Respiratory Disease Updates for Virginia

Respiratory Disease Updates for Virginia

January 16, 2024

Dear Colleague:

Virginia continues to see high levels of respiratory illness throughout the Commonwealth. Emergency department (ED) and urgent care visits due to influenza-like illness remain significantly elevated (6% of ED and urgent care visits), especially among young children in the 0-4 years age group (14.6% of ED and urgent care visits for this age group). Additionally, multiple indicators of COVID-19 activity remain elevated, but may be beginning to decrease. Respiratory Syncytial Virus (RSV) activity has declined over the last several weeks. Please read below for updates on how to continue keeping yourself and your patients healthy.

CDC Advises Clinicians to Resume Using ACIP Recommendations for the Use of Nirsevimab

Healthcare providers are encouraged to administer the monoclonal antibody immunization, nirsevimab, to protect infants against severe RSV. Nirsevimab, along with two RSV vaccines, became available in 2023, but demand initially exceeded supply. In response to an increase in supply of nirsevimab, the Centers for Disease Control and Prevention (CDC) recently alerted health care providers to return to using Advisory Committee on Immunization Practices (ACIP) recommendations on use of nirsevimab in young children. Key notes of this communication include:

  • Although supply of nirsevimab is expected to increase, available supply may continue to vary locally and by healthcare facility.
    • In settings where there is increasing supply, infants and children who are eligible to receive nirsevimab should be immunized as soon as possible. Doses should not be reserved for infants born later in the season when RSV exposure risks may be lower.
    • For settings that continue to have limited supply, nirsevimab should be prioritized to protect infants at the highest risk for severe RSV disease using the following principles: first by high-risk conditions and then by age, prioritizing the youngest infants first.
  • Pregnant people 32 through 36 weeks gestation should receive RSV vaccination through January. Pfizer Abrysvo is the only RSV vaccine recommended for use in those who are pregnant.
  • Administration of both nirsevimab and RSV vaccination for pregnant people is not needed to protect most infants. Seasonal administration of maternal RSV vaccine is only recommended through the end of January for most of the continental United States, including Virginia. Infants born to unvaccinated mothers during RSV season should instead receive nirsevimab through the end of March in Virginia.
  • As a reminder, neither RSV vaccine (Pfizer Abrysvo, GSK Arexvy) is approved for use in infants or young children.

I encourage all birthing hospitals and providers who treat children on Medicaid or who are uninsured to consider enrolling in the Virginia Vaccines for Children Program to ensure access to nirsevimab for these vulnerable populations. Providers with continued supply issues should contact their Sanofi representative. Please see CDC’s latest communication for more information.

Respiratory Immunization Rates in Virginia

In Virginia, immunization coverage for COVID-19 and influenza remains low for children and adults, with only 11% and 28% of eligible Virginians getting vaccinated, respectively. For RSV immunization coverage in Virginia, over 273,200 doses of RSV vaccine (Pfizer’s Abrysvo or GSK’s Arexvy) have been administered to adults aged 60 years and older (14.1% of the population). Approximately 7,100 doses of nirsevimab (Sanofi and AstraZeneca Beyfortus) have been administered to children under one year of age (7.3% of the population).

If you do not already, please consider carrying these vaccines for administration in your clinics to ensure access for your patients. Additionally, two programs in Virginia provide access to free COVID-19 vaccines: the Virginia Vaccines for Adults – Bridge (VVAB) Program and the Virginia Vaccines for Children (VVFC) Program, which also provides access to other vaccines and nirsevimab. To learn more about these programs, you can contact our team via the VDH Immunization Webpage.

COVID-19 and Influenza Treatment Recommendations

Healthcare providers should recommend antiviral medications for influenza and COVID-19 for all eligible patients, especially patients at high-risk of progression to severe disease such as older adults and people with certain underlying medical conditions. According to a recent notification from CDC, antiviral medications for COVID-19 and flu are currently underutilized. Prompt antiviral treatment has been shown to reduce the risk of disease complications, including hospitalization and death; these medications are important to treat patients, especially persons at high-risk of progression to severe disease. CDC recently circulated a Health Alert Network Health Advisory with therapeutic recommendations for COVID-19 and flu. Additionally, VDH maintains web pages for providers that share up to date treatment recommendations for COVID-19 and influenza. There is no current evidence that Paxlovid, or any COVID-19 antiviral drug, is less effective against the predominant Omicron JN.1 variant.

Expansion of Home Test to Treat Program

On December 6, 2023, the National Institutes of Health (NIH) announced the expansion of the Home Test to Treat program to include all adults nationwide and to provide services for both influenza and COVID-19. Through this federal program, eligible adults can receive free at-home testing for COVID-19 and influenza A and B, a free telehealth visit with a medical provider, and a prescription for COVID-19 and/or influenza treatment, if needed. Providers are encouraged to tell patients about this program and encourage them to contact the program early in their course of illness. For more detailed information or to register for the program, go to the Home Test to Treat Program website.

Thank you again for your continued partnership in keeping Virginians safe from respiratory illnesses. Please visit the VDH website for current clinical and public health guidance on respiratory diseases in Virginiaand other information.   


Karen Shelton, MD
State Health Commissioner