Respiratory Syncytial Virus (RSV) is a respiratory virus that is a major cause of lower respiratory illness, especially among infants, young children, and older adults. It starts to spread in the fall and peaks in the winter months. It can cause cold-like symptoms that are difficult to distinguish from other respiratory illnesses.

For more information on clinical signs and symptoms, surveillance, laboratory testing, IPAC, reporting and patient resources, please see Respiratory Viruses Information for Health Professionals.

Older Adults (> 60 years of age) RSV Prevention

Abrysvo™ is a new vaccine product available in Canada to protect people 60 years of age and older against RSV.

Abrysvo™ is the only RSV product that is publicly funded for older adults in Toronto for the 2024-2025 season.
Note: for the 2023-24 season, Arexvy was the RSV vaccine that was publicly funded. If someone has received Arexvy, they do not get re-vaccinated with Abrysvo.

Eligibility for Abrysvo™:

Eligibility includes those who were eligible during the 2023-2024 respiratory season plus an expansion to all residents in retirement homes.

Specifically, Ontario’s publicly funded RSV prevention program is targeted for eligible individuals 60 years of age and older who are:

  • Residents of long-term care homes, Indigenous long-term care homes (Elder Care Lodges) or retirement homes
  • Patients in hospital receiving alternate level of care (ALC) including similar settings (e.g., 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.

Co-administration:

As per the National Advisory Committee on Immunization (NACI), the RSV vaccine can be co-administered with other seasonal vaccines.

Beginning this fall, the Ministry of Health will expand the Ontario publicly funded infant RSV prevention program to include new products and increase eligibility.

New Products to prevent RSV infections in infants and young children:

  • Nirsevimab (Beyfortus®): a monoclonal antibody (mAb) immunizing agent given to infants just prior to or during RSV season. Given as a single dose and will replace palivizumab (Synagis).
  • Abrysvo™: a vaccine administered to pregnant individuals between 32 to 36 weeks gestational age for the prevention of severe RSV disease in infants. Vaccinated pregnant individuals deliver passive immunization, providing protective antibodies to their infants. This vaccine is available on a case-by-case basis in consultation with the pregnant individual and their health care provider.

NOTE: If the vaccine is given in pregnancy, the monoclonal antibody does not need to be given to the infant (except under specific circumstances such as a high-risk infant born to a pregnant person who received the vaccine).

Eligibility for Beyfortus®:

  • Any infant entering or born during their first RSV season:
    • All infants born in 2024
    • High-risk children up to 24 months of age who remain vulnerable from severe RSV disease through their second RSV season, with:
      • All premature infants (i.e., <37 weeks gestation
      • Chronic lung disease of prematurity (CLD), including bronchopulmonary dysplasia/chronic lung disease
      • Hemodynamically significant congenital heart disease (CHD)
      • Severe immunodeficiency
      • Down syndrome/Trisomy 21
      • Cystic fibrosis with respiratory involvement and/or growth delay
      • Neuromuscular disease
      • Severe congenital airway anomalies impairing clearing of respiratory secretions.

*RSV season is generally from November to April, peaking in December.

Eligibility for Abrysvo™:

Pregnant individuals who must live in Ontario and are 32 to 36 weeks gestational age and will deliver prior to or during RSV season (generally from November to April, peaking in December), in consultation with their health care provider.

Beyfortus® Administration Guidelines for Infants and Children

Category Weight Dose Timing
Infants born during the 2024-2025 RSV season

 

< 5 kg

 

50 mg product (0.5 mL) Administered at birth or before discharge preferred
≥ 5 kg 100 mg product (1 mL)
Infants born in 2024 before the current RSV season starts (up to 12 months of age)* < 5 kg

 

50 mg product (0.5 mL)  

Shortly before or during the RSV season

 

≥ 5 kg 100 mg product (1 mL)
Children over 12 months and up to 24 months of age and at continued high-risk from RSV infection N/A 200 mg (two 1 mL injections of 100 mg/mL) †
* NACI recommends Beyfortus® especially for infants less than 8 months of age due to risk of severe outcomes in younger infants.

† If a child weighs less than 10 kg entering their second RSV season, consideration can be given to administering a single dose of 100 mg at the clinical discretion of the provider

Co-administration:

  • Abrysvo™: can be co-administered with other seasonal vaccines.
  • Beyfortus®: can be co-administered with routine childhood vaccines, including influenza. No interval between live vaccines is necessary.

Health Canada has authorized the use of Abrysvo™ vaccine to be given to pregnant individuals between 32 and 36 weeks of pregnancy who will deliver near the start of or during RSV season.

Abrysvo™ is available on a case-by-case basis in consultation with the pregnant individual and their health care provider.

Beyfortus® is the preferred product for infant protection, however vaccination in pregnancy is available for those pregnant individuals who wish to be vaccinated.

NOTE: If the vaccine is given in pregnancy, the monoclonal antibody does not need to be given to the infant.

Eligibility

Pregnant individuals must live in Ontario and are:

  • 32 to 36 weeks gestational age and will deliver just prior to or during RSV season, in consultation with their health care provider.

Co-administration:

  • As per the NACI, the RSV vaccine can be co-administered with other seasonal vaccines.

Vaccine Side Effects & Risks

Abrysvo™
Clinical trials has shown that Abrysvo™ is generally well tolerated with the most common side effects reported include:

  • injection site pain, swelling and redness
  • headache
  • muscle ache
  • nausea

Beyfortus®
Clinical trials have shown that Beyfortus® is safe for most full-term and preterm infants (born at least 29 weeks gestation). Side effects are usually mild and last only a few days. The most common side effects reported include:

  • injection site pain, swelling and redness
  • rash
  • fever

Toronto health care providers can submit RSV vaccine orders for eligible clients using the updated Toronto Provider RSV Vaccine Order form.

  • Send completed forms to vaccineorder@toronto.ca
  • Do not submit batch orders.
  • TPH will be monitoring orders and may contact HCPs for clarification

Note: Beyfortus® 100mg cannot be split to make Beyfortus® 50mg doses. Please order the appropriate product based on administration guidelines.

An AEFI is an unwanted or unexpected health effect that happens after someone receives an injection, which may or may not be caused by the vaccine/monoclonal antibody. A causal relationship does not need to be proven before reporting. Of particular interest are unusual or unexpected events, or serious reactions requiring urgent care.

Toronto health care providers are required to report all Adverse Events Following Immunization (AEFI) to Toronto Public Health (TPH) under the Health Protection and Promotion Act.

To report, fax the completed AEFI Reporting Form (Public Health Ontario) to 416-696-3492 or email the completed form to AEFI@toronto.ca.

Most people who get RSV recover on their own within one to two weeks. However, RSV can cause severe illness in some people, and medical attention and treatment are needed. Antiviral medication is not routinely recommended to fight infection.