Respiratory Syncytial Virus (RSV) prevention programs

Overview

The risk of severe outcomes from Respiratory Syncytial Virus (RSV) is higher among infants, children under 24 months of age with certain medical conditions, and older adults.

RSV programs help provide protection for these vulnerable populations.

Administering RSV immunization products, along with COVID-19 and flu vaccines in the fall help to:

• reduce severe outcomes, including hospital admissions, ICU admissions, and deaths from RSV
• protect individual health and the health of families and communities
• protect and mitigate impacts on our health-care system

Monoclonal antibody prophylaxis

The Ontario RSV program publicly funds two Health Canada authorized products to help prevent respiratory syncytial virus (RSV) lower respiratory tract disease in infants and high-risk children:

• a monoclonal antibody (Beyfortus^®) given to infants just prior to or during their first RSV season or high-risk children in their second season
• a vaccine (Abrysvo^TM) given during pregnancy
  • In alignment with National Advisory Committee on Immunization (NACI), Beyfortus® is the preferred product to protect infants. Receiving both Abrysvo® and Beyfortus® is not generally recommended.

The RSV season is generally from November to April, with regional variation across Ontario and between years. Due to the seasonality of the RSV virus and to ensure optimal protection, Beyfortus^® or Abrysvo^TM should be administered shortly before or during the active RSV season.

Pending product availability, administration of Beyfortus^® and Abrysvo^TM for the infant program can begin in early October and should continue to be administered throughout the RSV season.

Details regarding program wind-down will be communicated to providers at the end of the RSV season.

Eligibility criteria

Beyfortus^® is currently funded for RSV prophylaxis in infants who are residents of Ontario and meet any of the following criteria:

• Infants born April 1 or after and who are less than 8 months of age at the time of immunization.
• Children up to 24 months of age who meet the following high-risk criteria for severe RSV disease through their second RSV season:
  • chronic lung disease of prematurity (CLD), including bronchopulmonary dysplasia, requiring ongoing assisted ventilation, oxygen therapy or chronic medical therapy in the 6 months prior to the start of RSV season
    • Note: Children who were less than 12 months of age and approved for coverage in the previous RSV season for chronic lung disease and bronchopulmonary dysplasia remain eligible.
  • 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 with recurrent pulmonary exacerbations requiring hospitalization, deteriorating pulmonary function and/or severe growth delay
  • 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

Vaccination in pregnancy

Abrysvo^TM is an RSV vaccine authorized for pregnant women between 32–36 weeks gestation who will deliver during the RSV season. It is used to actively immunize pregnant women, providing infants with passive maternal antibodies that help protect them from severe RSV illness.

The National Advisory Committee on Immunization (NACI) preferentially recommends the use of Beyfortus^® for infant protection.

Any pregnant woman between 32–36 weeks gestation, who is an Ontario resident and will deliver during the RSV season, is eligible to receive Abrysvo^TM. The Abrysvo^TM RSV vaccine may be considered as alternative option for pregnant women who do not wish or are not able to protect their infant using the monoclonal antibody.

Vaccine and monoclonal antibody

Administration of both the vaccine to the pregnant woman and a monoclonal antibody to the infant is not recommended, however may be considered under either of specific circumstances for:

• infants born less than 14 days after administration of Abrysvo^TM or
• infants who meet the medical criteria for increased risk of severe RSV disease
  • infants who are born premature (for example, less than 37 weeks gestation)
  • infants who meet any of the above high-risk criteria

There is currently no evidence on repeat vaccination using Abrysvo^TM in subsequent pregnancies.

Ordering information for publicly funded infant RSV prevention products

Both RSV immunization products will be available for ordering from your usual vaccine source (for example, local public health unit or the Ontario Government Pharmaceutical and Medical Supply Services).

Starting in the 2025–2026 RSV season, Ontario is expanding its adult RSV prevention program that was introduced in 2023 to include all adults 75 years and older, in addition to adults aged 60–74 who meet high-risk criteria or reside in specific higher-risk settings.

The Ontario RSV program publicly funds two Health Canada authorized products to help prevent RSV lower respiratory tract disease in older adults:

• Abrysvo^TM vaccine
• Arexvy vaccine

Current eligibility

Through Ontario’s publicly funded adult RSV prevention program, the full cost of RSV immunization is covered for Ontario residents who have not previously received a publicly funded RSV vaccine and are:

• aged 75 and older
• aged 60–74 and meet one of the following criteria:
  • resident of a long-term care home, Elder Care Lodge, or retirement home including similar settings (for example, co-located facilities)
  • patient in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
  • patient with glomerulonephritis (GN) who is moderately to severely immunocompromised
  • patient receiving hemodialysis or peritoneal dialysis
  • recipient of solid organ or hematopoietic stem cell transplants
  • individual who is homeless
  • individual who identifies as First Nations, Inuit, or Métis

Access to publicly funded RSV vaccines

Health-care providers should order vaccines from their local public health unit or directly from the Ontario Government Pharmaceutical and Medical Supply Services (OGPMSS), per their usual processes for other vaccines.

Private purchase of RSV vaccines

People between 60 to 74 years of age who do not qualify for the free RSV vaccine can still purchase the vaccine with a prescription from their family doctor or other primary care provider. Some private insurers may cover all or part of the cost of the vaccine.

Primary care providers cannot order publicly funded vaccine supply for patients wishing to purchase it privately. With a prescription, people can purchase the vaccine at their pharmacy and either have it administered at the pharmacy or by a primary care provider.

The ministry does not reimburse for vaccines purchased from the private market.

Pharmacy administration

Free RSV immunizations are not available through pharmacies for:

• older adults
• infants and high-risk children
• pregnant women

Following regulatory amendments made under the Pharmacy Act, pharmacy professionals are now authorized to administer the RSV vaccine, however pharmacists do not have direct access to the publicly funded RSV vaccine supply.

Individuals who have a prescription, and get the RSV vaccine at their local pharmacy, will have to pay out of pocket for the vaccine.

Co-administration

The RSV vaccine can be co-administered with both seasonal and non-seasonal vaccines. Co-administration is encouraged to help mitigate the impacts of the respiratory illness season.

Resources

These guidance documents are for health-care providers. They contain important information and recommendations for the RSV prevention programs.

Contact information

For inquiries regarding the adult RSV prevention program, please contact us.

For questions regarding vaccine storage and handling, vaccine ordering or local distribution, please contact your local public health unit.

For inquiries regarding the infant and high-risk children Respiratory Syncytial Virus (RSV) prevention program, please email: VacPro@ontario.ca.