Respiratory Syncytial Virus

How can my client born in the community receive Beyfortus?

Midwives may consider one or more of the following suggestions to facilitate access to Beyfortus for infants born in the community this RSV season: 

• Seek extension of hospital medical directive to the community setting
• Refer to general care provider (i.e. GP, NP, Family Health Team, Community Health Centre)
• Consider referral pathways to existing postpartum programs that may be able to offer vaccination concurrently (i.e. outpatient bilirubin clinic, Healthy Baby Healthy Children (HBHC) programs, Family Health Team that offers tongue-tie release or lactation support services)
• Obtain a medical directive from a local health-care provider (i.e. pediatrician, GP or NP) to administer in clinic or other out-of-hospital settings*
• Direct to a regional public health vaccine clinic. Vaccine clinics will serve uninsured and/or unattached clients 

The AOM recognizes that access is more difficult in northern, rural and remote locations where clients may not have the same outpatient services or public health units that offer vaccines locally. In these cases, it may be helpful to collaborate directly with your community partners to develop solutions tailored to your unique circumstances.

*Offering RSV vaccination in out-of-hospital settings relies on the midwife’s knowledge, skills and clinical judgment. Health-care providers administering vaccinations must be knowledgeable about the signs and symptoms of adverse reactions and possess the necessary skills to manage them appropriately.

[September 2024]

Who do I contact at my local public health unit regarding Beyfortus administration?

Midwives should contact the immunization program at your local public health unit. 

To learn which public health unit covers your community, view the list of health units sorted by municipality OR the list of municipalities sorted by health unit. Then, look up the contact information for your public health unit and sub-offices (PDF, 1 MB).

[September 2024]

How do I prepare to manage adverse reactions to Beyfortus in the community setting?

According to the National Advisory Committee on Immunization (NACI) and Ontario Ministry of Health, Beyfortus is safe for most infants. 

RSV prevention products, including the monoclonal antibody or vaccine, may be associated with mild side effects that typically resolve within a few days. Common side effects of Beyfortus (nirsevimab) include localized redness, swelling and/or pain at the injection site. Other mild side effects include rash and low-grade fever. 

Severe reactions, including hives (urticaria), swelling of the mouth or throat (angioedema), difficulty breathing, wheezing or shortness of breath (dyspnea), high fever (pyrexia), seizures or any other serious symptoms, require immediate assessment at the nearest emergency department. 

Offering RSV immunization in community settings relies on the midwife’s knowledge, skills, and clinical judgment. Health-care providers administering immunizations must be knowledgeable about the signs and symptoms of adverse reactions and possess the necessary skills to manage them appropriately. If planning to administer Beyfortus (nirsevimab) under a medical directive, refer to established protocols for guidance on appropriate actions to take in the event of an adverse reaction.

For more comprehensive information on immunizations, visit the Canadian Immunization Guide. To learn more about vaccine safety, including the management of anaphylaxis and other adverse reactions, refer to the section: Anaphylaxis and other acute reactions following vaccination. This section provides essential information on: 

• post-vaccination observation
• anaphylaxis management kits* 
• basic steps for managing anaphylaxis in a community setting 
• dosage of intramuscular epinephrine based on age or weight

*Anaphylaxis management kits should be readily available wherever vaccines are administered. Never administer an immunization without having an anaphylaxis management kit immediately available.

After immunization, be sure to inform parents about possible side effects and when they should page, visit the nearest emergency department or call 911.

For specific resources on RSV prevention products, including the monoclonal antibody or vaccine, visit:
 

Public Health Agency of Canada: Respiratory syncytial virus (RSV) vaccines

• Includes key information on authorized preparations in Canada, efficacy and effectiveness, vaccination guidelines for specific populations, administration practices, storage requirements, safety and potential adverse events

National Advisory Committee on Immunization (NACI): Statement on the prevention of respiratory syncytial virus disease in infants

• Provides comprehensive information on RSV prevention products, including a comparison table of products authorized for use in Canada, vaccine efficacy, concurrent administration with other vaccines, product safety, as well as contraindications and precautions

For detailed information on Beyfortus (nirsevimab) including contraindications and precautions, please refer to the product monograph. 

Download this information in PDF format.

[September 2024]

What considerations exist for the timing of Beyfortus administration in the community setting?

Beyfortus may be kept at room temperature (20 - 25°C) for a maximum of eight hours and must be discarded if not used within that time limit.  

Given these storage and disposal requirements, midwives may find the day one or two visit a more reasonable time for administration than immediately after the birth in home or community settings.

If planning to administer Beyfortus in the community setting, the midwife must be knowledgeable about the signs and symptoms of adverse reactions and possess the necessary skills to manage them appropriately.

[September 2024]

References

1. Health Canada. Respiratory syncytial virus (RSV): For health professionals. June 21, 2024. Accessed at: https://www.canada.ca/en/public-health/services/diseases/respiratory-syncytial-virus-rsv/health-professionals.html 

2. Abrams E., Doyon-Plourde P., Davis P., et al. Burden of disease of respiratory syncytial virus in infants, young children and pregnant women and people. Canada Communicable Disease Report Volume 50-1/2, January/February 2024. Accessed at: https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2024-50/issue-1-2-january-february-2024/burden-disease-rsv-infants-children-pregnant-women-persons.html