COVID, Influenza, & RSV Resource Page

Updated: September 2025
These resources will be updated as the respiratory viral season and product availability change across Chicago.  
Reach out to [email protected] for questions regarding this content. For individual product availability, contact your local site. This content is intended as a resource for prescribers at NM. Decisions surrounding vaccinations may be based on shared decision making between the patient (or patient's representative) and the treating clinician. ​

COVID-19, Influenza, and RSV Frequently Asked Questions:

COVID Treatment Guideline

Which vaccines and products are available: 

• COVID-19: for 2025-2026, the updated vaccine will be available in ambulatory settings and on formulary. Across NM, Pfizer Comirnaty vaccine will be available. For children 6 months - 4 years old: Moderna Spikevax will be available.
  • See ​Illinois Department of Health COVID-19 & Seasonal Respiratory Vaccination 2025-2026 for seasonal COVID vaccine clinician guidance. Qualifying groups for Illinois include patients age 6-24 months and over 18 years, ages 2-17 with risk factors or with shared decision making.
• Influenza: seasonal vaccine products for NM include Fluzone (0.5 mL IM; ≥ 6 months old) and High-dose Fluzone (0.7 mL IM; ≥65 years old)
• RSV: 
  • RSV vaccine for all ≥75 years old (one lifetime dose), 50-74 years old with risk factors for severe disease (one lifetime dose), and for pregnant patients between 32-36 weeks gestational age are available in outpatient settings and at community pharmacies.
  • Pediatric RSV monoclonal antibody (nirsevimab) for newborns and infants is available in the outpatient setting, for more information, see the RSV mAB drop down below.
• Pneumococcus: PCV20 (PREVNAR 20®) is on formulary at Northwestern Medicine for children and adults. 

Vaccine Specific FAQ Continued:​

COVID-19 vACCINES

​Disclaimer: resource links are updated frequently. Recommendations below are based on FDA approved package insert labeling.
Northwestern Medicine COVID-19 Patient Information
​​

COVID-19 Vaccine Adult and Children ≥12 years old:

• Adults ≥65 years of age and people 12-64 years of age with a condition that puts them at high risk for severe outcomes from COVID-19 should receive one of the following 2025-2026 COVID-19 vaccines:
  • Moderna (Spikevax): 0.5 mL IM dose x1
  • Pfizer-BioNTech (Comirnaty): 0.3 mL IM x1 dose

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Special populations and FAQ:

• ​Timing of COVID Vaccine after COVID illness recovery: may consider delaying vaccination for 3 months after symptom onset or positive test​
• Immunocompromised people:
  • Previously vaccinated: should receive one updated vaccine and have the option to receive an additional updated vaccine 2 months after their 1st updated vaccine 
• Pemivibart (Pemgarda): monoclonal antibody for COVID-19 pre-exposure prophyalxis for people who are moderately or severely immunocompromised and unlikely to mount an adequate immune response to COVID-19 vaccination
  • Administer at least 2 weeks after COVID-19 vaccination
  • Receiving Pemgarda does not prevent ability to receive a COVID-19 vaccine

​COVID-19 Vaccine Schedules for Children <12 years old:

• Children 5 to 11 years old: 
  • Moderna COVID-19 2025-2026 vaccine: 0.25 mL IM x1
  • Pfizer COVID-19 2025-2026 vaccine: 0.3 mL IM x1
• Children 6 months to <5 years old:
  • Moderna COVID-19 2025-2026 vaccine: 
    • <2 years old and not previously vaccinated: 2 doses of 0.25 mL; one month apart
    • Children 2 to <5 years old OR <2 years old and 1 or more previous COVID-19 vaccines: 0.25 mL IM x1
  • An 8-week interval between the first and second COVID-19 vaccine might be optimal for some people as it might reduce the rare risk of myocarditis and pericarditis associated with these COVID-19 vaccines. This only applies to people who are NOT moderately or severely immunocompromised.

Influenza vACCINES

​Special population FAQ:

• Pregnancy/Chronic Medical Conditions/Immunocompromised: Avoid Flumist intranasal (live vaccine) 
• 6 months – 8 years: should receive two doses of the influenza vaccine for their first season
• Age 65+: high dose vaccine is recommended 
• Adult solid organ transplants between 18-64 years old may receive high dose vaccine (Fluzone HD) or adjuvanted IIV (Fluad) per ACIP
• Caregivers/Contacts of high-risk patients who receive Flumist intranasal (live vaccine) should avoid severely immunocompromised patient for 7 days 
• Egg allergy: can receive any flu vaccine formulation 
• If previous severe allergic reaction to flu vaccine, avoid formulations that contain eggs
• In patients recovering from moderate to severe infection related illness, no flu vaccine wait period beyond illness recovery
• ​Reimbursement / patient cost:
  • Medicare Part B: covered with no patient cost-sharing
  • Medicaid/CHIP: covered with no patient cost-sharing

​Live flu vaccine considerations:

• COVID-19, RSV, and intramuscular influenza vaccines available at NM are all inactivated vaccines.
  • Inactivated vaccines can be given regardless of timing of any live or inactivated vaccine administration.
• Flumist intranasal (live vaccine), if used, should be administered simultaneously with other live vaccines or separate subsequent live vaccines by 4 weeks​

Influenza vaccination after antivirals: inactivated vaccines are appropriate anytime.

• Avoid giving Live attenuated vaccine (Flumist intranasal vaccine) after the patient received: 
  • Oseltamivir/Zanamivir: 48 hours before or 2 weeks after
  • Peramivir: 5 days before or 2 weeks after
  • Baloxavir: 17 days before or 2 weeks after

RSV VACCINE (Adults ≥ 50 Years old and Pregnancy)

RSV Vaccines for pregnant patients:

• Recommended by the CDC to be given in pregnancy during 32-36 weeks gestational age for the prevention of severe infant RSV infection
• Available outpatient: Abrysvo (Pfizer) 0.5 mL IM x1 dose​

 
RSV Vaccines for ≥50 years old:

• Any patient ≥75 years old is recommended to receive an RSV vaccine
• Any patient 50-74 years old is recommended to receive an RSV vaccine with risk factors for severe disease
• ​Available outpatient across NM sites: Abrysvo (Pfizer) 0.5 mL IM x1 dose
• Reimbursement / patient cost:
  • Medicare Part D: covered with no patient cost-sharing
    • Patients must have Part D for coverage. The patient may have to pay a vaccine administration fee at the time of service, but they can get reimbursed in full for this fee from their Part D plan
  • Medicaid/CHIP: covered with no patient cost-sharing

RSV Pediatric monoclonal Antibody: Nirsevimab (Beyfortus)

For inpatient nirsevimab (Beyfortus) use, please see the NM protocol. For general recommendations and timing, see below.
​

RSV Pediatric mAB Product (nirsevimab):

• Recommended by the Illinois Department of Public Health to be given to children <8 months old if:
  1. Mother did not receive RSV vaccine or unknown OR Mother was vaccinated but infant born <14 days after vaccination AND
  2. RSV season (October through March) AND
  3. Did not receive a previous dose of nirsevimab
  • For other exceptions, see the AAP considerations
  • Nirsevimab visual guide and administration instructions

Infants <8 months born during or entering 1st RSV season or 8-19 months old who are at increased risk of severe RSV disease entering their second RSV season:

• < 5 kg: 50 mg IM x1 dose
• ≥ 5 kg: 100 mg IM x1 dose​
• 8-19 months old with risk factors: 200 mg IM x1 dose (administered as 2 doses of 100 mg)

RSV Pediatric mAB Product (nirsevimab) FAQ:

• Either maternal vaccination or use of nirsevimab in the infant is recommended to prevent RSV lower respiratory tract infection, but administration of both products is not needed for most infants
• Nirsevimab is recommended to be given to newborns within the first week of life during RSV season
• Pediatric RSV mAB (nirsevimab) + routine childhood vaccines: ok to give simultaneously​​
• See AAP FAQ resource for more nirsevimab information
• See ACIP and AAP resource for additional information for patients post palivizumab (Synagis)
• For patients who received cardiopulmonary bypass, see Beyfortus package insert for dosing

Pneumococcal vaccines

NM Medicine Formulary

• PCV20 (PREVNAR 20®) is on formulary at Northwestern Medicine for children and adults.
• NM Medicine offers PCV20 vaccine to inpatients 65 and older who have no documented PCV15, PCV20, or PCV21 vaccination; an Illinois statute requires hospitals to identify and offer the vaccine to qualifying patients.
• Clinics or pharmacies outside of NM may carry PCV 15 or PCV 21.

CDC/ACIP Recommendations

• Go to the CDC’s PneumoRecs VaxAdvisor to provide personalized vaccine recommendations for each child and adult.
• Children: PCV20 or (PCV15 + PPSV23)
• Adults: ACIP recommends pneumococcal vaccination for all adults 50 years and older along with 19-49 years old with certain risk factors. The ACIP has equivalent recommendations for PCV20, PCV21 or both (PCV15 + PPSV23). PCV21 (CAPVAXIVETM), PCV15 (VAXNEUVANCE®) and PPSV23 (PNEUMOVAX®) are available at commercial pharmacies but are non-formulary at NM.

Co-Administration of vaccines

Co-administration of Vaccines: 

• Coadministration is acceptable [decisions surrounding vaccinations may be based on shared decision making between the patient (or patient's representative) and the treating clinician] for any combination of the following:
  • COVID-19, Influenza, and RSV (and other adult routine vaccines): ok to give simultaneously​
  • Pediatric RSV mAB (nirsevimab), routine childhood vaccines, COVID-19, and Influenza vaccines: ok to give simultaneously
  • In accordance with clinical trials and AAP’s general best practices for immunizations, simultaneous administration of RSV immunization with age-appropriate vaccines is recommended

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Treatment and Post-Exposure Prophylaxis (PEP):

COVID-19

Northwestern Medicine Treatment Options:

• COVID Treatment Guidance
• ​​Northwestern Medicine COVID-19 Patient Information 

Guidelines and Resources:

• ​IDSA COVID-19 Treatment Guidelines ​​
• NIH Inpatient Therapy Guidance - Hospitalized
• NIH Outpatient Therapy Guidance – Ambulatory

Paxlovid:​​

• Paxlovid Treatment Considerations
• Drug interaction Resources: University of Liverpool Drug-Drug Interaction Checker and IDSA Paxlovid Drug Interactions Guidance​

Molnupiravir

• EUA Information for Healthcare Providers

Influenza

See the CDC influenza Antiviral Medication Summary for more details

Oseltamivir
​Treatment:

• Adult dose: 75 mg twice daily for 5 days
• See Antimicrobial Dosing Page for adjustment for patients with renal dysfunction 
• Pediatric doses:
  • <1 year old: 3mg/kg/dose twice daily for 5 days
  • >1 year old and child's weight:
    • ≤15 kg: 30 mg twice daily for 5 days
    • >15 to 23 kg: 45 mg twice daily for 5 days
    • >23 to 40 kg: 60 mg twice daily for 5 days
    • >40 kg: 75 mg twice daily for 5 days

​Post-exposure prophylaxis:

• Adult dose: 75 mg daily for 7 days
• Pediatric doses: same doses above with once daily dosing for 7 days

Treatment and post-exposure prophylaxis for Novel Influenza A:

• Dosing: see treatment doses above. Treatment and prophylaxis dose and frequency are the same, durations are recommended from 5-10 days

​Baloxavir
Treatment and prophylaxis (regimen are the same):

• Adult dose: 
  • <80 kg: 40 mg x1
  • ≥80 kg: 80 mg x1
• Pediatric dose (for 5 years and older): 
  • <20 kg: 2 mg/kg oral suspension x1​
  • 20 to <80 kg: 40 mg x1
  • ≥80 kg: 80 mg x1

Avoid co-administration of baloxavir with calcium, iron, aluminum, zinc, and magnesium containing products

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Influenza post-exposure prophylaxis (PEP) considerations:

• ​Indications for PEP with oseltamivir: 
  • High risk of flu complications during first two weeks following vaccination with exposure 
  • High risk of flu complications who cannot receive vaccine with exposure 
  • Severe immune deficiencies or those who might not respond to vaccination with exposure 
• Patients receiving PEP should be educated to seek medical evaluation if they develop a febrile respiratory illness ​
• For hospitalized and LTC outbreak settings, oseltamivir should be given for at least two weeks and continuing up to one week after last known case

Influenza PEP High Risk per the IDSA Flu Guidelines:

• ​Asymptomatic adults and children aged ≥3 months who are at very high risk of developing complications from influenza (eg, severely immunocompromised persons) and for whom influenza vaccination is expected to have low effectiveness, after household exposure to influenza
• Adults and children aged ≥3 months who are unvaccinated and are household contacts of a person at very high risk of complications from influenza (eg, severely immunocompromised persons), after exposure to influenza

RSV

No routine antiviral treatment for RSV is recommended at this time.