AREXVY VACCINATIONS

Arexvy, an RSV vaccine, has been authorized for use in Canada for the prevention of lower respiratory tract disease caused by RSV in adults 60 years of age and older. NACI is reviewing the use of Arexvy.

What

Respiratory syncytial virus (RSV) infection is a major cause of lower respiratory illness, particularly among infants, young children and older adults.
In Canada, RSV causes yearly outbreaks of respiratory tract disease, usually starting in late fall and running through to early spring.
Reinfections with RSV are common but illness is usually milder with subsequent infections.
At present there is no vaccine available in Canada to prevent RSV. The only means of prevention is temporary passive protection with the monoclonal antibody preparation palivizumab (PVZ).
PVZ contains antibody only against RSV.

Who

PVZ should be offered to:

Infants born at less than 30 weeks gestational age (wGA) and less than 6 months of age at onset of or during the RSV season.
Children less than 24 months of age with chronic lung disease (CLD) of prematurity who require ongoing oxygen therapy within the 6 months preceding or during the RSV season.
Infants less than 12 months of age at the onset of the RSV season with haemodynamically significant congenital heart disease (hsCHD).
Infants born at less than 36 weeks gestational age and who are less than 6 months of age at onset of or during the RSV season and living in remote northern Inuit communities who would require air transport for hospitalization.

PVZ may also be considered for:

Infants born at 30 to less than 33 weeks gestational age and less than 3 months of age at onset of or during the RSV season and who are at high risk for exposure to RSV
Select children less than 24 months of age with severe chronic lung disease due to cystic fibrosis (CF) or other etiology who require ongoing oxygen therapy or assisted ventilation in the 6 months preceding or during the RSV season.
Infants less than 12 months of age with haemodynamically significant chronic cardiopathy other than congenital.
Children 12 to 24 months of age awaiting heart transplant or having received a heart transplant within 6 months of onset of the RSV season.
Children less than 24 months of age who are severely immunocompromised.
Healthy full term infants less than 6 months of age at the onset of or during RSV season living in remote Inuit communities with very high rates of hospitalization for RSV among term infants.
Infants born at less than 36 weeks gestational age and less than 6 months of age living in other remote communities with high rates of hospitalization for RSV and where air transport would be required for hospitalization.
Controlling an outbreak of RSV in a neonatal intensive care unit (NICU) when all other control measures have failed.

PVZ has not been evaluated inchildren 2 years of age and older.

How

The first dose of PVZ should be given at the onset of the local RSV season.
A second dose of PVZ should follow at 21 to 28 days and the interval between subsequent doses is 28 to 35 days.
The usual maximum number of doses is four.
An additional dose should be given after cardiac bypass or extracorporeal membrane oxygenation.
An additional dose may be considered in remote northern areas where RSV outbreaks may continue longer than is usual elsewhere.
PVZ may be co administered with any other live or inactivated vaccines.

Why

RSV is the most common cause of bronchiolitis and pneumonia among infants and young children.
PVZ is approximately 40 to 80% effective in preventing hospitalization, depending on age and underlying health condition.

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AREXVY VACCINATIONS

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