Practical Application of Nirsevimab Recommendations for Infants and Toddlers

Respiratory syncytial virus (RSV) is a common respiratory tract infection that causes bronchiolitis and pneumonia in infants and children. It is the leading cause of hospitalization of infants in the United States. Nirsevimab is a long-acting monoclonal antibody recommended for the prevention of severe disease in all infants under 8 months of age and certain high-risk toddlers. Recent data demonstrate a 90% protection against hospitalization from severe RSV disease for infants who received nirsevimab in their first RSV season. Providers should understand the mechanism of action, safety, efficacy, and prescribing recommendations for nirsevimab, especially when confronted with caregivers who are hesitant about medications and vaccines. Special circumstances may require nuanced prescribing of nirsevimab to safely provide optimal protection. In these circumstances, and during drug shortages, a lens of health equity should be used to protect the highest risk populations.