Nirsevimab should be administered in the first week of life to infants born shortly before and during the RSV season, according to updated recommendations by the Advisory Committee on Immunization Practices (ACIP) that were reported in Pediatrics.
The same update also recommended:
- pediatric use of the 20-valent pneumococcal conjugate vaccine (PCV20), which was approved for use in children in April 2023; and
- that all children at least 6 months of age with egg allergy should receive influenza vaccine.
The ACIP update reflected recommendations regarding RSV vaccines, influenza vaccines, pneumococcal vaccines, meningococcal vaccines, and COVID-19 vaccines discussed at meetings held June 21 to 23, 2023, as well as recommendations regarding nirsevimab made following a special meeting held on August 3, 2023.
“Major updates for pediatric clinicians include a new recommendation for the monoclonal antibody nirsevimab for prevention of RSV disease in all infants, recommendations regarding use of 20-valent pneumococcal conjugate vaccine (PCV20), and discussion of potential forthcoming changes to meningococcal and COVID-19 vaccination recommendations,” the article authors reported.
The ACIP voted unanimously to recommend use of nirsevimab for RSV as indicated in its US Food and Drug Administration (FDA) package insert on August 3, 2023, as well as unanimously for inclusion of nirsevimab in the Vaccines for Children (VFC) program. Nirsevimab is administered as 1 injection that lasts for at least 5 months, and according to the FDA label, children who have received nirsevimab should not receive palivizumab for the same RSV season.
After extensive discussion about which risk groups to include in the recommendation for nirsevimab in the second year of life, the ACIP agreed on the American Academy of Pediatrics’ current recommendations for use of palivizumab in the second season.
Clinicians are now advised by the ACIP to administer nirsevimab in the first week of life for infants born shortly before and during the RSV season; administration can be during the birth hospitalization or in the outpatient setting. Among infants aged less than 8 months, nirsevimab should be administered shortly before the first RSV season. In children aged 8 to 19 months at increased risk for severe RSV disease, it should be administered shortly before the beginning of their second RSV season. In most of the continental US, nirsevimab could be administered from October through the end of March based on prepandemic patterns.
The cost of nirsevimab, which is classified as a drug/therapeutic, is likely to be a potential implementation barrier, especially in ambulatory practices, the update authors noted.
The ACIP update also recommended use of the 20-valent pneumococcal conjugate vaccine (PCV20), which was approved for use in children in April 2023. The recommendations included the use of PCV20 in children aged 2 to 23 months per the current routine PCV dosing and schedule and for catch-up dosing in children with an incomplete PCV vaccination status, including healthy children aged 24 to 59 months and those with high-risk conditions aged 24 to 71 months.
For influenza vaccination, the ACIP continues to recommend vaccination of all persons at least 6 months of age who do not have contraindications. Recommendations on the timing of vaccination are unchanged from 2022 to 2023.
However, the recommendation was expanded to include children with egg allergy: the ACIP unanimously agreed that “All persons aged ≥6 months with egg allergy should receive influenza vaccine. Any influenza vaccine (egg based or non-egg based) that is otherwise appropriate for the recipient’s age and health status can be used.”
The update also discussed results of a Vaccine Safety Datalink study, which showed no association between number of vaccines in young children and risk for emergency department visits or inpatient admission for infection. “[T]here is no evidence that the current vaccine schedule ‘overwhelms’ the immune system,” said the update authors.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
This article originally appeared on Pulmonology Advisor
O’Leary ST, Yonts AB, Gaviria-Agudelo C, Kimberlin DW, Paulsen GC. Summer 2023 ACIP update: RSV prevention and updated recommendations on other vaccines. Pediatrics. Published online August 29, 2023. doi:10.1542/peds.2023-063955