Provider Guidance for the Prevention of Respiratory Syncytial Virus in Infants: Maternal Vaccination Versus Infant Monoclonal Antibody Treatment

ABSTRACT Importance In 2023, the Food and Drug Administration approved 2 new products to reduce the risk of lower respiratory infections caused by respiratory syncytial virus (RSV) in infants: Beyfortus (nirsevimab; AstraZeneca/Sanofi), a single-dose monoclonal antibody for infant administration, and Abrysvo (bivalent RSVpreF vaccine; Pfizer), a single-dose maternal vaccination. Objectives We aimed to synthesize data from the literature and the leading professional organizations to provide guidance on RSV and strategies to reduce the risk of infant infection. This information will assist prenatal care clinicians in counseling their patients regarding the choice between maternal vaccination and the infant monoclonal antibody. Evidence Acquisition A descriptive review of the guidelines from the Centers for Disease Control and Prevention, American College of Obstetrics and Gynecology (ACOG), American Academy of Pediatrics, Society for Maternal-Fetal Medicine, and the American Academy of Family Physicians. Results All 5 organizations recommend that RSV vaccination should be offered to all pregnant people during the RSV season (September–January in the continental United States). Infants younger than 8 months entering into their first RSV season born to those who did not receive maternal vaccination or received vaccination less than 14 days prior to birth should be offered monoclonal antibody administration. Conclusions RSV vaccination and monoclonal antibodies have the potential to significantly reduce the burden of lower respiratory tract infections due to RSV in infants. Future studies should further evaluate the durability of protection and other strategies to further protect the infant, including cocooning and the role of breast milk in immunity. Target Audience Obstetrics and gynecologists, family practice physicians, prenatal care providers. Learning Objectives After completing this activity, the learner will be better able to describe new maternal RSV vaccination and infant RSV monoclonal antibody to prevent lower respiratory tract infections due to RSV; analyze the research surrounding maternal RSV vaccination and infant monoclonal antibody administration; and initiate discussion with patients regarding their decision to proceed with maternal RSV vaccination and infant monoclonal antibody administration.