U.S. Department of 

Health and Human Services 

Centers for Disease 

Control and Prevention 

 

National Center for Immunization and Respiratory Diseases 

CDC’s Vaccines for Children Program Addendum: 

Special Considerations for Nirsevimab Updated 10/18/2023 

Nirsevimab is an FDA-licensed monoclonal antibody that provides 

passive immunity against RSV-associated infection. On August 3, 

2023, the Advisory Committee on Immunization Practices (ACIP) 

voted to recommend nirsevimab as an immunization for all infants 

aged <8 months, as well as some children up to age 20 months (see 

ACIP recommendations), and a VFC resolution was passed to include 

nirsevimab in the VFC program. This addendum provides supplemental

Vaccines 

for Children 

information and guidance related to the addition of the nirsevimab 

immunization to the VFC formulary. 

Inventory 

 VFC providers will be allowed a fexible, time-limited 

ramp-up period to meet the private inventory 

requirement for nirsevimab. During this time, awardees 

will not require VFC providers to meet the private 

inventory minimum requirements for nirsevimab if they 

do not intend to vaccinate their private pay patients. 

VFC providers are required to meet the private inventory 

requirement no later than August 1, 2024. 

 This includes VFC providers who serve only Medicaideligible patients and no privately insured children; they 

are not required to privately purchase nirsevimab. 

 If VFC providers utilize this fexibility to not maintain 

private stock during this season, providers should 

explore if other in-network options exist for their 

nirsevimab-insured private patients to access nirsevimab 

(i.e., from another local in-network practice or system 

that does have private inventory of nirsevimab, or FQHC, 

RHC, or deputized VFC provider authorized to immunize 

underinsured children). 

 CDC recognizes that with current supply and demand 

issues, this may not be possible, but if supply changes, 

we encourage providers to assist their private patients 

in identifying access routes. 

 In locations where providers report that demand for 

nirsevimab is low, awardees are to allow providers to 

order the minimum packaging of VFC nirsevimab that is 

feasible. In these cases, site visit reviewers will observe 

that nirsevimab inventory is a much lower quantity than 

other ACIP-recommended vaccines. 

 At the discretion of the awardee, certain specialty VFC 

providers, including birthing facilities (e.g., birthing 

hospitals or centers), may ofer a limited formulary 

of VFC vaccines, based on the populations served in 

their facility. VFC-enrolled birthing facilities ofering 

nirsevimab must ofer hepatitis B vaccine at birth as well 

(and vice versa). 

Eligibility Criteria 

 A child’s eligibility criteria for VFC nirsevimab are the 

same as for other VFC vaccines. 

Borrowing 

 For those VFC providers who maintain private stock 

of nirsevimab and vaccinating privately insured 

children, bidirectional borrowing of nirsevimab will 

be allowed for the 2023-2024 respiratory virus season 

as described below. 

 CDC's borrowing guidance does not supersede 

jurisdictional policy related to borrowing. VFC providers 

should refer to awardee or jurisdictional policy to 

determine if borrowing is allowed in their jurisdictional. 

NCIRDwt | 10/18/23 
NCIRDwt | 10/18/23 

CDC | NCIRD | CDC’s Vaccines for Children Program Addendum: Special Considerations for Nirsevimab



 Borrowing is only applicable if the provider is purchasing 

private stock and is approved only for instances when: 

 There is a lack of vaccine stock because of delayed or 

spoiled shipments. 

 As part of the initial set up of private purchasing 

contracts and ordering systems, there has been a delay 

for the provider in being able to procure private stock 

of nirsevimab. 

 Vaccine will expire soon and will be lost if not used. 

Provider locations with a small privately insured 

patient population can use this option to administer 

short-dated, privately purchased vaccine to a VFCeligible child and replace it with a longer-dated, 

VFC dose. 

 New staf calculated ordering intervals incorrectly, 

leading to a lack of sufcient private or public 

vaccine stock. 

 Borrowed nirsevimab must be repaid (dose for dose) 

within one month or after every 5 doses borrowed 

(after use of 5 doses for small practices, at the discretion 

of the awardee) and administered to the appropriate 

population (i.e., if federally VFC purchased VFC vaccine is 

borrowed for a privately insured patient and then repaid 

to VFC inventory, the repaid dose must be administered 

to a federally vaccine-eligible VFC child). 

 Awardees must receive proof of privately purchased 

doses that includes the number of doses, lot numbers, 

and documentation that authenticates doses returned 

or doses repaid were administered to the appropriate 

recipients. 

Vaccine Borrowing Documentation 

 A Vaccine Borrowing Report must be completed 

when either: 

 Privately purchased vaccine is administered to a 

VFC-eligible child, or 

 VFC vaccine is administered to a privately insured child. 

 Awardees may report the information using CDC’s 

template or by developing their own as long as it 

contains all the components of the CDC template. 

The template can be found on the ISD Awardees 

SharePoint Portal. 

Replacement 

Awardees with replacement models must be extremely 

cautious in applying these models for nirsevimab, based 

on the cost of this product and the potential for fraud. 

Virtual Enrollment 

 Awardees will be allowed to conduct virtual enrollment 

visits for specialty VFC providers, including birthing 

facilities. 

 Virtual enrollment site visits must be approved in writing 

(email) by CDC VFC staf. Minimally, awardees must 

review the following at the virtual enrollment visit: 

 Provider Agreement 

 Provider Profle 

 Vaccine Management Plan 

 Training documentation (if not done by program) 

 Electronic storage and handling documentation 

 Pictures of storage units 

 Pictures of DDL probe placement 

 Certifcates of calibration 

 Pictures of “Do Not Disconnect” Signage Placement 

NOTE: All awardees will be required to resume conducting enrollment visits in-person if 

CDC designates.