Medical Advisory: Increasing Respiratory Syncytial Virus (RSV) Transmission and Prevention Programs

Background

Hamilton Public Health Services (HPHS) is notifying healthcare providers of increasing respiratory syncytial virus (RSV) transmission in Hamilton. Locally, RSV test positivity has increased over the past three weeks from 2.3% on Nov 9 to 3.3% on Nov 23.
Provincial data shows an increase in hospitalizations due to RSV infection. RSV is a respiratory virus that is a common cause of bronchiolitis and pneumonia. Infants, those who are immunocompromised and older adults are at the highest risk of severe illness from RSV. Up-to-date information on respiratory virus transmission in Hamilton can be found on the HPHS Respiratory Virus Transmission Dashboard.

RSV Immunization Recommendations for Infants and High-risk Young Children

HPHS recommends all eligible infants and high-risk young children be immunized with Beyfortus® (nirsevimab), a monoclonal antibody that provides immediate protection against severe RSV disease lasting up to six months. The immunization is publicly funded and available for residents of Ontario who meet one of the following criteria:

• Born in 2024 up to 12 months of age
• Born during the 2024/2025 RSV season (now until early Spring 2025)
• Children up to 24 months of age who remain vulnerable from severe RSV disease through their second RSV season with:
  • 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

Given the recent increase in RSV activity, now is the time to immunize eligible infants and high-risk children to prevent severe outcomes from RSV including hospitalizations for bronchiolitis. Infants and high-risk children can access Beyfortus® (nirsevimab) through the following care pathways:

• Those born during the 2024/2025 RSV season will be offered RSV immunization prior to discharge from hospital.
• Those born in 2024 before RSV season can access the immunization through a primary care provider or McMaster Children’s Hospital.
• Those with barriers to accessing Beyfortus® (nirsevimab), such as unattached patients, can call 905-546-2424 ext. 7556 for assistance navigating to where they may access RSV immunization.

RSV Immunization Recommendations for Pregnant People

Pregnant people who wish to receive an RSV vaccine instead of immunizing their infant with Beyfortus are eligible for Abrysvo (RSVpreF) between 32 and 36 weeks of gestation. The National Advisory Committee on Immunization recommends immunization of the infant with Beyfortus over vaccination of the pregnant parent with Abrysvo.

Pregnant people should speak to their healthcare provider regarding options to protect their infants from RSV after birth.

RSV Immunization Recommendations for Older Adults

Individuals aged 60 years and older in the following populations are eligible to receive publicly funded Abrysvo (RSVpreF) or Arexvy (RSVPreF3) RSV vaccines:

• Residents of long-term care homes, Elder Care Lodges, or retirement homes
• Patients in hospital receiving alternate level of care (ALC), includes similar settings (ex. Complex continuing care, hospital transitional programs)
• Patients receiving hemodialysis or peritoneal dialysis
• Recipients of solid organ or hematopoietic stem cell transplants
• Those who identify as First Nations, Inuit, or Métis
• Those experiencing homelessness

Eligible older adults can access RSV vaccination through their health care provider or their congregate care home. Congregate care homes with questions about making RSV vaccines available to their residents can call 905-546-2424 ext. 7556.

Ordering RSV Immunizations from Hamilton Public Health Services

Beyfortus® (nirsevimab) and Abrysvo (RSVpreF vaccine) are available to order from HPHS Services for all healthcare providers with an approved vaccine holding point. Please note that only Arexvy (RSVPreF3) is not currently available in Hamilton. To access the order form, visit: https://www.hamilton.ca/people-programs/public- health/health-care-professionals/vaccine-ordering-cold-chain-adverse-events.

Hamilton Public Health Services appreciates the support of local healthcare providers in providing their patients with effective protection from RSV this respiratory season.