Respiratory syncytial virus (RSV) is a common respiratory virus. RSV most often causes mild, cold-like symptoms, infants, especially those born prematurely or with underlying medical conditions are at higher risk for severe disease and death. During the current season, October 2025 to February 2026, the U.S. Centers for Disease Control and Prevention (CDC) estimates that as many as ten thousand people have died due to RSV.
To protect infants from RSV, maternal immunization with RSVpreF should be given during the third trimester and at least 2 weeks before delivery. In addition, infants may be given RSV vaccination if they are at high-risk for severe RSV or if decreased transplacental antibody transfer or inadequate immune response to immunization is suspected.
In today's side-by-side comparison, we look at the latest guidance from the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) on preventing RSV in infants.
WHO & AAP Guidance for Comparison
| Item | WHO Position Paper on Immunization to Protect Infants Against Respiratory Syncytial Virus Disease, May 2025 | Recommendations for the Prevention of RSV Disease in Infants and Children: Policy Statement |
|---|---|---|
| Authoring Organization | World Health Organization | American Academy of Pediatrics |
| Publication Date | May 2025 | August 2025 |
| Graded Recommendations | Yes | No |
| Uses GRADE | Yes | No |
| Links | Overview / Full Text | Summary / Full Text |
Key Takeaways
Population
A major difference between these two articles is WHO makes recommendations for immunizations for both pregnant mothers and infants/children to prevent RSV. Their recommendations take into consideration the feasibility, cost, and complexity of vaccine programs to make them adaptable in various regions throughout the world.
The recommendations from the AAP are for infants and children in the United States.
Schedule and Timing of Vaccination
WHO recommends either maternal vaccination with RSVpreF or infant vaccination with a long-acting monoclonal antibody (mAb) for most regions.
The AAP recommends infant vaccination with a long-acting mAb depending on maternal vaccination status, season, and individual risk factors for severe RSV.
- Maternal
- WHO recommends maternal vaccination with RSVpreF at the first antenatal care (ANC) visit in the third trimester, ideally at least 2 weeks before delivery. The vaccine should not be given to women in active labor.
- The AAP does not make recommendations on maternal vaccination outside of using maternal vaccination status to help determine if an infant/child should receive an RSV vaccination.
- Infant/Child
- WHO suggests year-round RSV immunization may be preferable in most countries, but if there is a clear and consistent season, seasonal immunization may be considered.
- The AAP recommends seasonal administration of the RSV vaccination from October thru March in most of the continental US.
- WHO recommends countries implementing a year-round approach to RSV administer an immunization at birth (before discharge from the birthing facility) or at the earliest opportunity after birth.
- WHO recommends countries implementing a seasonal approach to RSV vaccination should administer an immunization at birth or at the earliest opportunity thereafter and shortly before the start of RSV season.
- The AAP recommends that infants born during RSV season or who had prolonged hospitalization and are being discharged during RSV season be vaccinated before they are discharged from the birthing facility or within one week of birth for those going home shortly after birth.
- The AAP recommends eligible infants less than 8 months of age born outside of RSV season be vaccinated shortly before or during RSV season.
Vaccine Choice
WHO recommends either maternal RSVpreF immunization or a long-acting mAb (nirsevimab) but not both for the same mother-infant pair unless maternal vaccination was less than 14 days before delivery or the infant is at high-risk for severe RSV and entering their first RSV season after the age of 6 months. WHO also states that in some high income settings both maternal and infant immunization may be offered.
The AAP recommends nirsevimab and clesrovimab as first-line immunization products for infants, administered shortly before or during the infants first RSV season. Use of short-acting mAb, palivizumab has been discontinued as of December 30, 2025.
Co-Administration with Other Vaccines
- Maternal
- WHO states that maternal RSVpreF can be administered on the same day as other immunizations, but other maternal immunizations should not be deferred until the third trimester so that they can be given with the RSV vaccine.
- The AAP does not address co-administration of maternal RSVpreF with other immunizations.
- Infant/Child
- Both societies state that RSV immunization can be administered simultaneously with other childhood immunizations.
- Vulnerable/Special Populations
- WHO recommends considering RSV immunization for children less than 2 years of age who are at very high risk for severe RSV when they are entering their second RSV season.
- The AAP recommends high-risk children between the ages of 8 and 19 months be vaccinated against RSV with nirsevimab in their second RSV season.
Comparison of Recommendations
| Type | WHO | AAP |
|---|---|---|
| Population | Given the global burden of severe RSV disease among young infants, WHO recommends that all countries introduce products for the prevention of severe RSV disease in this population. Decisions to use maternal RSV vaccination and/or a long-acting mAb should consider factors such as cost, cost-effectiveness, financing, supply, anticipated coverage and feasibility of implementation within the existing health system. In countries using a long-acting monoclonal antibody as the only immunization product against RSV, a dose for premature infants is important. Due to financial or programmatic constraints, some countries may opt for a selective approach – administering RSV mAbs only to high-risk infants, such as those born preterm or those with underlying conditions (e.g., severe lung or heart disease, immunocompromised status). | The American Academy of Pediatrics (AAP) recommends respiratory syncytial virus (RSV) immunization for: Infants <8 months of age born during or entering their first RSV season if: Pregnant parent did not receive RSVpreF vaccine during this pregnancy; Pregnant parent’s RSVpreF vaccination status is unknown; Or infant was born <14 days after the pregnant parent’s RSVpreF vaccination. Immunization is not needed for most infants <8 months of age whose pregnant parent received RSVpreF vaccine during the pregnancy and ≥14 days before giving birth. RSV immunization may be considered for infants born to a vaccinated pregnant parent in rare circumstances when, based on the clinical judgment of the health care provider, the potential incremental benefit of administration is warranted. These situations include, but are not limited to: Infants born to pregnant people who may not mount an adequate immune response to RSV vaccination (e.g., pregnant people with immunocompromising conditions). Infants born to pregnant people who have medical conditions associated with reduced transplacental antibody transfer (e.g., pregnant people living with HIV infection). Infants who have undergone cardiopulmonary bypass (see nirsevimab FDA package insert and clesrovimab FDA package insert) or extracorporeal membrane oxygenation (ECMO), leading to loss of maternal antibodies. Infants with substantial increased risk for severe RSV disease (e.g., hemodynamically significant congenital heart disease, intensive care admission with a requirement of oxygen at discharge). |
| Schedule and Timing of Maternal Vaccination | For countries deciding to use the maternal vaccine as the primary preventive strategy, WHO recommends administering a single dose of RSVpreF in the third trimester of pregnancy, as defined in the local context (defined as ≥28 weeks gestation in most settings). Maternal RSV vaccination should be administered at the first ANC visit in the third trimester to increase the likelihood that vaccine-induced antibodies against RSV will be transferred to infants born preterm. Ideally, vaccination should occur more than two weeks before delivery…no upper limit of week of gestation for vaccination is recommended except for women in active labour who should not receive the RSV vaccine. Although a causal link between maternal RSV vaccination and preterm birth has not been established, the recommendation to limit vaccination to the third trimester is precautionary. Currently, there are no contraindications for the use of either RSV immunization product among persons living with HIV, although data on this population remain limited. | Not addressed. |
| Schedule and Timing of Childhood Vaccination | A year-round approach to RSV immunization is likely to be preferable for both products in most countries in tropical and subtropical regions where RSV circulates for much of the calendar year and/or seasonality patterns are not well-described. In addition, a year-round approach is likely to enhance programmatic feasibility and would not be affected by year-to-year or within-country variability in RSV seasonality that could make a seasonal approach challenging. For countries with documented clear and consistent seasonal peaks in RSV circulation, a seasonal approach to RSV immunization can be considered on the basis of programmatic and cost considerations. For countries deciding to use a long-acting monoclonal antibody as the primary preventive strategy, WHO recommends a single dose at birth, or at the earliest opportunity thereafter if year-round administration is adopted. In settings where long-acting mAbs are offered in a year-round approach, the product should be administered to infants soon after birth and before being discharged from the birthing facility. If not given as a birth dose, it can be given during the first postnatal health-care contact. In a seasonal approach, administration of a single dose of a long-acting monoclonal antibody is recommended for infants and should begin shortly before the start of the RSV season, as well as at birth or the earliest opportunity thereafter for infants born during the RSV season. In a seasonal approach, when given to older infants just before entering their first RSV season, a long-acting monoclonal antibody can be administered at routine immunization visits or other scheduled well-child visits. | While the timing of the onset and duration of RSV season may vary, RSV immunization may be administered from October through the end of March in most of the continental United States. The timing of the onset, peak, and decline of RSV activity vary geographically, and providers may adjust timing of administration based on guidance from public health authorities (e.g., Centers for Disease Control and Prevention [CDC], local health departments) or regional medical centers. Infants born during the RSV season should receive RSV immunization within one week of birth, ideally during their birth hospitalization. However, administration can occur during any visit to a health care setting, including well-child visits. Eligible infants with prolonged birth hospitalizations because of prematurity or other causes, who are discharged during RSV season, should receive RSV immunization shortly before or promptly after discharge from the hospital. Eligible infants who are <8 months of age and born outside of RSV season should receive RSV immunization shortly before or during the RSV season. Administration can occur during any visit to a health care setting, including well-child visits. |
| Product Choice | WHO recommends the use of either the maternal RSV vaccine (RSVpreF) or a long-acting monoclonal antibody (nirsevimab), but not both, for the same mother-infant pair. An exception to this recommendation is the option to offer a long-acting monoclonal antibody to babies whose mothers were vaccinated <14 days before delivery and to infants of vaccinated mothers who are still at high risk of severe RSV disease upon entering their first RSV season after the age of six months, when antibodies from maternal vaccination have waned. In some high income settings, both maternal vaccination and mAbs administered to infants might be used within a comprehensive RSV preventive programme. | Nirsevimab and clesrovimab are considered the first-line recommended immunization products for administration to infants to protect against medically attended RSV disease. They are long-acting monoclonal antibody products administered as a single dose for administration during an infant’s first RSV season. The AAP recommends any licensed RSV immunization product appropriate for age and health status and does not prefer one product over another. Palivizumab is a short-acting monoclonal antibody product that is administered in monthly doses during the RSV season. Palivizumab is no longer routinely recommended for use and will be discontinued as of December 31, 2025. |
| Co-Administration with Other Vaccines | RSVpreF can be administered along with other vaccines recommended during pregnancy, including simultaneous vaccination at different anatomical sites on the same day. However, other vaccines that can be given earlier in pregnancy (e.g., tetanus vaccine) should not be delayed or deferred for co-administration with RSVpreF. In settings using only maternal vaccination, RSV vaccine can be given during subsequent pregnancies as there is potential benefit and no expected harm from revaccination. However, no data are currently available on the efficacy or safety of additional vaccine doses in subsequent pregnancies. Long-acting monoclonals can be co-administered with vaccines (e.g., BCG, Hepatitis B, DTP). Long-acting mAbs can be given to newborns in subsequent pregnancies and can also be given to newborns of mothers who have been given maternal RSV vaccine in a prior pregnancy. | Not addressed. In accordance with AAP’s general best practices for immunizations, (https://publications.aap.org/redbook) simultaneous administration of RSV immunization with age-appropriate vaccines is recommended. |
| Vaccination of Vulnerable and Special Populations | If feasible and affordable, a dose of long-acting monoclonal antibody can be considered for infants and children aged <2 years who are at very increased risk for severe RSV disease (e.g., having severe lung or heart disease, severely immunocompromised, extremely premature) upon entering their second RSV season. | Only children 8 through 19 months who meet high-risk criteria should receive RSV immunization in their second RSV season. Nirsevimab is approved for this indication; clesrovimab is not. Infants and children 8 through 19 months of age at high risk of severe RSV disease and entering their second RSV season, regardless of the RSV vaccination status of the pregnant parent or the child’s prior receipt of nirsevimab or clesrovimab when <8 months of age in their first RSV season. High-risk criteria include the following: Children with chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) at any time during the 6-month period before the start of the second RSV season. Children with severe immunocompromise. Children with cystic fibrosis who have either: manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persists when stable), or weight-for-length that is less than the 10th percentile. American Indian or Alaska Native children. |
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