Implementing RSVpreF Vaccine and Nirsevimab Across a Health System: A Quality Improvement Initiative

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Publication Date

7-16-2026

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Presentation: 41:13

Abstract

Respiratory syncytial virus (RSV) is a leading cause of hospitalization among infants, with treatment largely limited to supportive care. In 2023, the Food and Drug Administration approved two immunizations to prevent RSV disease in infants: RSVpreF vaccine administered during pregnancy and nirsevimab administered to infants from birth to eight months of age. This quality improvement initiative describes implementation of these immunizations across ambulatory and inpatient settings in a mid-sized health system over three RSV seasons, with the goal of maximizing RSV protection among eligible infants. Key interventions included creation of a multidisciplinary steering group, process mapping during initial implementation, staff and clinician education, and electronic health record enhancements to support patient identification and safe administration. Before the second RSV season, the health system’s five then-current birthing hospitals obtained Vaccines for Children certification, allowing nirsevimab administration soon after birth and before discharge. A sixth birthing hospital joined the initiative before the third season. The primary measure was total RSV protection events, calculated as the combined number of RSVpreF vaccine doses administered during pregnancy and nirsevimab doses administered to infants. Total RSV protection events increased from 2,444 in season one to 4,475 in season two and 4,926 in season three for a total of 11,845 RSV protection events across three seasons. An exploratory outcome, same-season RSV-related emergency department visits or hospital admissions, was 2.3, 5.8, and 4.2 per 1,000 nirsevimab doses across the three seasons, respectively. This initiative demonstrated the feasibility of rapidly implementing RSVpreF vaccination and nirsevimab across a health system. Multidisciplinary leadership, standardized workflows, EHR support, and hospital-based nirsevimab administration were key elements in expanding RSV protection for infants.

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English

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