Enrolling Birthing Hospitals in Vaccines for Children to Protect Infants From RSV

Summary

• Already known: nirsevimab, a long-acting monoclonal antibody against respiratory syncytial virus (RSV), should be given within 1 week of birth to infants not protected by maternal RSV vaccination. The Vaccines for Children (VFC) program gives CDC-purchased immunizations, including nirsevimab, to eligible children at no cost.
• This report: a CDC effort with professional groups and health departments raised VFC-enrolled birthing hospitals from 763 (27.1% of 2,817) at the start of the 2023–24 RSV season to 1,021 (36.2%) by the end of 2024–25. Nirsevimab doses ordered roughly doubled.
• Implication: more enrollment can widen access to RSV immunization.

Why birthing hospitals

• The disease: RSV is the leading cause of hospitalization among U.S. infants, with 50,000–80,000 hospitalizations and 100–300 deaths a year in children under 5.
• The recommendation: in 2023, ACIP recommended either maternal RSV vaccination or nirsevimab for infants under 8 months in their first RSV season (October–March in most of the U.S.), ideally during the birth hospitalization or the first week of life. In September 2023, ACIP added nirsevimab to VFC.
• Who VFC serves: children who are uninsured or underinsured, on Medicaid, or American Indian or Alaska Native — about 52.2% of children aged 19–35 months, 93.4% of them on Medicaid. Medicaid-insured infants get severe RSV more often and are less likely to see a pediatrician in their first week, so the birth hospital may be their best chance. VFC enrollment also offsets nirsevimab's high cost.

What CDC did

• Listening: in April 2023, focus groups with 11 jurisdictions found hard-to-build relationships with hospitals, thin capacity, and a need for flexible rules.
• Simpler rules: CDC updated VFC policies for ordering and inventory, and let birthing hospitals stock only what is recommended in the first week — hepatitis B vaccine and nirsevimab — instead of every childhood vaccine.
• Partners: from August 2023, with the American Hospital Association, Association of Immunization Managers, America's Health Insurance Plans, ACOG, the American Academy of Pediatrics, the American College of Nurse-Midwives, CMS and Perinatal Quality Collaboratives: training, resources and learning collaboratives.

Results

By the end of the 2024–25 season, enrolled birthing hospitals covered about 41.8% of U.S. hospital births.

• Biggest gains among states and cities: New York state (2 to 54), Utah (5 to 24), Maine and Connecticut (to 100%), and New York City (26 to all 38).
• Doses: birthing hospitals ordered 46,738 VFC doses of nirsevimab in 2023–24 and 102,057 in 2024–25.

Next steps

• A target: from July 1, 2025, each jurisdiction must enroll ≥30% of its birthing hospitals as a condition of VFC funding; by March 31, 2025, 39 of 61 (63.9%) had.
• A second antibody: clesrovimab, recommended by ACIP in June 2025, will also be available through VFC.

Sources

Based on "Notes from the Field: Expanding Birthing Hospital Enrollment in the Vaccines for Children Program to Increase Infant Immunization Against Respiratory Syncytial Virus — United States, October 2023–March 2025," by Kerry E. Olmsted, Terrin Ramsey-Omonua, Ebony S. Thomas, James T. Lee, Llandess Owens, Sam Graitcer and Jamie Mells, Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention, using the American Hospital Association Annual Survey and CDC's Maternity Practices in Infant Nutrition and Care survey; a work of the United States government in the public domain. A social-media graphic is left out.