SIBRO Recommendation

The first choice of RSV prevention is Nirsevimab;
alternatively, palivizumab is to be considered in case of unavailability of Nirsevimab.

Eligibility considerations regarding Nirsevimab were as follows:

Clinicians should target the administration of Nirsevimab in the 1st week of life for infants born shortly before and during the RSV season.
ALL infants aged 12 months born during or going into their first RSV season are recommended to receive one dose of Nirsevimab.
Toddlers aged 13–24 months who are at increased risk of severe RSV disease are recommended to receive one dose of Nirsevimab.
An immunoprophylaxis strategy in the KSA for all infants during their first RSV season is strongly recommended to dramatically reduce the RSV burden and use of health‐care resources.

The SIBRO panel recommends RSV mAb as a prevention strategy that should be inserted into routine immunization calendars

RSV: Respiratory syncytial virus; mAb: monoclonal antibody

References

Alharbi, A. S., Alqwaiee, M., Al-Hindi, M. Y., Mosalli, R., Al-Shamrani, A., Alharbi, S., Yousef, A., Al Aidaroos, A., Alahmadi, T., Alshammary, A., Miqdad, A., Said, Y., & Alnemri, A. (2018). Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). Annals of thoracic medicine, 13(3), 127–143. https://doi.org/10.4103/atm.ATM_60_18

Saudi Initiative of Bronchiolitis Diagnosis, Management, and Prevention (Nirsevimab administration guide)

RSV: Respiratory syncytial virus; mAb: monoclonal antibody

References

Alharbi, A. S., Alqwaiee, M., Al-Hindi, M. Y., Mosalli, R., Al-Shamrani, A., Alharbi, S., Yousef, A., Al Aidaroos, A., Alahmadi, T., Alshammary, A., Miqdad, A., Said, Y., & Alnemri, A. (2018). Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). Annals of thoracic medicine, 13(3), 127–143. https://doi.org/10.4103/atm.ATM_60_18

Recommendations for Nirsevimab Immunoprophylaxis
^*The recommended interval between the last dose of palivizumab and a dose of Nirsevimab (in High-risk Infants) is 1 month (similar to the interval if the infant were to receive another dose of palivizumab).[5]
^& The recommendations for Nirsevimab for high-risk children apply to infants and children recommended to receive palivizumab. [1]
To realize the full benefits of mAbs before each season, it is recommended that age-eligible infants be recalled at the start of the RSV season before they become ineligible based on age if nirsevimab is available Administering nirsevimab through the end of the season is important because the risk of severe disease is highest during the first few months of life [31]
^#Maternal vaccination efficacy is not established in: Women with high-risk pregnancies such as multiple pregnancy, pregnancy induced or chronic diseases, evidence of placental insufficiency or fetus/newborn with major congenital anomaly Infants who have undergone cardiopulmonary bypass or extracorporeal membrane oxygenation leading to loss of maternal antibodies. Infants with substantial increased risk for severe RSV disease (eg, hemodynamically significant congenital heart disease, intensive care admission and requiring oxygen at discharge). Infant born within 14 days of maternal RSV vaccine [58]
^@ High-risk infants who are hospitalized or still in NICU during the season should get the recommended schedule. Also, eligible infants at the beginning of the season and ready for discharge from NICU should receive the first dose up to 72 hours prior to discharge. [28]
^{^}The mAb included Palivizumab & Nirsevimab does not interfere with the immune response to live or inactivated vaccines. The childhood immunization schedule should be followed for all children, regardless of mAb use [30]
Intramuscular (IM) injection Use a 22–25-gauge needle. [5]	Age	Needle length	Injection site
	Newborns (1st 28 days)	⅝^"a	Anterolateral thigh muscle
	Infants (1–12 months)	1^"	Anterolateral thigh muscle
	Toddlers (1–2 years)	1–1¼^"	Anterolateral thigh muscle ^c
		⅝^b–1^"	Deltoid muscle of arm

RSV=Respiratory syncytial virus, CLD=Chronic lung disease, IM=Intramuscular, mAbs=Monoclonal antibodies, NICU=Neonatal intensive care unit

Considerations for high-risk infants

Immunoprophylaxis for high-risk infants should be administered during the regular follow-up in high-risk infants’ specialized clinics.
The first choice of RSV immunoprophylaxis is Nirsevimab. Alternatively, Palivizumab is to be considered in case of unavailability of Nirsevimab.
If Palivizumab was administered in the previous RSV season. Nirsevimab is to be given for the next season.
If Palivizumab was administered initially for <5 doses in the season, one dose of Nirsevimab is recommended. No further Palivizumab is needed.
In the context of a limited supply of Nirsevimab, it is recommended to suspend using Nirsevimab in Palivizumab-eligible children.

RSV: Respiratory syncytial virus

References

Alharbi, A. S., Alqwaiee, M., Al-Hindi, M. Y., Mosalli, R., Al-Shamrani, A., Alharbi, S., Yousef, A., Al Aidaroos, A., Alahmadi, T., Alshammary, A., Miqdad, A., Said, Y., & Alnemri, A. (2018). Bronchiolitis in children: The Saudi initiative of bronchiolitis diagnosis, management, and prevention (SIBRO). Annals of thoracic medicine, 13(3), 127–143. https://doi.org/10.4103/atm.ATM_60_18

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MAT-KW-2400552-V1 - November 2024