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Severe RSV Infection Occurring at the End of Nirsevimab's Protection Window: A Case Report

Sebastiano Mazza1, Benedetta Ciccone1, Anna Maddalena D'Apolito1

  • 1Dipartimento Donna e Bambino, Azienda Ospedaliera Universitaria Foggia, Foggia, Apulia, Italy.

Case Reports in Pediatrics
|July 29, 2025
PubMed

Insights

A five-month-old infant developed severe respiratory syncytial virus (RSV) bronchiolitis despite nirsevimab prophylaxis. This case suggests potential waning immunity near the end of the 150-day protection window, emphasizing the need for ongoing surveillance.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Immunology

Background:

  • Respiratory Syncytial Virus (RSV) bronchiolitis is a significant cause of infant hospitalization.
  • Nirsevimab is a monoclonal antibody providing passive immunity against RSV.
  • Early-life immunization aims to protect vulnerable infants during their first RSV season.

Observation:

  • A late preterm infant received nirsevimab on day 3 of life.
  • 142 days later, the infant developed severe RSV-A bronchiolitis and human rhinovirus co-infection.
  • Hospitalization and high-flow nasal cannula support were required.

Findings:

  • The case occurred near the end of nirsevimab's 150-day protection period.
  • RSV-A and human rhinovirus co-infection were confirmed by PCR.
  • The infant recovered with supportive care.

Implications:

  • This case raises concerns about potential waning nirsevimab immunity in early-season immunized infants.
  • Human rhinovirus co-infection may exacerbate RSV disease severity.
  • Ongoing surveillance is crucial for optimizing nirsevimab immunization strategies in prolonged RSV seasons.

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