A Clinician’s Handbook for Childhood & Adult Immunizations in Georgia

RSV-AREXVY-ABRYSVO

Pathophysiology

Similar to some other respiratory infections, a cough or sneeze easily spreads RSV.

Typically, contagious for 3-8 days – people with weakened immune systems can be contagious as long as 4 weeks after symptoms gone

Vaccine Description

  • GSK Arexvy (adjuvanted)
  • Pfizer Abrysvo®

Both vaccines contain a part of the RSV virus and work by causing an immune response that can protect from respiratory disease if infected with RSV in the future.

Indications for Use

AREXVY is a vaccine indicated for active immunization for the prevention of lower respiratory tract disease (LRTD) caused by respiratory syncytial virus (RSV) in individuals 60 years of age and older.

ABRYSVO is a vaccine indicated for

  • Active immunization of pregnant individuals at 32 through 36 weeks gestational age for the prevention of lower respiratory tract disease (LRTD) and severe LRTD caused by respiratory syncytial virus (RSV) in infants from birth through 6 months of age.
  • Active immunization for the prevention of LRTD caused by RSV in individuals 60 years of age and older

AREXVY

Dose & Route

AREXVY is supplied in two vials that must be reconstituted prior to administration. One vial contains the lyophilized powder component and the second vial contains a liquid diluent adjuvant suspension. Reconstitute according to the  Package Insert – AREXVY (fda.gov). Once reconstituted then administer a single dose (0.5 mL) of AREXVY as an intramuscular injection. AREXVY – Administer a single dose (0.5 mL) of AREXVY as an intramuscular injection.

Storage & Handling

Before reconstitution of AREXVY:

  • Store vaccine and diluent refrigerated between 2°C and 8°C (36°F and 46°F).
  • Store these in their original package and keep them together in the refrigerator to optimize organization.
  • Never freeze the vaccine or diluent.
  • Protect the vial from light.

Once reconstituted administer AREXVY immediately or store protected from light in the refrigerator between 2°C and 8°C (36°F to 46°F) or at room temperature [up to 25°C (77°F)] and use within 4 hours. Discard reconstituted vaccine if not used within 4 hours. Never freeze the reconstituted vaccine. Protect the reconstituted vaccine from light.

ABRYSVO

Dose and Route

ABRYSVO – is supplied in a kit containing a vial of lyophilized powder and a prefilled syringe containing the sterile water diluent component, and a vial adapter. Reconstitute according to the Package Insert – ABRYSVO (fda.gov).

After reconstitution, administer a single dose (0.5 mL) of ABRYSVO as an intramuscular injection.

Storage & Handling

Before reconstitution of ABRYSVO:

  • Store vaccine and diluent refrigerated between 2°C and 8°C (36°F and 46°F).
  • Store these components in their original package and keep them together in the refrigerator to optimize organization.
  • Never freeze the vaccine or diluent

Once reconstituted administer ABRYSVO immediately or store at room temperature [15°C to 30°C (59°F to 86°F)] and use within 4 hours. Discard reconstituted vaccine if not used within 4 hours. Do not refrigerate. This is very different than other reconstituted vaccines. Typically, storage after reconstitution is refrigerated storage only or refrigerated or room temperature storage. For this vaccine, do NOT put it back in the refrigerator. Discard reconstituted vaccine if not used within 4 hours. Never freeze the vaccine or diluent.  MORE

Contraindications

Do not administer AREXVY to anyone with a history of a severe allergic reaction (e.g., anaphylaxis) to any component of AREXVY.

Precautions

To avoid the potential risk of preterm birth with use of ABRYSVO, administer ABRYSVO as indicated in pregnant individuals at 32 through 36 weeks gestational age.

Adults with a minor acute illness, such as a cold, can receive RSV vaccination. Moderate or severe acute illness, with or without fever, is a precaution to vaccination; vaccination should generally be deferred until the patient recovers.

Special Instructions

ABRYSVO is not for use in infants and should not be confused with other RSV products.

CDC recommends that adults 60 years of age and older may receive a single dose of RSV vaccine using shared clinical decision-making (SCDM). This means that health care providers and their patients should have a conversation to determine if RSV vaccination will be beneficial.

Risk factors for severe RSV disease for consideration

Epidemiologic evidence indicates that persons aged 60 years and older who are at highest risk for severe RSV disease and who might be most likely to benefit from vaccination include those with chronic medical conditions such as:

  • Lung disease;
  • Cardiopulmonary disease;
  • Kidney disorders;
  • Liver disorders;
  • Neurologic or neuromuscular conditions;
  • Hematologic disorders;
  • Diabetes mellitus;
  • Moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment);

As well as

  • Persons who are frail;
  • Persons of advanced age;
  • Persons who reside in nursing homes or other long-term care facilities;
  • Persons with other underlying conditions or factors that the provider determines might increase the risk for severe respiratory disease.

ACIP: Use of RSV Vaccines in Older Adults

Package Insert – AREXVY (fda.gov);  Package Insert – ABRYSVO (fda.gov);

RSV (Respiratory Syncytial Virus) Immunizations | CDC

Wording adapted from CDC to provide more clarity. https://www.cdc.gov/vaccines/vpd/rsv/hcp/pregnant-people.html