Respiratory syncytial virus (RSV) in healthy individuals often presents with mild symptoms, but for infants and older adults, RSV can be dangerous. These vulnerable populations are at increased risk of severe outcomes from RSV, such as bronchiolitis (inflammation of the lungs), pneumonia, exacerbation of underlying health conditions, hospitalization, and death.1,2
In the past, options to prevent RSV in vulnerable populations were limited, but recent advancements in RSV prevention have transformed the landscape of care. For the first time, patients, caregivers, and healthcare professionals have access to preventative options that help protect the most vulnerable patient demographics from severe complications of RSV.
Pharmacists, as accessible and trusted healthcare professionals, have a unique opportunity to guide patients and parents in making informed decisions about their respiratory health by educating them on the risks of RSV and helping them navigate the latest preventative therapies.
RSV in Infants and Pregnancy
By the age of two, nearly all children will have been infected with RSV, highlighting the urgent need for protection early in life.3 Infants and young children face a significantly higher risk of severe RSV outcomes, including hospitalization, due to their developing immune systems. RSV is responsible for approximately 16 times more hospitalizations in young children than influenza and is ranked as the third leading cause of lower respiratory deaths in children younger than five years of age. 1 Alarmingly, over half of RSV-related hospitalizations in children occur in those under six months of age, with the highest rates observed in the first three months of life.4
Historically, Synagis® (palivizumab) was the sole option for protecting high-risk infants against RSV infections. Recently, Health Canada approved two additional preventative therapies to enhance RSV protection in infants:
- Abrysvo™ (RSVpreF vaccine): Abrysvo is a vaccine with a dual indication in pregnant individuals and older adults. The vaccine is indicated for pregnant individuals from 32 through 36 weeks of pregnancy, as well as adults 60 years of age and older. 5 When the vaccine is administered in pregnant individuals, protective antibodies are transferred to the fetus, safeguarding newborns during their first 6 months of life.
- Beyfortus® (nirsevimab): A long-acting monoclonal antibody indicated for newborns and infants born during or entering their first RSV season, as well as in children up to 2 years old who remain vulnerable to severe RSV disease in their second RSV season. A single dose of Beyfortus can protect against RSV for at least 5 months, the typical length of an RSV season.3,6
Recognizing the significant risks RSV poses to infants and the new products available, the National Advisory Committee on Immunization (NACI) issued a statement recommending that Canadian provinces work towards a universal RSV immunization program for all infants.
Currently, NACI recommends Beyfortus as the first-line therapy for infant protection against RSV due to the duration of protection, efficacy, and safety profile. Additionally, the current NACI recommendations states that if nirsevimab is expected to be given to a healthy infant, RSVpreF during pregnancy may not offer extra benefits. 3
However, both maternal vaccination with Abrysvo and infant immunization with Beyfortus have demonstrated effectiveness in reducing RSV-related complications in infants and, depending on patient specific factors, may be offered as options to caregivers. Organizations such as the FMWC Maternal RSV Task Force and Society of Obstetricians and Gynaecologists of Canada have emphasized the importance of a shared decision-making approach between parents and health care providers that takes into additional considerations such as product availability, timing of administration, cost-effectiveness, and logistical implementation. Whichever product is chosen, patients should be counselled that dual immunization—maternal vaccination combined with infant monoclonal antibodies—has not been studied and is not routinely recommended for RSV protection.7,8
Both Beyfortus and Abrysvo are publicly funded and can be accessed for free through the infant RSV Prevention Program in Ontario. The publicly funded supply of Abrysvo and Beyfortus is only available through hospitals, primary care providers, or local public health units, however, Abrysvo is also available for private purchase through pharmacies.
RSV Vaccines in Adults
In recent years, the RSV vaccine landscape for adults has evolved significantly. As of February 2025, three vaccines are approved for use in adults by Health Canada:
- Arexvy™: Indicated for individuals 60 years and older, as well as for those aged 50 to 59 who are at increased risk for RSV disease.9
- Abrysvo™: Approved for individuals 60 years and older. Abrysvo is also indicated for use in pregnant individuals from 32 through 36 weeks of pregnancy.5
- mRESVIA™: Indicated for individuals aged 60 and older.2
Current NACI guidelines recommend a single dose of either the Arexvy or Abrysvo RSV vaccine in adults 75 years of age or older, particularly for those who are at increased risk of severe RSV disease, as well as in adults 60 years of age and older who are residents of nursing homes and other chronic care facilities.10 NACI also recommends vaccination be considered by adults aged 60 to 74 years in consultation with their health care provider..10 NACI is currently reviewing the use of mRESVIA in adults, with the vaccine expected to become available to Canadians sometime in 2025.
Both Arexvy and Abrysvo are publicly funded for high-risk adults under the RSV Prevention Program in Ontario. Older adults who are indicated for an RSV vaccine, but do not meet the eligibility criteria for the publicly funded RSV programs, can privately purchase an RSV vaccine at a pharmacy. In Ontario, pharmacists are authorized to administer an RSV vaccine to individuals 5 years of age and older. At the time of this article, Arexvy and Abrysvo are classified as Schedule I products under the NAPRA National Drug Schedule, and a valid prescription from the patient’s physician or primary care provider is required before the vaccine can be administered to Ontario patients. To support pharmacy professionals in finding scheduling for specific vaccines, the National Association of Pharmacy Regulatory Authorities (NAPRA) has provided an update on clarification of vaccine scheduling in the NDS.
Conclusion
Pharmacists, as medication experts, are uniquely positioned to educate caregivers and patients on the various preventative RSV options available in Ontario. By staying informed about the latest guidelines and products, pharmacists can continue to provide trusted and proactive healthcare, ensuring that vulnerable patients receive optimal care.
Disclaimer: This blog post was developed by the Ontario Pharmacists Association (OPA) with a grant provided by GlaxoSmithKline Canada (GSK), Pfizer, and Sanofi. The information provided in the blog is intended to provide pharmacists with general information and is not intended to provide or take the place of medical advice, diagnosis or treatment, or professional judgement. It is intended to supplement materials provided by regulatory authorities, and should there be any discrepancies, municipal, provincial, and federal laws, policies, and guidelines shall prevail. The information provided in this document are current at the time of publication. The decision for use and application of this document is the responsibility of the user. OPA expressly disclaims responsibility, and shall have no liability for any damages, loss, injury, or liability whatsoever suffered as a result of reliance on the information contained in this resource.
Reference
- Abrams EM, Doyon-Plourde P, Davis P, Brousseau N, Irwin A, Siu W, Killikelly A. Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. Can Commun Dis Rep 2024;50(1/2):1–15. https://doi.org/10.14745/ccdr.v50i12a01
- Public Health Agency of Canada. Respiratory syncytial virus (RSV) vaccines: Canadian Immunization Guide. Ottawa (ON): Government of Canada; August 2024. Respiratory syncytial virus (RSV) vaccines: Canadian Immunization Guide – Canada.ca
- Government of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). Statement on the prevention of respiratory syncytial virus (RSV) disease in infants. May 17, 2024. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/vaccines-immunization/national-advisory-committee-immunization-statement-prevention-respiratory-syncytial-virus-disease-infants/naci-statement-2024-05-17.pdf.
- Bourdeau M, Vadlamudi NK, Bastien N, et al. Pediatric RSV-Associated Hospitalizations Before and During the COVID-19 Pandemic. JAMA Network Open. 2023;6(10):e2336863. doi: 10.1001/jamanetworkopen.2023.36863
- AbrysvoTM Product Monograph. 2023. Available from: https://pdf.hres.ca/dpd_pm/00073900.PDF
- BeyfortusTM Product Monograph. 2023. Available from: 00075966.PDF
- Society of Obstetricians and Gynaecologists of Canada. SOGC Statement on RSV Immunization to Prevent Infant RSV Infection. July 2024. Available from: https://sogc.org/common/Uploaded%20files/Position%20Statements/SOGC%20Statement%20RSV_07182024_EN.pdf
- The Federation of Medical Women of Canada (FMWC) Maternal RSV Task Force. Respiratory Syncytial Virus (RSV): Recommendations for the Prevention of Disease in Infants for the 2024 – 2025 RSV Season. June 2024. Available from: https://fmwc.ca/content/user_files/2024/06/FMWC-Maternal-RSV-Task-Force-White-Paper-_-Final-June-27th.pdf
- ArexvyTM Product Monograph. 2023. Available from: https://ca.gsk.com/media/6988/arexvy.pdf
- Government of Canada. An Advisory Committee Statement (ACS). National Advisory Committee on Immunization (NACI). Statement on the prevention of respiratory syncytial virus (RSV) disease in older adults. July 12th, 2024. https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/national-advisory-committee-immunization-summary-statement-prevention-rsv-disease-older-adults.html
