RSV prevention programs

Under Ontario’s Infant and High-Risk Children RSV Prevention Program, there are two products 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, and Abrysvo^TM can be given to pregnant individuals to subsequently protect their infants. Both products are publicly funded for individuals who are Ontario residents and meet eligibility criteria.

Beyfortus^® and Abrysvo^TM 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^TM for the infant and high-risk children program can begin in early October.

All infants born Apr. 1, 2025, or later who are up to eight months of age at the time of administration are eligible for Beyfortus^TM. Infants must be less than eight months of age before the end of the RSV season to be eligible for immunization, those born earlier in the year should be vaccinated toward the start of the season.

In addition, children up to 24 months of age who are at increased risk 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 postmenstrual 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.

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

Pathways for administration to infants

• Infants born in hospital during RSV season should be immunized prior to discharge.
• Infants not immunized in hospital prior to discharge, or infants born outside of hospital, can be immunized by primary care, including: 
  • Infants up to eight months old at the time of administration, who were born Apr. 1, 2025, or after
• Children up to 24 months who are high-risk due to specific health conditions can be immunized by primary care, pediatric specialists, or outpatient hospital clinics
• Currently, the National Advisory Committee on Immunization (NACI) preferentially recommends the use of Beyfortus^® for infant protection due to its effectiveness, long-lasting protection, and positive safety profile. However, when parents or guardians do not wish to or are unable to immunize their infant with Beyfortus^®, the pregnant individual between 32-36 weeks gestation can be vaccinated for passive protection of the infant, if they will deliver during the RSV season.

Immunizing the infant directly with Beyfortus^TM is preferred; however, when parents or guardians do not wish to or are unable to immunize their infant with Beyfortus^TM,  the pregnant individual can be vaccinated for passive protection of the infant.   

Pregnant individuals in the third trimester of pregnancy (from 32 to 36 weeks gestation) who will deliver near the start of or during RSV season are eligible for an RSV vaccine. The product to be used is Abrysvo^TM.  

In most circumstances, if the infant will be receiving will be receiving Beyfortus^TM, there is not an added benefit to the pregnant individual receiving Abrysvo^TM. However, when a pregnant individual has received Abrysvo^TM, immunization with Beyfortus^TM for the infant should be considered for: 

• Infants born less than 14 days after administration of Abrysvo^TM OR infants who meet the medical criteria for increased risk of severe RSV disease, including all premature infants (i.e., <37 weeks gestation) 

Publicly funded RSV vaccines Arexvy and AbrysvoTM  are available for all individuals aged 75 and older and 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)
• 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 or hematopoietic stem cell 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 this season. 

• Fee code: G700 (basic fee) + G538 (other immunizing agents)

Note: If the RSV monoclonal antibody or vaccine is the sole reason for the visit, G700 may be eligible for payment in addition to G538.  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 G538 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) + G538 (other immunizing agents)

• Service: Appropriate assessment fee code, e.g., H001/H261 (newborn care in hospital and/or home) + G538 (other immunizing agents)

• Service: Appropriate individual counselling code (e.g., K013)* + G538 (other immunizing agents) 

* 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.