Speakers
- Dr Conall Watson
- Professor Chrissy Jones
- Nigel Gooding
- Mandy Matthews
- Dr Anoo Jain
- Laura Wilson
- Dr Thomas Williams MRCPCH PhD
Date of Recording
July 3, 2026
Available Until
July 2, 2027
Please note that the content of this webinar represents the expertise and views of the speakers and chairs and does not necessarily represent formal College policy. The speakers are, however, referring to national and regional guidance
RCPCH campaign for an RSV vaccination programme
Visit the RCPCH website to read more
Green book – Immunisation against infectious disease
https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book
Respiratory syncytial virus: the green book
https://www.gov.uk/government/publications/respiratory-syncytial-virus-the-green-book
Guide to the use of human and animal products in vaccines
https://www.gov.uk/government/publications/use-of-human-and-animal-products-in-vaccines/guide-to-the-use-of-human-and-animal-products-in-vaccines
Northern Ireland
Presentation slides from the webinar
RCPCH Grand Round – RSV immunisation update 2026 [all speakers]
ENFLONSIA® 105 mg solution for injection in pre-filled syringe
https://www.medicines.org.uk/emc/product/102120/smpc#gref
Beyfortus 50 mg solution for injection in pre‑filled syringe
https://www.medicines.org.uk/emc/product/101052/smpc#gref
The table below contains the questions posted by the audience during the webinar (verbatim) and the written responses from the speaker panel.
It may be useful to use ‘Find on page’ (CTRL + F on your keyboard) to search for a specific word or phrase relating to a question you may have.
| Question | Answer |
| why do we think more deprived families are less likely to immunise? | Barriers to accessing healthcare, if they don’t have a car and can’t afford transport to the GP. Disadvantaged families tend to miss opportunities of accessing health care. Chronic health issues within the home especially if parental then less able to get to appointments. etc Also, there tends to be less access to health education and knowledge in families who are deprived. |
| Is there a more cost-effective contract price for either clesrovimab or nirsevimab that has been negotiated to prioritise NHS resources? | Pharmacy department procurement teams will have access to the prices for clesrovimab and nirsevimab on the Medicines Procurement and Supply Chain (MPSC) framework. |
| Blueteq – Infant’s chronological age (at time of treatment). Feel this data is inaccurate at time of completing the form as we are unable to predict the exact date of treatment at this point, due to needing to submit the form prior to the treatment date, and baby’s condition and discharge date being variable and often unpredictable. So how important is the accuracy of the infant’s chronological age when inputting this on the blueteq form? | Can complete Blueteq form just before treatment date or immediately afterwards. |
| Last year the push was to order only when patients were confirmed – this was difficult given the supply issues. Presumably this year we can hold stock at the start of the season and top-up throughout. Similarly with the blueteq forms – some of the data age/ gestational age was not compulsory – making these compulsory might improve the data set. | Supply of both clesrovimab and nirsevimab will be available in England to support the 2026/27 season. Supply may be phased over July to December so trusts are encouraged to order responsibly, noting that not all stock for the seaon is required on day 1. |
| Are there any data coming through showing other high risk babies apart from CLD, CHD or SCID? | If there are other groups that specialist organisations feel should receive RSV immunisation, with evidence to support this then they can approach JCVI to review and discuss further. |
| Is there any information for giving either subcutaneous due to anticoagulation | There is no data from clinical trials as all was given IM. Please refer to the Green Book RSV chapter for consideration on SC and IM use in warfarinised/heparinised infants. IM may still be an option for some depending on the assessment of a suitable clinician/independent prescriber potentially as an MDT assessment. Subcut would be off-label. Post event note: it would be useful to develop a case series of safety/reactogenicity in SC recipients. |
| Table 1 in the Green Book for Chronic Lung disease and Congenital heart disease (taking into account gestational and postnatal age) was based on the cost-effectiveness of Palivizumab. Is it still valid for Nirsevimab/Clesrovimab? | The Green Book box and table on CLD and CHD was developed for palivizumab but remains valid for nirsevimab/clesrovimab. |
| 0.7mL dosing – in one administration or likely to be spilt dosing for smaller babies? | It is very reasonable to split the 0.7mL clesrovimab intramuscular dose to be given as two (or potentially more) divided IM doses (e.g. left and right leg anterolateral thigh) if there is a concern the volume is too high for a single site injection in a neonate or other low muscle mass patient. |
| Can a Blueteq form be deleted by the user if a patient needs to be given the alternative agent due to lack of availability? | A Blueteq form can be deleted or updated to note treatment not received in this scenario. |
| in terms of supply & procurement; is there supply of each product 50% or 100% ; will there be an issue if we all use 1 first line; will one run out? any guidance to mange stock | Both manufacturers have been contacted to discuss stock availability and we are not expecting this to be a problem this year. Supply may be phased over July to December so trusts are encouraged to order responsibly, noting that not all stock for the seaon is required on day 1. |
| If Trusts choose to move to the cost effective choice, is there enough in the supply chain to meet this demand? | Both manufacturers have been contacted to discuss stock availability and we are not expecting this to be a problem this year. Supply may be phased over July to December so trusts are encouraged to order responsibly, noting that not all stock for the seaon is required on day 1. |
| Or should nirsevimab 50mg in 0.5ml be used? | If this is related to the 0.7mL clesrovimab question, clesrovimab is licensed from birth and the dose can be given divided to two IM sites. There is no reason to chose nirsevimab 50mg/0.5ml simply to be using a lower volume product. Note that the Sumsuzzman systematic review in Lancet Child and Adolescent Health suggests their finding of a lower central estimate for nirsevimab protection in infants <3months old compared to older may be related to the weight-banded lower dosing in this age group. |
| Table 1 in the Green Book for Chronic Lung disease and Congenital heart disease (taking into account gestational and postnatal age) was based on the cost-effectiveness of Palivizumab. Is it still valid for Nirsevimab/Clesrovimab? | Yes |
| Is it anticipated that centres will select to use either nirsevimab or clesrovimab for the season (supplies allowing) as opposed to using/ordering both to avoid prescribing errors? | This is a decision for Trusts/centres. Hospital pharmacies and paediatric MDTs are familar with having multiple products available for the same indications and managing drug risk. As the products have equal first line status, the clinical consequences of a direct nirsevimab/clesrovimab error are likely to be low. |
| is there any information re Halal products that comply with Islamic laws for Nirsevimab or now also Clesrovimab | There is no mention of pork gelatine in the excipient lists or elsewhere in the summaries of product characteristics for either product. Further input from health professionals highly familar with Islamic laws is very welcome. Clesrovimab https://www.medicines.org.uk/emc/product/102120/smpc#gref Nirsevimab https://www.medicines.org.uk/emc/product/101052/smpc#gref Additional information on the use of human and animal products in vaccines is available from https://www.gov.uk/government/publications/use-of-human-and-animal-products-in-vaccines/guide-to-the-use-of-human-and-animal-products-in-vaccines |
| are there going to be separate bluteq forms for Clesrivomab & nirsevimab? how do we choose which one to request for the individual baby? ( esp. for mop up clinics to avoid prescribing/ administration errors) | Yes – there will be separate forms for both drugs; one form per drug and per high-risk group so 8 forms in total |
| Who can we contact if we have information regarding groups of children outside of the commissioning criteria? | A commissioning decision would be required; if there are other groups that specialist organisations feel should receive RSV immunisation, with evidence to support this then they can approach JCVI to review and discuss further. |
| Please answer the question on timing as that affects discharge from the units from a practical point of view | For infants being discharged from a neonatal unit, we would recommend administration approx 1 week prior to a planned discharge date. If the baby is being moved from a neonatal unit to a paediatric clincal area then a dose should be administered ideally at least 1 week before the transfer. |
| If a patient was discharged last week of February and did not receive a dose can they have the dose in September catch up clinic? | Yes, as this would be classed as their 1st RSV season, so if eligible they should join the catch-up clinic, if they meet the criteria |
| Should the mab be given to babies whilst still an inpatient who may or may not be discharged by 28th/29th Feb or is it better to not immunise until the following year when the baby will be in the community for the rsv season? | If not discharged by end of Feb, then would suggest following these infants up in the following season catch up clinic, providing all criteria would stil be met (e.g. less than 12 months of age for BPD , CHD or very/extremely pre-term). |
| The most up to date version of JCVI advice is dated 18th March 2026, not 3rd June as mentioned in the presentation. | Green book RSV chapter was updated 3rd June; see https://www.gov.uk/government/publications/respiratory-syncytial-virus-the-green-book |
| There was an older comorbitiy table is that still the same | The 3 June Green Book chapter introduced an additional table for older adult RSV risk groups as table 1. The infant risk table is erronously also still labelled as table 1 in this version and will be amended in the next update of the chapter |
| We have babies on heparin infusions or warfarin, should we still give it IM. | The Green Book covers this in the administration section of the RSV chapter. |
| what would happen if there is an accident in giving the dose and the dose is not administered – i.e. user or product error, would the patient be eligible to get a replacement or does this not get reimbursed | The Trust is expected to provide the patient with a suitable dose of a long acting monoclonal antibody, at the appropriate time to give them protection in the RSV season. If the dose was not administered due to an error, prompt steps should be taken to provide timely protection. The cost of drug lost through an an accident or error (or fridge failure etc) is usually borne by the trust. Reducing the frequency of this obviously increases the resources available for patient care. |
| Could you please answer the question on screen regarding will there be anticipated stock availability issues? | Both manufacturers have been contacted to discuss stock availability and we are not expecting this to be a problem this year. Supply may be phased over July to December so trusts are encouraged to order responsibly, noting that not all stock for the seaon is required on day 1. |
| There used to be an old comorbidity table – are we still Using this |
Please refer to the Green Book RSV chapter Box and Table. |
| BPSU study reporting severe RSV hospitalisation cases? | This is a welcome suggestion; it warrants some consideration on which patient groups might be appropriate (potentially 12m and older) for BPSU cards to be able to do risk group assessment without being overly high volume |
| are they the same price? | Pharmacy department procurement teams will have access to the prices for clesrovimab and nirsevimab on the Medicines Procurement and Supply Chain (MPSC) framework. |
| What are the differences in cost between Nirsevimab and Clesrovimab? | Pharmacy department procurement teams will have access to the prices for clesrovimab and nirsevimab on the Medicines Procurement and Supply Chain (MPSC) framework. |
| Is the catch up window 4 weeks, as it was last year? | Mid September to Mid October. |
| clesrovimab doesn’t seem to have made it to the BNFC app yet, will it be added? | Would expect this to be included in BNFC with it’s updates. |
| We were only asked once in last years clinic if this was an approved product ie animal or human deriviant but no information available to provide the answer to family | Thanks, this is helpful for understanding; further discussion is welcome; it appears there are differing interpretations on whether monoclonal antibodies are halal or haram. The high risk of severe RSV in children who are eligible for clesrovimab and nirsevimab in the UK selective immunisation programme may also inform considerations on medicial necessity and permissibility within Islamic law. The SmPC state: Clesrovimab is a fully human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody produced in Chinese hamster ovary (CHO) cells by recombinant DNA technology. Nirsevimab is a human immunoglobulin G1 kappa (IgG1κ) monoclonal antibody produced in Chinese hamster ovary (CHO) cells by recombinant DNA technology. |
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Speakers
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Dr Conall Watson
Consultant Epidemiologist, Public Health Infection Programmes - UK Health Security Agency
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Professor Chrissy Jones
Professor in Paediatric Immunity and Infection - University of Southampton
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Nigel Gooding
Consultant Pharmacist - Neonates and Paediatrics and Lead Pharmacist - East of England ODN
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Mandy Matthews
Senior Pharmacy Lead, Specialised Commissioning - NHS England
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Dr Anoo Jain
Consultant in Neonatal Medicine, Bristol NHS Foundation Trust, Honorary Treasurer of the British Association of Perinatal Medicine (BAPM)
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Laura Wilson
Seasonal Vaccination & Strategy Unit Head - Scottish Government
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Dr Thomas Williams MRCPCH PhD
Senior Clinical Research Fellow, University of Edinburgh & Honorary Consultant in Paediatric Respiratory and Sleep Medicine
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