COVID, Influenza, & RSV Resource Page

Updated: November 2024
These resources will be updated as the respiratory viral season and product availability change in Chicago and across the United States.  
Reach out to [email protected] for questions regarding this content. For individual product availability, contact your local site. This content is intended as a clinical resource for prescribers at NM.​

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

COVID Guideline

Co-administration of Vaccines: 

• Coadministration is acceptable 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

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​
  

Which vaccines and products are available: 

• COVID-19: for 2024-2025, the updated (monovalent) vaccine are available, targeted against Omicron variant KP.2. See CDC updates for more information.
• Influenza: seasonal vaccine products for NM are in drop down below.
• RSV: 
  • RSV vaccine for all ≥75 years old (one lifetime dose), 60-74 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.

​​For vaccine locations: see the CDC vaccines.gov​​​
For patient facing information: See FDA Resources for Fall Respiratory Illness Season

Viral Vaccine Specific FAQ Continued:​

COVID-19 vACCINES

See CDC COVID Vaccine FAQ for further patient FAQs.
​Disclaimer: resource links are updated frequently
​

​Northwestern Medicine COVID-19 Patient Information

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

• Immunocompetent people should receive one of the following 2024-2025 monovalent COVID-19 vaccines:
  • Moderna (Spikevax): 0.5 mL IM dose x1
  • Pfizer-BioNTech (Comirnaty): 0.3 mL IM x1 dose
• Immunocompromised people: 
  • Previously vaccinated: should receive one updated monovalent vaccine and have the option to receive an additional updated vaccine 2 months after their 1st update vaccine
  • Not previously vaccinated:
    • Moderna (Spikevax): 3 doses of 0.5 mL IM; 4 weeks between each dose
    • Pfizer-BioNTech (Comirnaty): 3 doses of 0.3 mL IM; 3 weeks between dose 1 & 2, 4 weeks between dose 2 & 3

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Special populations and FAQ:

• ​Immunocompromised people: have the option to receive an additional monovalent vaccine dose 2 months after the last 2024-2025 monovalent dose
• People ages 65 years and older: eligible for a second 2024-2025 COVID-19 vaccine between 2-6 months after their first vaccine
• Timing of COVID Vaccine after COVID illness recovery: may consider delaying vaccination for 3 months after symptom onset or positive test
• See CDC Recommendations for people vaccinated outside of the United States
• Reimbursement / patient cost:
  • Medicare Part B: covered with no patient cost-sharing
  • Medicaid/CHIP: covered with no patient cost-sharing

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

• Children 5 to 11 years old: 
  • Moderna COVID-19 2024-2025 vaccine for emergency use: 0.25 mL IM x1
  • Pfizer COVID-19 2024-2025 vaccine for emergency use: 0.3 mL IM x1
• Children 6 months to 4 years old:
  • Moderna COVID-19 2024-2025 vaccine for emergency use: 
    • Not previously vaccinated: 2 doses of 0.25 mL; week 0, week 3-8 after dose 1
    • 1 or more previous COVID-19 vaccines: 1 dose of 0.25 mL 4-8 weeks after last dose
  • ​​Pfizer COVID-19 2024-2025 vaccine for emergency use:
    • ​Not previously vaccinated: 3 doses of 0.3 mL; week 0, week 3-8, and ≥8 weeks after dose 2
    • Previously received 1 COVID-19 vaccine: 2 doses of 0.3 mL; 3-8 weeks after previous dose and ≥8 weeks after dose 2
    • Previously received >1 COVID-19 vaccine: 0.3mL IM x1, ≥8 weeks after the last dose
  • 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 applies only to the following people who are not moderately or severely immunocompromised
• See CDC Recommendations for COVID-19 Vaccine Interchangeability
• Immunocompromised children 6 months and older:
  • ​​Previously fully vaccinated: should receive one updated vaccine and have the option to receive an additional updated vaccine 2 months after their 1st update vaccine
  • ​Not previously vaccinated: ​3 doses of Pfizer-BioNTech or Moderna updated vaccine. See CDC recommendations for schedule

Influenza vACCINES

For comprehensive information, see CDC Flu Vaccine Site.

​Vaccine products available at NM:

• Regional Medical Group/Northwestern Medical Group: Fluzone (0.5 mL IM; ≥ 6 months old) and High-dose Fluzone (0.7 mL IM; ≥65 years old)
• Regional Medical Group, Northwestern Workforce, Non-Ambulatory: Fluarix (0.5 mL IM; ≥ 6 months old)
• Available at all sites: Flumist (0.2 mL intranasal 2 to 49 years old), Flucelvax (0.5 mL IM; ≥ 6 months old) 

​
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
• Self-administered intranasal influenza vaccine will not be available this season 2024-2025
• Reimbursement / patient cost:
  • Medicare Part B: covered with no patient cost-sharing
  • Medicaid/CHIP: covered with no patient cost-sharing

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 ≥ 60 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 ≥60 years old:

• Any patient ≥75 years old is recommended to receive an RSV vaccine
• Any patient 60-74 years old is recommended to receive an RSV vaccine with risk factors for severe disease
• ​Available outpatient: 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 CDC 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

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​

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

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Treatment and Post-Exposure Prophylaxis (PEP):

COVID-19

Northwestern Medicine Treatment Options:

• Clinical Pathway – ED, Floor and ICU Patients
• NIH Inpatient Therapy Guidance - Hospitalized
• NIH Outpatient Therapy Guidance – Ambulatory​
• Northwestern Medicine COVID-19 Patient Information 

Guidelines and Resources:

• ​NIH COVID-19 Treatment Guidelines
• ​IDSA COVID-19 Treatment Guidelines ​​

Paxlovid:​​

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

Molnupiravir

• EUA Information for Healthcare Providers
• ​Patient EUA Fact Sheet

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.