RSV Data

Prophylaxis Guidelines

Updated 10/7/2021

AAP Interim Guidance for Use of Palivizumab Prophylaxis (9/23/2021) "The AAP recognizes the importance of maintaining flexible approaches including early initiation of palivizumab administration during this atypical interseasonal change in RSV epidemiology in 2021. Pediatric health care leaders will be key leaders to inform ongoing need in communities warranting specialized consideration. The need for palivizumab administration to eligible infants during this atypical interseason should be supported where activity approaches fall-winter season and should be reassessed at least monthly. This guidance document is not meant to supplant typical seasonal palivizumab administration guidance.”

2021- 22 RSV Assessment and Synagis Authorization (9/7/2021) The resurgence of respiratory syncytial virus (RSV) activity during the summer resulted in HHSC’s decision to allowing all members in all DSHS regions who meet prior authorization criteria to receive monthly doses of Synagis (palivizumab). During the fall and winter season, providers will be required to re-assess the need for prophylaxis therapy for the members in their regions as of October 1, 2021 (schedule available here). Providers must request a new prior authorization and if approved, members will be eligible for up to 5 monthly doses of Synagis (palivizumab). The fall and winter season schedule for each region will be available for reference. The instructions for obtaining prior authorization for people enrolled in Medicaid and CHIP managed care, traditional Medicaid, and the CSHCN Services Program are now available.

Respiratory Syncytial Virus and Synagis Authorization During Summer and Winter 2021-22 (8/25/2021) "As a result of the recent summertime resurgence in RSV activity, HHSC began opening DSHS regions gradually from June 21 through July 23, 2021. With the traditional 2021-22 RSV season approaching, all Texas DSHS regions will remain open. All children who meet prior authorization criteria will be eligible for up to 5 monthly doses of Synagis (palivizumab)...Children who received doses of Synagis (palivizumab) during the summer RSV season will require reassessment as of October 1, 2021. Children who may require additional doses of Synagis (palivizumab) due to age, and clinical condition, will require completion of a new prior authorization process for possible additional doses.

HHSC will consider the traditional 2021-22 RSV season a new season beginning October 1, 2021, separate from the unusual summer season.”

AAP releases interim guidance on preventing RSV during delayed season (8/10/2021) Due to unusual RSV activity, AAP supports the use of palivizumab in regions having a significant number of cases, similar to a typical winter season. The AAP interim guidance on administration of palivizumab during this delayed season is the same as for a typical season: Consider administering the humanized monoclonal antibody in up to five monthly doses to prevent RSV in high-risk infants and children in areas experiencing high rates of the virus.

Eligible children include premature infants, especially those born at less than 29 weeks’ gestation, infants with chronic lung disease of prematurity, infants with certain types of hemodynamically significant congenital heart disease, infants and young children with certain immunodeficiency states, and infants with pulmonary abnormalities or neurological and neuromuscular conditions that impair ability to clear secretions from the upper airway.

Clinicians should reassess the need for palivizumab at least monthly.


Atypical Respiratory Syncytial Virus (RSV) Season Advisory (7/21/2021) HHSC news release on the unprecedented summertime resurgence of RSV activity. On July 23, 2021, HHSC opened all DSHS regions, and providers may start monthly Palivizumab (Synagis) injections for RSV prophylaxis for clients who meet clinical criteria. This reopening is considered the start of a new RSV season, separate from the regular 2020-21 RSV season. When this announcement was released, clients who meet the prior authorization criteria qualify for up to 5 monthly shots of Palivizumab (Synagis).

HHSC to Reopen RSV Season in Select Regions (7/2/2021) HHSC reopened the RSV season for certain regions on June 21, 2021. Providers may start monthly palivizumab (Synagis) prophylaxis treatment for all eligible clients beginning on the dates shown below:

Date Regions
June 21
  • Region 3 - Dallas-Fort Worth
  • Region 5 - Southeast Texas
  • Region 6 - Gulf Coast
  • Region 7 - Central Texas
  • Region 9 - West Texas
  • Region 10 - Upper Rio Grande
  • Region 11 - Lower South Texas
June 28
  • Region 4 - Upper East Texas
July 9
  • Region 8 - Upper South Texas
July 23
  • Region 1 - High Plains
  • Region 2 - Northwest Texas

2020-21 RSV Schedule by Texas Public Health Regions

Palivizumab/Synagis Vendor Drug Program


2016-17 Prophylaxis Guidelines for Texas

The Texas Pediatric Society (TPS), the Texas Chapter of the American Academy of Pediatrics (AAP), Committee on Infectious Diseases and Immunizations and the Department of State Health Services (DSHS) Emerging Acute Infectious Disease Branch (EAIDB) have been gathering data on the timing of the RSV season in Texas since 2001.  Using data from the 2001-2015 RSV seasons submitted by providers and healthcare facility laboratories to the CDC NREVSS program, gathered and presented by EAIDB in support of ongoing activities by TPS, we have analyzed the RSV season across the state by Public Health (PH) Regions.  The number of RSV antigen tests and the number of positive, and the percent positive were gathered by ISO week number and by PH regions for each and cumulatively for all of these RSV seasons.  Standard CDC definitions for the onset and end of RSV season were applied to the cumulative data. The RSV season in Texas varies regionally.  Based on 14 years of data, the start of the RSV season for the Coastal, Central, and Southern Regions is usually in October, and the end of the season is sometime from late January to mid-March.  For the Northern and Western Regions the onset is usually in November, and the end of the season is usually sometime in March to mid-April.  Based on this analysis, we offer these dates for the timing of RSV prophylaxis in hopes of optimizing protection for high risk infants in Texas:

  • Upper Coastal TX- Regions  5, 6,- October 1st to February 28th
  • Central, and Lower South TX- Regions   7 , 11 -October 15th to March 14th
  • Northeast and Upper South  TX- Regions  3, 4, 8- November 1st to March 31st
  • Far North and West TX- Regions  1, 2, 9, 10  – November 15th to April 14th

These recommendations have changed from last year, now using 4 groups instead of 2 to better match differences regionally in onset and end of season. Region 8 has moved from an early to a later based on current data. To view a map of the regions and counties, please click here. Astute physicians and providers should be allowed to utilize their local experience and local RSV epidemiology data to time the start of prophylaxis in their area, and may be more efficient in utilization of resources with this.  They should be allowed access to a similar duration of prophylaxis as their peers who use set start and stop dates.  There is good protection from RSV for more than 4 weeks after the last dose of prophylaxis for infants who have received 2 or more doses.  The timing of RSV infection varies locally, regionally, and annually.  This statement and other advice on the timing of RSV prophylaxis may be incorrect at times.  The TPS endorses the use of the new 2014 AAP guidelines on the prevention of RSV in high risk infants and children.  


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Please direct questions or suggestions to Dr. Manju Gaglani, MBBS, FAAP, FIDSA, FPIDS, McLane Children’s Baylor Scott & White Health, 254-935-5047,, or Alix Bronner, Texas Pediatric Society,, 512-370-1509.