MEMO: RSV Immunization Updates and Eligibility Reminders

TO: Health Care Professionals in the Niagara Region

FROM: Vaccine Preventable Disease program, Niagara Region Public Health

REFERENCE: RSV Immunization Updates and Eligibility Reminders

DATE: October 21, 2024

This memo contains information on Beyfortus® eligibility and administration guidelines as well as eligibility reminders for Ontario’s High-risk Older Adult RSV Prevention Program. This is in response to questions Public Health is receiving and is in follow up to the RSV Prevention Programs memo shared on September 19.

Updates Regarding Beyfortus® Eligibility

Public Health has a limited supply of 100mg doses of Beyfortus®. We anticipate receiving additional doses of 100mg as well as doses of 50mg by the end of October. Please monitor Ordering Vaccinations for this information. Doses will be released as inventory is received from the Ontario Ministry of Health.

We are sharing the following information to assist with planning for the arrival of Beyfortus®.

Infants and children who meet any of the following criteria are eligible for 1 dose of Beyfortus® before or during the 2024/25 RSV season (typically November to April of each year with some season to season variation):

Born in 2024 prior to the 2024/2025 RSV season (up to 12 months of age), or
Born during the 2024/25 RSV season, or
Children over 12 months and up to 24 months of age who are high risk for severe RSV disease and experiencing their second RSV season
- These children are eligible for 1 dose of Beyfortus® during the 2024/25 RSV season regardless of whether they have received other RSV mAb products in past seasons
- Children born before April 1, 2023 are not eligible as this would be their third RSV season

Infant and High-risk Children RSV Prevention Program Rollout

Hospitals

Both Niagara Health and West Lincoln Memorial Hospital plan to offer Beyfortus® to eligible infants before discharge during the RSV season.

Primary care

Offer Beyfortus® to all eligible patients by:

Recommending vaccination during well-baby check-up visits at 2, 4 and 6 months
Proactively calling families with infants / high-risk children who may otherwise not be seen for routinely scheduled visits
All infants born in 2024 and up to 12 months of age
High-risk children over 12 months and up to 24 months of age

Plan ahead for the Beyfortus® doses you will need based the number of eligible patients you will see in a month, their age, and their weight. Initial orders of Beyfortus® will be limited to a few doses per office while Public Health awaits additional shipments. Please continue to place orders as needed using vaccines for primary care offices.

Catch-up clinics

Niagara Health will be offering catch-up immunization to eligible in-patient pediatrics. Niagara Health will not be offering any outpatient RSV clinics.
West Lincoln Memorial Hospital (WLMH) will be running catch-up clinics for infants beginning in late October. This includes infants who were not born at a Hamilton Health Sciences affiliated hospitals. McMaster Children’s Hospital will be sending a letter to over 3000 families in Hamilton and surrounding regions (including infants born to WLMH) to notify families about these clinics. Appointments can be booked by calling 905-945-2253 ext.11401.
Niagara Falls Community Health Centre has planned RSV immunization clinics starting at the end of October through their Care for Kids Program. This is for infants born in 2024 and eligible high-risk children who do not have a primary care provider.
Niagara Region Public Health (NRPH) will have limited appointments for infants without a primary care provider. NRPH will be doing targeted outreach to offer designated catch-up appointments in November.

If your practice plans to run RSV catch-up clinics to eligible infants and children without a primary care provider, please contact Public Health and we will feature this information in an upcoming Physicians’ Newsletter.

Beyfortus® vs. Abrysvo® Eligibility

Ontario’s publicly funded infant RSV prevention program includes Abrysvo®, but Beyfortus® is the recommended product to protect infants and young children from RSV. Using both is unnecessary except in certain circumstances.

If the patient received Abrysvo® during pregnancy, the infant is only eligible (and publicly funded) to receive Beyfortus® if one of the following criteria is met:

The infant was born premature (born prior to 37 weeks gestation), or
The infant was born less than 14 days after the patient received Abrysvo® during pregnancy, or
It is unknown when/if Abrysvo® was received during pregnancy, or
The infant is at high risk for severe RSV disease

Health care providers should discuss the use of Abrysvo® in cases where administration of Beyfortus® is not agreed to or available (e.g. not giving birth in Ontario).

Beyfortus® Administration Guidelines

Infants born during the current RSV season
- < 5 kg receive 50 mg in 0.5 mL (100 mg/mL), ideally administered at birth
- ≥ 5 kg receive 100 mg in 1 mL (100 mg/mL), ideally administered at birth
Infants born in 2024 before the current RSV season (up to 12 months of age)
- < 5 kg receive 50 mg in 0.5 mL (100 mg/mL), ideally administered before the start of the RSV season
- ≥ 5 kg receive 100 mg in 1 mL (100 mg/mL), ideally administered before the start of the RSV season
Children over 12 months and up to 24 months of age and at continued high-risk from RSV infection
- < 10 kg receive 200 mg (two 1 mL injections of 100 mg/mL), ideally administered before the start of their second RSV season
  - The health care provider can use their clinical discretion regarding administering a single dose of 100 mg, rather than 200 mg
- ≥ 10 kg receive 200 mg (two 1 mL injections of 100 mg/mL), ideally administered before the start of their second RSV season

Under no circumstances are the 100mg doses of Beyfortus® to be split into two 50mg doses. Beyfortus® can be given concurrently with both live and inactivated vaccines.

Eligibility Reminder for Ontario’s High-risk Older Adult RSV Prevention Program

Although the National Advisory Committee on Immunization (NACI) recommends RSV immunization programs for adults 75 years of age and older, Ontario’s publicly funded RSV prevention program targets specific high-risk individuals and settings. Use the High risk order form to order vaccine for these patients.

Health care providers who have patients 60 years of age and older that are not eligible to receive publicly funded RSV can provide these patients a prescription to purchase the vaccine privately.

More Information

Monitor Respiratory Syncytial Virus (RSV) prevention programs for updates from the Ontario Ministry of Health (Tip: at the bottom of page, look at the “updated” date).
A patient fact sheet for parents and expectant parents is available for download to learn how to protect their child against RSV
Visit Immunization, Vaccine for Health Professionals webpage
Email: VacPro@ontario.ca if you have questions for the Ministry of Health about Respiratory Syncytial Virus (RSV) prevention programs
For any other questions, call the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396