Respiratory Syncytial Virus (RSV)
Clinical Snapshot
Respiratory syncytial virus (RSV) is a single-stranded, enveloped RNA virus that causes respiratory illness at every stage of life, from a first infection in infancy through repeated reinfections into older adulthood, since immunity after natural infection is incomplete and short-lived. The virus spreads by respiratory droplets and by contact with contaminated surfaces, and in most of Canada follows a seasonal pattern beginning in fall (September/October), peaking in winter (January/February), and tapering through spring (March/April); RSV season in northern latitudes is shifted later, running roughly December through April/May. Its surface fusion (F) protein drives both viral entry and the formation of syncytia (fused, multinucleated cells) in the airway lining, and it is this F protein — specifically its prefusion conformation — that every current RSV vaccine and monoclonal antibody targets.[1] Most people of any age experience RSV as a self-limited upper respiratory illness. The disease burden that matters clinically concentrates at the two ends of life: in infants, RSV is the leading cause of bronchiolitis and a leading cause of hospitalization in the first year of life; in older adults and people with chronic cardiopulmonary disease or immunocompromise, RSV causes pneumonia and exacerbations of underlying chronic disease. There is no specific antiviral treatment recommended for routine RSV infection at any age — management of active illness is supportive care, and the pharmacotherapy that actually changes outcomes at a population level is prevention: nirsevimab or clesrovimab for infants, palivizumab for a narrower high-risk group, and RSV vaccines for pregnant patients and older or at-risk adults. This is a genuinely fast-moving area of practice — Canada authorized a second infant monoclonal antibody and updated its national immunization guidance for both infants and older adults in 2026 alone — and pharmacists are often a patient's first point of contact for counselling on eligibility and scheduling.
Recognize the Condition
Immunity after natural RSV infection is incomplete and short-lived, so reinfection occurs throughout life — a first infection in infancy does not protect against illness later in childhood, adulthood, or older age.
How RSV presents across the lifespan
Infants — bronchiolitis is the classic presentation
RSV typically begins with 1-2 days of mild upper respiratory symptoms (rhinorrhea, mild cough, low-grade fever) before progressing to bronchiolitis: wheeze, tachypnea, and increased work of breathing (grunting, nasal flaring, chest wall retractions), often with a paroxysmal cough. Feeding difficulty and irritability are common as work of breathing increases. Symptoms typically worsen over the first 3-5 days before improving, and cough can persist for 2-3 weeks even after the acute illness resolves. RSV is the most common cause of bronchiolitis and the most common cause of hospital admission in the first year of life.
Older children
Presents more like a typical upper respiratory tract infection — nasal congestion, sore throat, cough, and sometimes wheeze — usually milder than in infancy, since larger airway caliber makes obstructive symptoms less likely.
Healthy adults
Symptoms overlap substantially with other circulating respiratory viruses (influenza, COVID-19): nasal congestion, sore throat, cough, myalgia, fatigue, and headache. Roughly half of symptomatic patients develop systemic symptoms of some severity, and most cases resolve without complication.[2]
Older adults and adults with chronic disease
Presentation can be atypical — less prominent fever, and more nonspecific symptoms such as fatigue, confusion, or worsening of an underlying chronic condition (for example, increased dyspnea in COPD, or a heart failure decompensation) rather than a clear-cut respiratory illness. A high index of suspicion is needed, since RSV can progress to pneumonia or a significant exacerbation of chronic cardiopulmonary disease in this group.
Risk Factors
- Infants: prematurity (under 37 weeks, especially under 29 weeks), age under 6 months at the start of RSV season, chronic lung disease of prematurity (bronchopulmonary dysplasia), hemodynamically significant congenital heart disease, immunocompromise, Down syndrome, neuromuscular disease, congenital airway anomalies, and cystic fibrosis.
- Infants and young children, general: birth shortly before or during RSV season, household crowding, exposure to tobacco smoke, older siblings or daycare attendance, and lack of breastfeeding.
- Older adults: age 75 years and older, residence in a nursing home or other chronic care facility, and general frailty.
- Adults of any age with chronic disease: chronic lung disease (including COPD and asthma), chronic heart disease (including heart failure and coronary artery disease), diabetes mellitus, chronic kidney or liver disease, and immunocompromising conditions (including transplant recipients, hematopoietic stem cell transplant, and active cancer therapy).
- Adults on specific therapies: dialysis and home or chronic oxygen therapy.
- General transmission risk: close contact with young children, congregate living settings, and RSV season (roughly fall through spring in most of Canada).
Red Flags & Refer
Most RSV illness is managed with reassurance and supportive care. Escalate or refer urgently for any of the following:
- In an infant: signs of impending respiratory failure — apnea, grunting, marked chest wall retractions, nasal flaring, cyanosis or pallor, and lethargy or decreased responsiveness.
- In an infant: poor feeding with signs of dehydration — a marked reduction in wet diapers, or a sunken fontanelle.
- Fever in an infant under 3 months of age, or fever above 40.5°C at any age.
- In an infant: symptoms significantly worsening within the first 72 hours, or no improvement (or any worsening) after 3-5 days — bronchiolitis symptoms characteristically worsen before they improve, but this pattern still needs reassessment against the expected trajectory.
- In an older or high-risk adult: worsening dyspnea, hypoxemia, altered mental status, signs of decompensated heart failure or a COPD exacerbation, or inability to maintain oral intake or hydration.
- Any suspicion of a secondary bacterial infection (for example, a new focal pneumonia) rather than uncomplicated viral RSV illness.
- Any immunocompromised patient with suspected or confirmed RSV lower respiratory tract infection — refer for specialist assessment, given the limited, specialist-directed role of ribavirin in this population.
Assessment & Diagnosis
Differentiating RSV from other common respiratory viruses
RSV, influenza, and COVID-19 commonly circulate together and produce substantially overlapping symptoms; clinical differentiation alone is unreliable, which is why testing matters more for these three viruses than for most other causes of upper respiratory infection.[2]
| Feature | RSV | Influenza | COVID-19 |
|---|---|---|---|
| Typical onset | Gradual, over 1-2 days | Abrupt | Variable, often gradual |
| Fever | Low-grade or absent in roughly half of symptomatic patients; can be higher in infants | Often high, abrupt onset | Variable |
| Dominant symptoms | Nasal congestion, cough, sore throat; wheeze prominent in infants | Myalgia, fatigue, and headache prominent alongside respiratory symptoms | Highly variable; loss of taste or smell is more specific but not required |
| Population most affected by severe disease | Infants and older or high-risk adults | Any age; older adults and pregnant patients at higher risk of severe disease | Older adults and immunocompromised or high-risk adults |
| Specific antiviral treatment | None recommended for routine cases | Oseltamivir or another neuraminidase inhibitor, most effective when started early | Nirmatrelvir/ritonavir or remdesivir in eligible high-risk patients |
| Specific prevention | Nirsevimab/clesrovimab (infants), RSV vaccine (older/at-risk adults, pregnancy) | Annual influenza vaccine | COVID-19 vaccine, updated periodically |
Definitive differentiation requires testing — multiplex PCR is preferred where available, since it distinguishes all three from a single sample. Do not assume a diagnosis from symptoms alone when the distinction changes management, such as antiviral eligibility for influenza or COVID-19, or infection-control cohorting decisions in a hospital or long-term care setting.
History
- Onset and progression of symptoms; ask specifically about respiratory distress and feeding/hydration in infants, and about functional decline or worsening of an underlying chronic condition in older adults.
- Age, gestational age at birth for infants, and risk factors for severe disease (see Risk Factors).
- Immunization history — has the infant already received nirsevimab, clesrovimab, or palivizumab this season, or has the adult already received an RSV vaccine, and if not, do they qualify.
- Exposure history — known sick contacts, daycare or school attendance, or a congregate living setting.
Physical examination
- Vital signs, with particular attention to respiratory rate, oxygen saturation, and work of breathing.
- In infants: assess for grunting, nasal flaring, retractions (suprasternal, intercostal, subcostal), wheeze or crackles on auscultation, and hydration status (mucous membranes, fontanelle, capillary refill).
- In older or high-risk adults: assess for signs of pneumonia, decompensated heart failure, or an acute exacerbation of chronic lung disease.
Investigations
Testing changes management mainly when it determines antiviral eligibility for an alternative diagnosis (influenza, COVID-19), guides infection-control cohorting in a hospital or long-term care setting, or informs prevention-product eligibility going forward. For a typical outpatient presentation where the result will not change management, testing is not required — RSV bronchiolitis, in particular, remains a clinical diagnosis in most outpatient settings.
- Real-time PCR, including multiplex panels that also test for influenza and COVID-19, is the preferred test where testing is indicated — antigen testing and viral culture have lower sensitivity for RSV.
- Pulse oximetry is reserved for more significant illness (for example, moderate-to-severe bronchiolitis in an infant, or any older or high-risk adult with respiratory symptoms) and is not needed for mild, typical cases.
- Chest imaging is not routinely indicated for typical bronchiolitis or typical RSV illness in an adult — reserve it for atypical presentations, diagnostic uncertainty, or a suspected complication such as pneumonia or effusion.
Treatment Targets
- Relieve symptoms through supportive care — hydration, oxygenation, and comfort measures.
- Prevent complications: hypoxemia, dehydration, and respiratory failure in infants; pneumonia and exacerbation of chronic cardiopulmonary disease in older or high-risk adults.
- Prevent RSV infection and severe disease before it occurs through appropriate immunoprophylaxis — the single highest-yield intervention available for this condition.
- Avoid unnecessary bronchodilators, corticosteroids, antibiotics, and chest imaging in uncomplicated bronchiolitis.
- Promote antimicrobial stewardship — RSV is viral, and antibiotics are not indicated unless a specific secondary bacterial infection is confirmed or strongly suspected.
Choose Initial Treatment
All patients There is no specific antiviral treatment recommended for routine RSV infection at any age. Manage active illness with supportive care: rest, hydration, and antipyretic/analgesic therapy as needed for comfort.
Infants with bronchiolitis Supportive care is oxygen- and hydration-focused: supplemental oxygen for hypoxemia, and more frequent, smaller-volume feeds (or intravenous/nasogastric fluids if oral intake is inadequate) to maintain hydration. Saline nasal drops with suction may help clear secretions and support feeding, though evidence for a meaningful effect on bronchiolitis outcomes is limited.
Avoid Bronchodilators such as salbutamol[3], systemic or inhaled corticosteroids[4], and antibiotics[5] are not recommended for otherwise healthy infants with uncomplicated bronchiolitis — current evidence, including the American Academy of Pediatrics bronchiolitis guideline and Canadian Paediatric Society recommendations, does not support routine use of any of these, and each carries its own adverse-effect and cost burden without a demonstrated benefit in this population.[6][7] Nebulized hypertonic or aerosolized saline is also not recommended, and the combination of nebulized epinephrine with oral dexamethasone has shown only equivocal evidence and is not recommended in otherwise healthy children with bronchiolitis.[7]
Preferred Acetaminophen or ibuprofen for fever, headache, and myalgia, with supportive hydration and rest. Escalate to medical assessment for any red flag (see Red Flags and Refer) rather than continuing supportive care alone.
Specialist-directed only Aerosolized ribavirin has a narrow, hospital/specialist-directed role in severe, laboratory-confirmed RSV lower respiratory tract infection, typically in immunocompromised patients (for example, hematopoietic stem cell or solid organ transplant recipients) or select critically ill infants with an underlying cardiac, pulmonary, or immune condition. It is not a primary-care- or community-pharmacy-directed therapy, and initiation requires infectious diseases or critical care involvement.
1st line, all infants entering their first RSV season Nirsevimab or clesrovimab (whichever is available through the local immunization program) — a single weight-based or fixed-dose intramuscular injection that protects for the entire season, per pivotal-trial[8] and real-world effectiveness data.[9] Current national guidance recommends offering this to every infant entering their first RSV season as a universal program, not only those with high-risk conditions.[1]
1st line, high-risk children entering their second RSV season Nirsevimab 200 mg IM (as two 100 mg injections) remains an option for children under 24 months of age who remain at increased risk of severe RSV disease into a second season; clesrovimab is not currently authorized in Canada for second-season use.[1]
Alternative — when nirsevimab/clesrovimab is unavailable, or for specific high-risk infants where monthly dosing is preferred Palivizumab 15 mg/kg IM monthly throughout RSV season (4-5 doses) for infants born under 35 weeks' gestation and/or under 6 months of age with chronic lung disease of prematurity or hemodynamically significant congenital heart disease.[10][1]
Alternative — if monoclonal antibody prophylaxis is not feasible or not available Maternal immunization with the bivalent RSV vaccine (Abrysvo) at 32-36 weeks' gestation is a reasonable alternative to protect the infant through passive antibody transfer, though nirsevimab/clesrovimab is preferred when accessible, based on demonstrated superior real-world effectiveness against RSV-related hospitalization.[11][1]
Strongly recommended — adults 75 years of age and older, and adults 65-74 years of age at increased risk of severe RSV disease A single dose of an RSV vaccine (Arexvy, Abrysvo, or mResvia, per local program/formulary availability) — protection has been demonstrated for at least 3 RSV seasons after one dose, and revaccination timing has not yet been established.[12]
Strongly recommended — adults 18 years of age and older in specific high-risk categories Nursing home/chronic care facility residents, lung transplant recipients, hematopoietic stem cell transplant recipients (within 2 years of transplant or on ongoing immunosuppression), and adults on home/chronic oxygen therapy or dialysis.[12]
Individual decision, in discussion with a healthcare provider Other adults 60-74 years of age not otherwise high-risk, and younger at-risk adults (18-59 years of age with a qualifying chronic condition) outside the specific high-risk categories above, may reasonably choose vaccination on an individual basis — most younger adults will benefit more from waiting until an older age or until a qualifying condition develops.[12]
Non-Pharmacologic Treatment
- Hand hygiene (soap and water, or 60% or more alcohol-based hand sanitizer) and covering coughs/sneezes to reduce spread — patients are typically contagious roughly 1-2 days before symptom onset and for about 14 days after, sometimes longer in infants and immunocompromised patients.
- Stay home from work, school, or daycare while symptomatic, and avoid visiting hospitals, long-term care facilities, or high-risk individuals (infants, older adults) while contagious.
- Masking is reasonable for a symptomatic individual around others, for a caregiver of someone who is ill, or where required by a setting or personal choice; children under 2 years of age should not wear masks or other face coverings because of the risk of asphyxiation.
- In infants: more frequent, smaller-volume feeds can help maintain total daily intake when an infant is congested or tires easily during feeding; saline nasal drops with bulb or device suction before feeds may help clear secretions.
- Cool-mist humidification and steam have not been shown to improve outcomes in bronchiolitis and are not necessary.
- At-home monitoring in infants: track feeding and wet-diaper frequency, watch for worsening work of breathing, and expect symptoms to often peak in the first 3 days before improving — any deterioration, or no improvement after 3-5 days, should prompt reassessment.[6]
Special Populations
Pregnancy
Symptomatic treatment of RSV illness in pregnancy is the same as for other patients: acetaminophen for fever/pain. Avoid NSAIDs (for example, ibuprofen) after 20 weeks' gestation because of the risk of reduced amniotic fluid[14], and specifically in the third trimester because of the risk of premature closure of the ductus arteriosus.[15]
For prevention, the bivalent RSV vaccine (Abrysvo) is specifically studied and authorized for administration at 32-36 weeks' gestation to protect the infant through passive antibody transfer; it has not been studied before 24 weeks or after 36 weeks of gestation, and it is not interchangeable with the adjuvanted (Arexvy) or mRNA (mResvia) RSV vaccines for this indication, neither of which is authorized in pregnancy.[11]
Breastfeeding
No RSV-specific restriction applies to breastfeeding — acetaminophen, and ibuprofen outside the pregnancy-specific NSAID cautions above, are both compatible with breastfeeding. Maternal RSV vaccination and infant nirsevimab, clesrovimab, or palivizumab can all be given without interrupting breastfeeding.
Pediatrics
Bronchiolitis-specific supportive care, prevention eligibility, and dosing are detailed throughout this chapter. Readers managing pediatric wheeze or croup alongside RSV season should also see the Croup and Asthma in Infants and Children chapters for overlapping supportive-care and airway-assessment principles, which are not repeated in full here.
Older adults and adults with chronic disease
This is the population targeted by RSV vaccination (see Choose Initial Treatment for the current age/risk-based eligibility tiers) and the population most likely to present atypically (see Recognize the Condition) — maintain a lower threshold for assessment when an older or high-risk adult reports vague symptoms such as fatigue, confusion, or worsening of a chronic condition during RSV season.
Immunocompromised patients
Immunocompromising conditions increase both the risk of severe RSV disease and the population in which specialist-directed ribavirin is occasionally used (see Choose Initial Treatment). Vaccine immune response may be reduced with significant immunosuppression, but vaccination is still generally recommended given the elevated risk of severe disease in this group.
Renal / hepatic impairment
No dose adjustment is required for acetaminophen (within labelled dosing), the RSV monoclonal antibodies, or RSV vaccines based on renal or hepatic function. Use standard caution with ibuprofen in significant renal impairment or dehydration, and avoid acetaminophen doses above the labelled maximum in significant hepatic impairment.
Monitoring & Follow-Up
- In infants: reassess urgently if there is no improvement, or any worsening, after 3-5 days — expect symptoms to often worsen over the first 72 hours before improving, and expect cough to potentially persist 2-3 weeks after the acute illness resolves.
- Track receipt of the infant's nirsevimab, clesrovimab, or palivizumab dose, and for palivizumab specifically, confirm monthly adherence throughout the season; confirm maternal vaccination timing (32-36 weeks' gestation) was met if that pathway was used instead.
- In older or high-risk adults: reassess for worsening dyspnea, hypoxemia, or decompensation of an underlying chronic condition.
- No routine test-of-cure or repeat RSV-specific testing is needed after typical, resolved illness at any age.
Common Errors to Avoid
- Using bronchodilators, corticosteroids, or antibiotics for uncomplicated bronchiolitis in an otherwise healthy infant — none are supported by current evidence, and each carries its own risk and cost.
- Ordering chest imaging or bloodwork routinely for typical bronchiolitis when the result will not change management.
- Assuming an older adult's vague symptoms (fatigue, confusion, worsening of a chronic condition) are simply age-related rather than considering RSV, especially during RSV season.
- Treating nirsevimab, clesrovimab, or palivizumab as a treatment for active RSV infection — they are prevention only, given before or at the start of a season's exposure risk.
- Missing eligibility for RSV vaccination in an adult 18-59 years of age with a qualifying chronic condition, because RSV vaccines are often thought of as "an older-adult vaccine" only.
- Assuming palivizumab and nirsevimab/clesrovimab are interchangeable in dosing frequency — palivizumab requires adherent monthly dosing for full-season protection, unlike the single-dose long-acting antibodies.
- Recommending an over-the-counter combination cough/cold product for a child under 6 years of age.
- Missing that maternal RSV vaccination and infant nirsevimab/clesrovimab are largely redundant when both are accessible — nirsevimab/clesrovimab is preferred when available rather than routinely using both.
- Forgetting to ask about RSV immunization status at any pharmacy encounter during RSV season, given how new and rapidly changing this landscape is — pharmacists are well positioned to identify eligible patients who are not yet aware these options exist.
Clinical Decision Algorithm
Drug Tables
How to use this table: Doses are adult doses and require patient-specific confirmation (renal/hepatic function, weight, allergy history). Pediatric dosing is weight-based per the current product monograph unless stated. Drug pricing is intentionally omitted. Select any drug name to open its complete Pharmasist Drug Database page.
RSV Prevention
Long-acting monoclonal antibodies (infant RSV prevention)
Preferred over palivizumab for most infants — a single dose protects for an entire RSV season.
| Drug | Dosage | Adverse effects | Comments |
|---|---|---|---|
| Nirsevimab | First RSV season, under 5 kg: 50 mg IM single dose First RSV season, 5 kg or more: 100 mg IM single dose Second RSV season (high-risk, under 24 months): 200 mg IM single dose, given as two 100 mg injections at different sites | Rash, mild fever, injection site reactions | Preferred, universal first-season option. Give at birth if born during RSV season, or shortly before season start otherwise. Can be co-administered with routine childhood vaccines at a separate site.[8][9][16] |
| Clesrovimab | First RSV season, any weight: 105 mg IM single dose Cardiac surgery with cardiopulmonary bypass: Additional 105 mg IM dose once stable postoperatively | Injection site reactions, rash | Newest option (Health Canada approval February 2026); same fixed dose regardless of weight. Not currently authorized in Canada for a second RSV season. An additional dose is recommended after cardiac surgery with cardiopulmonary bypass.[17][16] |
Monoclonal antibody — monthly dosing (narrower high-risk use)
Reserve for infants who do not have access to nirsevimab or clesrovimab, or specific high-risk situations where monthly dosing is preferred.
| Drug | Dosage | Adverse effects | Comments |
|---|---|---|---|
| Palivizumab | Adults: Not applicable — pediatric-only indication Infants (high risk, for example under 35 weeks' gestation and/or under 6 months of age with chronic lung disease of prematurity or hemodynamically significant congenital heart disease): 15 mg/kg IM once monthly (approximately every 28-30 days), 4-5 doses through RSV season | Injection site reactions, fever, irritability, nervousness | Requires an adherent monthly injection schedule for full-season protection, unlike the single-dose long-acting antibodies above. An additional dose may be considered if the local RSV season runs longer than usual.[10][16] |
RSV vaccines — maternal immunization and older/at-risk adults
All target the prefusion conformation of the RSV F protein; a single dose per indication, with revaccination schedules not yet established.
| Drug | Dosage | Adverse effects | Comments |
|---|---|---|---|
| Respiratory syncytial virus (RSV) vaccine, bivalent prefusion F protein | Pregnancy: 0.5 mL IM single dose, given at 32-36 weeks' gestation Adults 60 years of age and older, and 18-59 years at increased risk: 0.5 mL IM single dose | Injection site soreness, mild flu-like symptoms (myalgia, malaise, low-grade fever) | The only RSV vaccine studied and authorized for use in pregnancy. Also authorized for older/at-risk adults. Not authorized before 24 weeks or after 36 weeks of gestation.[11][18] |
| Respiratory syncytial virus prefusion F protein (adjuvanted) | Adults: 0.5 mL IM single dose Children: Not applicable — adult-only indication | Injection site soreness, mild flu-like symptoms (myalgia, malaise, low-grade fever) | Not authorized for use in pregnancy. Reactogenicity in trials was reported as slightly higher than the bivalent vaccine.[19] |
| Respiratory syncytial virus vaccine, mRNA (mRNA-1345) | Adults 60 years of age and older, and 18-59 years at increased risk: 0.5 mL IM single dose Children: Not applicable — adult-only indication | Injection site pain, fatigue, headache, myalgia, arthralgia, mild fever/chills | Same mRNA lipid-nanoparticle platform as currently authorized COVID-19 vaccines. Not authorized for use in pregnancy. As with the other RSV vaccines, Guillain-Barré syndrome cases have been reported in postmarketing safety monitoring; surveillance continues.[20][13] |
Symptomatic supportive care
First-line comfort measures for active illness at any age; neither treats the underlying infection.
| Drug | Dosage | Adverse effects | Comments |
|---|---|---|---|
| Acetaminophen | Adults: 325-1000 mg PO/PR every 4-6 hours as needed, maximum 4 g/day (lower in hepatic impairment) Children/infants: 10-15 mg/kg PO/PR every 4-6 hours as needed, per current weight-based product dosing | Hepatotoxicity with overdose or chronic excess dosing | Preferred antipyretic/analgesic in infants, children, and adults, including in pregnancy. |
| Ibuprofen | Adults: 200-400 mg PO every 4-6 hours as needed Children/infants 6 months of age and older: 5-10 mg/kg PO every 6-8 hours as needed, per current weight-based product dosing | GI upset; renal caution with dehydration or reduced oral intake | Avoid under 6 months of age. Avoid after 20 weeks' gestation in pregnancy. |
Antiviral — specialist-directed only
Reserved for severe, laboratory-confirmed RSV lower respiratory tract infection in a hospital setting; not a primary-care- or community-pharmacy-initiated therapy.
| Drug | Dosage | Adverse effects | Comments |
|---|---|---|---|
| Ribavirin (inhaled) | Adults: Per hospital/specialist protocol — continuous small-particle aerosol Children/infants: Per hospital/specialist protocol — continuous small-particle aerosol | Bronchospasm; conjunctival and respiratory irritation in caregivers/staff exposed to the aerosol; teratogenic | Continuous aerosol administration in hospital, typically for immunocompromised patients (for example, hematopoietic stem cell or solid organ transplant recipients) or select critically ill infants. Contraindicated in pregnancy, including for staff who are or may become pregnant and handle the aerosol. |
Also avoid: over-the-counter cough and cold products (antitussives, decongestants, expectorants) in children under 6 years of age, per product labelling and Health Canada guidance.[21]
References
- Summary of NACI statement of April 10, 2026: Updated guidance to protect infants and children from respiratory syncytial virus (RSV) disease: use of monoclonal antibodies (nirsevimab and clesrovimab) and the RSVpreF vaccine — Public Health Agency of Canada, National Advisory Committee on Immunization (NACI). PHAC/NACI Statement, April 10, 2026
- Respiratory syncytial virus infection in adults — BMJ (Nam HH, Ison MG). BMJ 2019;366:l5021
- Bronchodilators for bronchiolitis — Cochrane Database of Systematic Reviews (Gadomski AM, Scribani MB). Cochrane Database Syst Rev 2014;(6):CD001266
- Glucocorticoids for acute viral bronchiolitis in infants and young children — Cochrane Database of Systematic Reviews (Fernandes RM, Bialy LM, Vandermeer B, et al.). Cochrane Database Syst Rev 2013;(6):CD004878
- Antibiotics for bronchiolitis in children under two years of age — Cochrane Database of Systematic Reviews (Farley R, Spurling GKP, Eriksson L, Del Mar CB). Cochrane Database Syst Rev 2014;(10):CD005189
- Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis — Pediatrics (Ralston SL, Lieberthal AS, Meissner HC, et al.; American Academy of Pediatrics). Pediatrics 2014;134(5):e1474-e1502
- Bronchiolitis: recommendations for diagnosis, monitoring and management of children one to 24 months of age — Paediatrics & Child Health (Friedman JN, Rieder MJ, Walton JM; Canadian Paediatric Society, Acute Care Committee). Paediatr Child Health 2014;19(9):485-491
- Nirsevimab for Prevention of RSV in Healthy Late-Preterm and Term Infants — New England Journal of Medicine (Hammitt LL, Dagan R, Yuan Y, et al.). N Engl J Med 2022;386(9):837-846
- Nirsevimab for Prevention of Hospitalizations Due to RSV in Infants — New England Journal of Medicine (Drysdale SB, Cathie K, Flamein F, et al.). N Engl J Med 2023;389(26):2425-2435
- Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk Infants — Pediatrics (The IMpact-RSV Study Group). Pediatrics 1998;102(3):531-537
- Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants — New England Journal of Medicine (Kampmann B, Madhi SA, Munjal I, et al.). N Engl J Med 2023;388(16):1451-1464
- Summary of NACI statement of April 10, 2026: Updated guidance on respiratory syncytial virus (RSV) vaccines for older adults and for adults at high risk of severe RSV disease — Public Health Agency of Canada, National Advisory Committee on Immunization (NACI). PHAC/NACI Statement, April 10, 2026
- Post-licensure safety monitoring of respiratory syncytial virus (RSV) vaccines in adults aged 60 years and older — Advisory Committee on Immunization Practices (ACIP), Centers for Disease Control and Prevention (Shimabukuro T). CDC/ACIP Meeting Presentation, February 29, 2024
- Labelling update regarding the use of non-steroidal anti-inflammatory drugs (NSAIDs) beyond 20 weeks of pregnancy and risk of kidney damage to unborn babies — Health Canada, Government of Canada. Government of Canada, Health Canada Recalls and Safety Alerts, June 8, 2021
- Nonsteroidal antiinflammatory drugs during third trimester and the risk of premature closure of the ductus arteriosus: a meta-analysis — Annals of Pharmacotherapy (Koren G, Florescu A, Costei AM, et al.). Ann Pharmacother 2006;40(5):824-829
- Canadian Immunization Guide, Part 4 — Immunizing Agents: Respiratory syncytial virus (RSV) vaccines — Public Health Agency of Canada. Government of Canada, Canadian Immunization Guide (updated 2026)
- Clesrovimab in Infants at Increased Risk For Severe Disease During 2 RSV Seasons: A Randomized Clinical Trial — JAMA Pediatrics (Zar HJ, Bont LJ, Manzoni P, et al.; SMART study group). JAMA Pediatr 2026 Jul 20 (online ahead of print)
- Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults — New England Journal of Medicine (Walsh EE, Pérez Marc G, Zareba AM, et al.). N Engl J Med 2023;388(16):1465-1477
- Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults — New England Journal of Medicine (Papi A, Ison MG, Langley JM, et al.). N Engl J Med 2023;388(7):595-608
- Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults — New England Journal of Medicine (Wilson E, Goswami J, Baqui AH, et al.). N Engl J Med 2023;389(24):2233-2244
- Concerns about children's medication: avoiding cough and cold medications — Health Canada, Government of Canada. Government of Canada, Health Canada
Professional reference only. Apply clinical judgment and verify patient-specific decisions against current authoritative guidance and product information.