MEMO: 2024 – 2025 Respiratory Syncytial Virus (RSV) Prevention Programs in Ontario

TO: Health Care Professionals in Niagara Region

FROM: Vaccine Preventable Disease program, Niagara Region Public Health

REFERENCE: RSV Prevention Programs

DATE: September 19, 2024

The RSV season is generally from November to April. Ontario’s RSV prevention programs target the highest risk populations and settings.

Ontario’s Infant and High-risk Children RSV Prevention Program

During the 2022-23 respiratory season, Ontario saw 3,850 hospitalizations for RSV in children under two years old, with 538 cases requiring intensive care. To reach and protect more infants and children up to 24 months of age, the monoclonal antibody (mAb) Beyfortus® is recommended and publicly funded for infants entering or born during their first RSV season and high-risk children who remain vulnerable to severe RSV disease entering their second RSV season.

NACI recommends the administration of Beyfortus® over the vaccination of pregnant individuals using Abrysvo® vaccine (RSVpre-F) based on its efficacy, duration of protection, and safety profile
Beyfortus® should be offered if:
- The pregnant individual did not receive the RSV vaccine during pregnancy (32 to 36 weeks gestational age), or RSV vaccination status is unknown, or
- The infant was born within 14 days of the pregnant individual receiving RSV vaccine
If a pregnant individual has received Abrysvo®, the infant is only publicly funded for Beyfortus® if they are at high risk for RSV or born less than 14 days after Abrysvo® was administered. Infants who meet the medical criteria for increased risk from severe RSV disease include:
- Chronic lung disease (CLD), including bronchopulmonary dysplasia, requiring ongoing assisted ventilation, oxygen therapy or chronic medical therapy in the six months prior to the start of RSV season
- Hemodynamically significant congenital heart disease (CHD) requiring corrective surgery or are on cardiac medication for congestive heart failure or diagnosed with moderate to severe pulmonary hypertension
- Severe immunodeficiency
- Down syndrome/Trisomy 21
- Cystic fibrosis with respiratory involvement and/or growth delay
- Neuromuscular disease impairing clearing of respiratory secretions
- Severe congenital airway anomalies impairing the clearing of respiratory secretions
Beyfortus® and Abrysvo® will provide around 6 months of protection for infants. They do not provide long-term immunity to infants, but they help protect them when they are most at risk of getting severe RSV disease.
Abrysvo® may be given on the same day as tetanus, diphtheria, acellular pertussis, COVID-19, and influenza vaccines
Abrysvo® is the only RSV vaccine approved for pregnant individuals. Do not use Arexvy® (RSV vaccine for older high-risk adults) for pregnant individuals.
Follow routine vaccine storage and handling guidelines for Beyfortus®
Please note that Public Health anticipates receiving Beyfortus® mid to late October

Reporting Beyfortus® side effects post-administration

Beyfortus® is a mAb and not a vaccine. To report a side effect of Beyfortus®, see the Health Canada’s Side Effect Reporting Form. Suspected adverse events following administration of Beyfortus® are not reported to Public Health.

Ontario’s High-risk Older Adult RSV Prevention Program

Older adults, particularly those with existing comorbid conditions have an increased risk of RSV-related hospitalization and mortality. There are two publicly funded vaccine products, only available to eligible high-risk older adults: Arexvy® (adjuvanted recombinant protein subunit) and Abrysvo® (bivalent recombinant protein subunit).

Please note:

Individuals that received a dose of RSV vaccine during the 2023 - 2024 season are not eligible to receive another dose this season
Current evidence supports the use of a single dose of RSV vaccine. The timing for subsequent doses is unknown at this time. Studies are ongoing to determine the duration of protection.
As per the Ontario Ministry of Health guidance, RSV vaccine for high-risk older adults can be co-administered with COVID-19 and influenza vaccines as well as other recommended vaccines
- Public Health anticipates receiving COVID-19 and influenza vaccines in early fall, at which time these vaccines will be available to order
- RSV vaccine for high-risk older adults is currently available. You can order and administer RSV vaccination now if you wish.
- RSV vaccine for high-risk older adults may be administered concurrently with, or at any time before or after, other vaccines

Health care provider action

The administration of RSV products will occur through multiple settings to reach eligible populations effectively. Public Health anticipates receiving Beyfortus® mid to late October. Please monitor Ordering Vaccinations for an announcement indicating Beyfortus® is available to order.

Please educate your patients on their RSV protection options.

Primary care providers
- Use the Physicians and Primary Care Vaccine Order Form to order RSV products for the infant and high-risk prevention program.
  - Administer Beyfortus® to eligible infants and high-risk young children up to 24 months of age. Beyfortus® is the preferred product to protect infants.
  - Administer Abrysvo® to pregnant individuals (from 32 to 36 weeks gestational age) based on clinical judgment
Administer Arexvy® and Abrysvo® to eligible high risk older adults. These vaccines cannot be ordered to keep a stock in the fridge. Please order with the intent to administer.
- The High Risk Vaccine Order Form can be used to order RSV vaccine for high-risk older adults
Hospitals and pediatric specialists
- Administer Beyfortus® to newborns during the RSV season before discharge from hospital
- Administer Beyfortus® to infants up to 24 months of age who are at high risk for severe RSV disease during their second season
- Use the Physicians and Primary Care Vaccine Order Form to order RSV products for the infant and high-risk prevention program
Midwives
- Discuss Beyfortus® and Abrysvo® with pregnant individuals
- Based on clinical judgment, administer Abrysvo® to pregnant individuals (from 32 to 36 weeks gestational age)
- Order Abrysvo® using the Midwives Vaccine Order Form

For more information

Ontario’s Respiratory Syncytial Virus (RSV) Prevention Programs
For inquiries regarding the infant and high-risk children Respiratory Syncytial Virus (RSV) prevention program, please email: VacPro@ontario.ca
Call the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396
Visit Immunization, Vaccine for Health Professional