Guidelines
RSV Prophylaxis

RSV Prophylaxis

Criteria for Approval

Infants born prematurely at less than 32 completed weeks gestational age and less than 6 months of age at the start of, or during, the local RSV season.

Children less than 24 months of age with bronchopulmonary dysplasia (BPD)/chronic lung disease (CLD) of prematurity who have required oxygen and/or ongoing medical therapy within the 6 months preceding the RSV season.

Duration of oxygen and/or details of medical therapy must be provided with the request. BPD/CLD medical therapies include: corticosteroids, bronchodilators, and diuretics specifically for the management of BPD/CLD.

Children less than 24 months of age with haemodynamically significant cyanotic or acyanotic congenital heart disease (requiring corrective surgery or on cardiac medication for haemodynamic considerations).

Specific diagnosis and/or cardiac medications must be provided with the request.

Infants in the 33 to 35 completed weeks gestational age cohort and less than 6 months of age at the start of, or during, the local RSV season and who live in isolated communities where hospital care is not readily accessible and ambulance transportation for hospital admission is required.

Infants in the 33 to 35 completed weeks gestational age cohort and less than 6 months of age at the start of, or during, the local RSV season who DO NOT live in isolated communities AND have a Risk Assessment Tool Score between 49 and 100.

A completed Risk Assessment Tool signed by the requesting physician must accompany the RSV request form. The Risk Assessment Tool is now part of the Enrolment Form and can be accessed HERE.

Infants with Down Syndrome/Trisomy 21 and less than 24 months of age at the start of the local RSV season.