Respiratory Disease Updates for Virginia

via VDH

Dear Colleague:

Respiratory virus season has started and the Centers for Disease Control and Prevention (CDC) predicts we will see a similar number of hospitalizations due to respiratory illness as last season. Please read below for updates on how to prepare for the upcoming season to help keep you and your patients healthy and safe.

Immunizations Available to Protect Against Three Major Respiratory Illnesses

Fortunately, we now have immunizations to protect against three major respiratory illnesses: respiratory syncytial virus (RSV), COVID-19, and influenza (flu). Please see VDH’s summary table on fall and winter immunizations that you can share with your patients. The VDH Respiratory Diseases in Virginia website provides clinical and communication resources, including the VDH Respiratory Disease Toolkit.

Thank you for your partnership in ensuring all eligible Virginians have access to these important immunizations. VDH administers the Virginia Vaccines for Adults – Bridge (VVAB) Program and the Virginia Vaccines for Children (VVFC) Program. The VVAB program ensures access to COVID-19 vaccines for under and uninsured adults in Virginia. The VVFC program ensures access to the CDC Advisory Committee on Immunization Practices (ACIP) routinely recommended vaccines for uninsured and Medicaid-enrolled children in Virginia. I encourage you to offer these immunizations in your office and enroll in these programs if applicable. To learn more about these programs, you can contact our team via the VDH Immunization Webpage.

FDA Advises Health Care Providers to Ensure Correct Moderna Vaccine Dosing

On November 1, 2023, the U.S. Food and Drug Administration (FDA) issued a MedWatch alert regarding the Moderna COVID-19 Vaccine (2023-2024 Formula) for children aged 6 months to 11 years. The single dose vial of the Moderna COVID-19 Vaccine for this age group contains notably more than the actual dose (.25 mL), and there is concern that some providers may administer the entire contents of the vial. Please work with your staff to ensure the correct amount of vaccine is withdrawn from the vial to ensure patients receive the correct dose. For more information, visit the FDA webpage.

CDC Provides Options for Clinicians in Response to a Limited Supply of Nirsevimab

On October 23, 2023, CDC issued a Health Alert Network (HAN) Health Advisory in response to a limited supply of nirsevimab, a monoclonal antibody product to protect infants and young children from lower respiratory tract infection caused by RSV. For the 2023–2024 RSV season there are not sufficient 100mg dose prefilled syringes of nirsevimab to protect all eligible infants weighing ≥5 kg and supply of the 50mg dose prefilled syringes might also be limited. Below is a summary of the CDC recommendations to protect infants from RSV during the shortage; please refer to the CDC Health Alert for complete detail:

  • Prioritize 100mg doses of nirsevimab for infants at the highest risk for severe RSV disease: young infants (age <6 months) and infants with underlying conditions that place them at highest risk for severe RSV disease.
  • Avoid using two 50mg doses for infants weighing ≥5 kilograms (≥11 pounds) to preserve supply of 50mg doses for infants weighing <5 kilograms (<11 pounds). Please note that some insurers may not cover the cost of two 50mg doses for an individual infant.
  • Suspend using nirsevimab in palivizumab-eligible children aged 8–19 months during the current RSV season. These children should receive palivizumab per American Academy of Pediatrics recommendations.
  • Continue to offer nirsevimab to American Indian and Alaska Native children aged 8–19 months who are not palivizumab-eligible and who live in remote regions, where transporting children with severe RSV for medical care is more challenging, or in areas with known high rates of RSV among older infants and toddlers.
  • Discuss nirsevimab supply issues when educating pregnant people about RSVpreF vaccine (Abrysvo) as RSV vaccination during pregnancy is safe and effective (when given at 32-36 weeks) and will reduce the number of infants needing nirsevimab during the RSV season.

VDH Releases New Respiratory Disease Vaccine Dashboard and Weekly Activity Report

On November 14, 2023, VDH updated its COVID-19 vaccination dashboards to add a respiratory disease vaccine dashboard that displays both COVID-19 and influenza (flu) vaccine data. These dashboard updates will help Virginians more effectively monitor COVID-19 and flu vaccine protection for 2023–2024.

  • The COVID-19 Vaccine Summary Dashboard now shows the total doses of 2023–2024 COVID-19 vaccine administered and the percentage of people in Virginia who have received a 2023–2024 COVID-19 vaccine. It will also display the vaccination rate per 100,000 people and a map displaying percentage of the population who has received a 2023–2024 COVID-19 vaccine by locality.
    • Dashboards with previous COVID-19 vaccines and the percentage of people vaccinated with a primary series and who are up to date on COVID-19 vaccines have been retired.
  • The Respiratory Disease Vaccine Dashboard displays the percentage of people vaccinated with a 2023–2024 COVID-19 and/or 2023–2024 flu vaccine.

VDH also began publishing a weekly Respiratory Disease Report to provide a summary of key viral respiratory illness activity for COVID-19, flu, and RSV in Virginia. This report will be published weekly on Fridays on the Respiratory Disease webpage.

Thank you again for your continued partnership. Please visit the VDH website for current clinical and public health guidance on respiratory diseases in Virginia and other information.   


Karen Shelton, MD
State Health Commissioner