with other routine vaccines	Yes. Simultaneous administration of mAb with age-appropriate vaccine is recommended	mAbs are not expected to interfere with the immune response, safety, and reactogenicity of other vaccines
	If an infant is diagnosed with an acute RSV illness, give a dose of mAbs to help reduce the severity of the illness	mAbs have not been studied as a treatment in infants with RSV and are not licensed for the treatment of RSV disease	mAbs should be given to recovering infants after 4 weeks from the onset of acute RSV illness
	High-risk infants who are hospitalized or still in NICU during the season	Should get the recommended schedule
	Eligible infants at the beginning of the season and ready for discharge from NICU	Should receive the first dose up to 72 h before discharge
Nirsevimab	The institution decided to start nirsevimab, and a high-risk infant already received palivizumab <5 doses	Should receive nirsevimab. No further Palivizumab is needed	The recommended interval between the last dose of palivizumab and a dose of nirsevimab (in high-risk infants) is no later than 1 month
	Splitting a 100 mg manufacturer-filled syringe into two 50 mg doses	No, nirsevimab 100 mg doses are approved for single use, it is a serious administration error	Manufacturer-filled syringes are  Prepared with a single dose and sealed under sterile conditions  Do not contain a preservative to help prevent the growth of microorganisms Intended for ONE patient for ONE injection  Never administer medications from the same  syringe to more than one patient, even if the needle is changed
	If a high-risk child mistakenly received a 100 mg dose of nirsevimab instead of the 200 mg dose	Another half-dose should be administered as soon as possible but no later than the end of the season. This counts as a 200 mg dose

mAbs=Monoclonal antibodies, RSV=Respiratory syncytial virus, NICU=Neonatal intensive care unit