Respiratory Syncytial Virus (RSV) prevention programs

Overview

The Respiratory Syncytial Virus (RSV) prevention programs target the highest risk populations and settings. Administering RSV vaccines and prophylactics in the fall, as well as COVID-19 and flu vaccines, may:

• provide protection to high-risk infants and older adults
• protect individual health and the health of families and communities
• protect and mitigate impacts on our health care system

Infant and high-risk children RSV prevention program

Monoclonal antibody prophylaxis

Ontario expanded the high-risk infant RSV prevention program beginning for the 2024–25 season by increasing the program to all infants and high-risk children up to 24 months of age. This expansion includes the switch from the previous monoclonal antibody, Synagis® (palivizumab), to a new monoclonal antibody, Beyfortus® (nirsevimab). Through this program, the Ministry of Health covers the full cost of Beyfortus®, which is used to prevent a serious lower respiratory tract infection caused by RSV in infants and young children.

Beyfortus is not available on the private market or through pharmacies.

This immunization is only provided just prior to and during the active RSV season to infants who meet the ministry’s eligibility criteria. The active season is generally from November to April, with some variation between seasons. The specific start and end dates for the 2024–25 season are based on provincial epidemiology. These dates are communicated when they are known.

For the 2024-25 RSV season, providers may begin to administer Beyfortus as soon as the product is received. There will be no official communication for the start of this season. The ministry will declare an end to the season.

Eligibility criteria

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

• Born in 2024 prior to the RSV season (The National Advisory Committee on Immunization specifically recommends that infants less than 8 months of age or less be immunized).
• Born during the 2024–25 RSV season.
• Children up to 24 months of age who remain vulnerable from severe RSV disease through their second RSV season, with:
  • 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 < 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
  • cystic fibrosis with respiratory involvement and/or growth delay
  • severe congenital airway anomalies impairing the clearing of respiratory secretions

Vaccination in pregnancy

In addition, the ministry will make the RSV vaccine, Abrysvo®, available to pregnant residents of Ontario from 32 to 36 weeks gestational age who will deliver near the start of or during the 2024–25 season. When administered during pregnancy, RSV protection is provided to the infant from birth to six months of age.

The National Advisory Committee on Immunization (NACI) recommends Beyfortus® as the preferred product to protect infants, based on its:

• efficacy (how well it works)
• duration of protection
• good safety profile

Only one of these products is recommended to protect infants from RSV and using both is unnecessary except in certain circumstances (for example, a high-risk infant born to someone who received the vaccine).

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).

High-risk older adult RSV vaccine program

Ontario will continue the high-risk older adult RSV vaccine program that was introduced in 2023 with expanded eligibility in 2024–25. The vaccine is indicated for adults aged 60 years and older.

Current eligibility

Ontario’s publicly funded RSV prevention program is targeted for high-risk individuals and settings. The program includes individuals who are aged 60 years and older and who are also:

• residents of long-term care homes, Elder Care Lodges, or retirement homes including similar settings (e.g., co-located facilities)
• patients in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
• patients receiving hemodialysis or peritoneal dialysis
• recipients of solid organ or hematopoietic stem cell transplants
• individuals experiencing homelessness
• individuals who identify 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 aged 60 years and older 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.

Pharmacy administration

Following regulatory amendments made under the Pharmacy Act, pharmacy professionals are now authorized to administer the RSV vaccine.

While pharmacists are authorized to administer the adult RSV vaccine in Ontario, pharmacists do not have direct access to the publicly funded RSV vaccine supply.

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

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

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 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 high-risk older adult RSV vaccine 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.