Immunisation Weekly Update:

Infant RSV immunisation program launches this week

The National RSV Mother and Infant Protection Program (RSV-MIPP) consists of two key components, offering multiple opportunities for infants to be protected from severe RSV disease.

• Abrysvo® maternal component: the NIP-funded maternal RSV vaccine program for pregnant women which commenced on 3 February 2025.
• Beyfortus™ infant component: the NSW Health state-funded nirsevimab program for eligible infants, commencing from 3 March 2025.

The Ministry of Health has brought forward the launch of the nirsevimab (Beyfortus™) infant RSV prevention program to 3 March 2025, earlier than the initially planned 17 March, as communicated in a letter to providers.

Refer to the RSV Prevention Program – Information for health professionals for further information and program resources.

Ordering

Nirsevimab (Beyfortus™) is now available to order via the nirsevimab special order form from the NSW Vaccine Centre.

There is currently no option to bulk order and a form must be completed for each individual, indicating the patient’s eligibility to receive nirsevimab. Ensure product has arrived ahead of the patient’s immunisation appointment.

Eligibility

The NSW Health infant RSV prevention program will fund nirsevimab (Beyfortus™) for the following infants (including those without a Medicare card):

• Newborn infants born from 3 March 2025 who are not protected by​​ maternal RSV vaccination or with risk factors for severe RSV disease – these newborns will be offered nirsevimab prior to discharge from hospital.
• Vulnerable infants born from 1 October 2024 to 16 March 2025 who meet the eligibility criteria for the NSW RSV Vulnerable Babies Program and not protected by maternal vaccination and did not receive nirsevimab at birth – these infants can receive nirsevimab catch-up through their local GP.
• At-risk children up to 24 months of age with risk conditions for severe RSV disease entering their second RSV season without known prior RSV infection – these children can receive nirsevimab through their local GP.

A catch-up letter is provided upon discharge of vulnerable infants eligible for catch-up nirsevimab, advising parents to contact their GP to discuss the immunisation from 1 March 2025.

Eligibility resources:

• Beyfortus™ eligibility clinical decision aids for newborn infants and at-risk children up to 24 months of age are available to assist providers to determine an infant’s eligibility to receive nirsevimab.
• The Abrysvo® and Beyfortus™ factsheet provides a summary of patient eligibility criteria.

Beyfortus^™ (nirsevimab) dosage and administration

Nirsevimab is a long-acting monoclonal antibody (mAB) for the prevention of RSV lower respiratory tract disease in neonates and infants born during or entering their first RSV season, and children up to 24 months of age who remain at risk of severe RSV disease through their second RSV season.

Presentation

Nirsevimab is available in two strengths: a 50mg 0.5mL prefilled syringe (purple) and a 100mg in 1mL prefilled syringe (blue).

Dosage

The recommended dosage of nirsevimab depends on the infants body weight at time of dosing, and whether the infant is entering their first or second RSV season:

• First season – infants weighing less than 5kg: 50mg by IM injection
• First season – infants weighing 5kg and over: 100mg b​y IM injection 
• Second season – infants at risk of severe RSV disease: 200mg by 2 x 100mg IM injections (given as two separate injections at the same visit)

Injection site

Nirsevimab is administered intramuscularly (IM) at the injection site recommended by the Immunisation Handbook. The gluteal muscle should not be used routinely as an injection site because of the risk of damage to the sciatic nerve. If two injections are required, different injection sites should be used.

Recording multiple doses on AIR

Some children require administration of 2 x 100mg doses of nirsevimab, therefore two separate injections, which may occur in different limbs. However, AIR does not record multiple doses as it is assumed to be a reporting error/duplicate data. For this scenario, Services Australia recommends that vaccinations providers report this to the AIR as one single dose.

See the information sheet developed by Services Australia on how to report infant vaccinations to the AIR, including for infants without a Medicare card.

Co-administration

Nirsevimab can be given at the same time as routine childhood vaccines. When co-administered with vaccines, they should be given with separate syringes and at different injection sites. Refer to NCIRS injection site poster.

Administration errors

The NCIRS clinical guidance on RSV immunisation product administration errors webpage provides advice on the management of a range of possible RSV immunisation product administration errors. This includes situations where the incorrect product is administered and where a product is administered to a person who is younger or older than the approved age registered for that product.

Authority to administer RSV immunisation products

Authorised nurse immunisers (ANIs) can independently administer Abrysvo® and Beyfortus™ as detailed in the Authority and Vaccination Standards – for Authorised Registered Nurse/Midwife Immunisers.

Pharmacist immunisers can independently administer Abrysvo® as detailed in the NSW Pharmacist Vaccination Standards and NSW Authority – Supply of vaccines by pharmacists.

Registered nurses (RNs), midwives and enrolled nurses (ENs) can prepare and administer Abrysvo®​ vaccine and Beyfortus™ under a medication order from a medical practitioner or nurse practitioner, who must also be available for supervision or advice if required. See NCIRS resource: Administration of vaccines – Scope of practice for healthcare professionals.

NIP influenza program advice and ATAGI statement 2025

Key messages for 2025 influenza program:

• Recommendation: Flu vaccine is recommended annually for all people ≥6 months of age to prevent influenza and its complications. A healthcare provider recommendation is the strongest predictor of a person’s decision to vaccinate – emphasise the importance of influenza vaccination to all patients ≥6 months of age.
• Vaccination timing: Annual influenza vaccination is recommended when it becomes available in March/April 2025, before the start of the influenza season.
• NIP funding eligibility: free flu vaccines will be available to eligible people under the NIP, including all children aged 6 months to 5 years, all adults aged 65 years and over, and people aged 5 years to 64 years with specific risk factors. Refer to 2025 flu vaccine eligibility poster.
• Coadministration: Influenza vaccines can be given at the same time as most other vaccines including COVID-19, RSV, and pneumococcal vaccines. Refer to the Immunisation Handbook.
• Pregnancy: Influenza vaccines are recommended for pregnant women in every pregnancy, at any stage of pregnancy, and can be co-administered with pertussis (20 to 32 weeks), maternal RSV (28 to 36 weeks), COVID-19 (if required) and other vaccines indicated during pregnancy.
• Adults aged 65 years and over: both Fluad® Quad adjuvanted vaccine (NIP funded) and Fluzone High Dose Quadrivalent (private market) are equally preferentially recommended over standard influenza vaccines.

Refer to 2025 influenza program resources:

• ATAGI statement on the administration of seasonal influenza vaccines in 2025
• NIP 2025 Influenza Vaccination – Program advice for health professionals
• 2025 influenza (flu) vaccination – Consumer fact sheet

Flu vaccine pre-allocation orders close on Friday

Prepare for the upcoming influenza season:

• Acknowledge your pre-allocation flu vaccine order by COB Friday 7 March 2025.
• Complete the 2025 flu checklist.
• Order flu campaign posters to display in your clinic.
• Download the 2025 Influenza Vaccination Toolkit.
• Refer to NSW Health site for information about the 2025 seasonal influenza vaccination program.

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