RSV Prevention in Practice: Eliminating Gaps in Immunization Coverage

This episode bridges the gap between clinical trial data and everyday practice, focusing on how pediatricians can systematically ensure no eligible infant falls through the cracks. Dr. Tan underscores the core clinical principle: monoclonal antibodies should be administered as soon as possible after birth, as the youngest infants carry the greatest risk of severe RSV disease. She notes that one monoclonal antibody remains the only approved option for a second dose in children 8 to 19 months of age who are at elevated risk.

Dr. Creech identifies three common failure points in prophylaxis delivery. First, providers may document maternal vaccination without verifying the timing — if vaccination occurred fewer than 14 days before delivery, the infant requires monoclonal antibody prophylaxis regardless. Second, prophylaxis may not be administered during the birth hospitalization, due to factors ranging from parental hesitancy to reimbursement challenges under diagnosis-related group (DRG) bundle payments. Third, infants born outside of RSV season may not be proactively tracked so that they receive prophylaxis before their first RSV season begins. Dr. Creech calls for practices to develop formal action plans with dedicated champions and periodic review. He also offers a motivating clinical goal: with current tools, severe RSV disease in infants should become uncommon, even if it cannot be fully eliminated.

The moderator notes that data from the most recent season already show reduced ICU admissions for RSV-associated bronchiolitis and altered RSV seasonality patterns — early signals of real population impact from these prophylaxis strategies.

In the next episode, "Deciding Who Gets RSV Prophylaxis: First and Second Season Eligibility," Dr. Tan and Dr. Simões detail the eligibility criteria for monoclonal antibody prophylaxis in the first and second RSV seasons, addressing coverage gaps and equity concerns.