RSV prevention programs

Under Ontario’s Infant and High-Risk Children RSV Prevention Program, there are two publicly funded products for eligible Ontarians that can be used for the prevention of disease during the RSV season.

• Beyfortus^® (nirsevimab) is a monoclonal antibody and can be given to infants and high-risk children up to 24 months of age
• Abrysvo^® (RSVpreF) can be given to pregnant individuals to subsequently protect their infants

With the significant positive outcomes (i.e., high uptake and reduced hospitalizations) observed through Ontario's RSV prevention program over the past two respiratory illness seasons, Ontario will continue to offer nirsevimab (Beyfortus®) for eligible infants and high-risk children based on demonstrated effectiveness and duration of protection.  

For those interested in an alternative approach, RSVpreF (Abrysvo®) vaccination during pregnancy is also an effective option for infant RSV protection.  

Health care providers caring for pregnant individuals should provide information on both RSVpreF (Abrysvo®) and nirsevimab (Beyfortus®) to support informed decision-making and obtain informed consent.

Eligibility

All infants born Apr. 1, 2026, or later and who are less than eight months of age at the time of administration are eligible for Beyfortus®. Infants born earlier in the year should be vaccinated toward the start of the season.

In addition, children up to 24 months of age who remain at increased risk for severe RSV disease due to certain health conditions are eligible. This includes children with:

• Chronic lung disease of prematurity (CLD), including bronchopulmonary dysplasia, requiring ongoing assisted respiratory support and supplemental oxygen therapy at 36 weeks post-menstrual age (gestational age at birth plus chronological age) or discharged home, if earlier 
  
  • Note: Children who were less than 12 months of age and approved for coverage in the previous RSV season for chronic lung disease and bronchopulmonary dysplasia remain eligible
• Hemodynamically significant congenital heart disease (CHD) requiring corrective surgery or are on cardiac medication for congestive heart failure or diagnosed with moderate to severe pulmonary hypertension
• Severe immunodeficiency
• Down syndrome / Trisomy 21
• Cystic fibrosis with recent pulmonary exacerbations requiring hospitalization, deteriorating pulmonary function and/or severe growth delay
• Neuromuscular disease impairing clearing of respiratory secretions 
• Severe congenital airway anomalies impairing the clearing of respiratory secretions

To identify infants and high-risk children in your practice who are eligible for RSV immunization, consider using OMD’s EMR queries.

Pathways for administration for infants

Beyfortus® and Abrysvo® (during pregnancy) should be administered shortly before and during the active RSV season. The active RSV season is typically Nov. 1 to Mar. 31, generally peaking in December. Pending product availability, administration of either Beyfortus® or Abrysvo® (during pregnancy) for the infant and high-risk children program can begin October 1. 

The RSV season typically concludes on March 31, and RSV immunizing agents for the infant program should not be administered after this date. If seasonal epidemiology warrants a change, the ministry will provide notice of the revised infant prevention program end date.

Beyfortus® can be given alongside other vaccines during routine childhood vaccine visits. 

• Eligible infants born in hospital during RSV season:
  • Should be immunized prior to discharge
  • If not immunized prior to discharge, can be immunized by primary care
• Eligible infants born outside of hospital: can be immunized by primary care, public health, or midwife practices  
• Eligible children: can be immunized by primary care, pediatric specialists, or outpatient hospital clinics

Under the Ontario RSV prevention program, RSVpreF (Abrysvo®) is available to pregnant individuals between 28 and 36 weeks gestation who are expected to deliver during the RSV season.

Abrysvo® is indicated by Health Canada for use in pregnant individuals between 32 and 36 weeks gestation. The National Advisory Committee on Immunization (NACI), in alignment with the World Health Organization, recommends that Abrysvo® may be administered between 28 and 36 weeks gestation based on the available efficacy and safety data. Note that administration before 32 weeks is considered off-label and is subject to the sole clinical judgment of the health care provider.

Administration of both Abrysvo® in pregnancy and Beyfortus® to the infant is not recommended except for:

• Infants born less than 14 days after administration of Abrysvo® OR
• Infants increased risk of severe RSV disease, including all premature infants (i.e., <37 weeks gestation) OR
• Infants who meet any of the criteria for high risk (see ‘Eligibility’ above)

There is currently no evidence on repeat vaccination with RSVpreF (Abrysvo®) in subsequent pregnancies. Pregnant individuals should discuss with a health care provider. To provide RSV protection to infants born in subsequent pregnancies, consider administration of nirsevimab (Beyfortus®) to the infant after birth. 

The older adult RSV immunization program will operate year-round as studies have shown the vaccines offer multi-year protection.

Publicly funded RSV vaccines Arexvy and Abrysvo®  are available for:

• All individuals aged 75 and older
• Those 60 to 74 years who are: 
  • residents of long-term care homes, Elder Care Lodges, or retirement homes including similar settings (e.g., co-located facilities)
  • recipients of a hematopoietic stem cell transplant within the past two years or with ongoing immunosuppression
  • individuals on home oxygen or requiring chronic oxygen therapy, regardless of residence
  • patients in hospital receiving alternate level of care (ALC) including similar settings (e.g. complex continuing care, hospital transitional programs)
  • patients with glomerulonephritis (GN) who are moderately to severely immunocompromised 
  • patients receiving hemodialysis or peritoneal dialysis
  • recipients of solid organ transplants
  • people experiencing homelessness
  • people who identify as First Nations, Inuit, or Métis

Boosters are not recommended by NACI at this time. If the individual received an RSV vaccine in a previous season, they do not need another one. 

• Fee code: G700 (basic fee) + G849 (Respiratory Syncytial Virus [RSV])

Note: If the RSV monoclonal antibody or vaccine is the sole reason for the visit, G700 may be eligible for payment in addition to G849.  Eligibility requirements for G700 are on page J3 of the current OHIP Schedule of Benefits for Physician Services.

If you are administering the RSV monoclonal antibody or vaccine at the same time as another vaccine, you can bill G849 for the RSV product in addition to the applicable vaccine fee codes. If these two vaccines are the sole reason for the patient’s visit, G700 can be applied to the visit.

• Service: Appropriate assessment fee code (for example, A007 for intermediate assessment or well baby care) + G849 (Respiratory Syncytial Virus [RSV])

• Service: Appropriate assessment fee code, e.g., H001/H261 (newborn care in hospital and/or home) + G849 (Respiratory Syncytial Virus [RSV])

• Service: Appropriate individual counselling code (e.g., K013)* + G849 (Respiratory Syncytial Virus [RSV])

* One unit of counselling = one-half hour or major part thereof (minimum time requirement for first unit is at least 20 minutes)

NOTE: To be eligible for payment using the K013 individual counselling code, the visit must be pre-booked as a counselling visit, which is a visit dedicated solely to an educational dialogue with a physician.

For example, if a parent comes in for a well-baby visit and a second appointment is required to provide education around vaccine safety and efficacy, a second visit could be booked as a counselling visit and billed using the K013 individual counselling code. 

If the visit is not pre-booked as a counselling visit, the amount payable will be adjusted to a lesser assessment fee.

For more information on billing counselling codes, refer to the Schedule of Benefits or page 14 of this OHIP brief on assessments and consultations.