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RSV

RSV is common — vaccines and antibodies now help protect infants, older adults and those most at risk

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Key Summary

  • What it is: Respiratory syncytial virus (RSV) is a highly contagious virus that infects the lungs and airways; most children catch it before age 2.
  • Symptoms: Often starts like a cold (fever, runny nose, sore throat), but can progress to bronchiolitis or pneumonia in infants and young children.
  • How it spreads: Through coughing, sneezing, laughing, or touching contaminated surfaces and then the eyes, nose, or mouth.
  • Who is at risk:
    • Infants under 6 months, preterm babies, and young children with heart/lung conditions.
    • Older adults (especially 65+), First Nations peoples, and those with chronic illnesses or weakened immunity.
  • Complications: Breathing difficulties, hospitalisation, worsening of asthma, COPD or heart failure in adults; RSV causes around 6,000 child hospitalisations per year in Australia, mostly under 5s.
  • Prevention:
    • Good hygiene — handwashing, covering coughs, keeping sick people away from babies and older adults.
  • Vaccines: Arexvy & Abrysvo
  • Monoclonal antibodies: Nirsevimab (for infants/young children entering RSV season) and Palivizumab (for high-risk babies).
  • Treatment: Most infections are mild and resolve within 10 days; care includes rest, fluids, nasal drops for infants, and paracetamol/ibuprofen for fever. Severe cases may need hospital oxygen or fluids.

About RSV

Respiratory syncytial virus (RSV) is a common virus that infects the airways and lungs. It is highly contagious and spreads easily. Most children will become infected with RSV before they turn two years of age.1 The main treatment for RSV infection is rest and plenty of fluids. Regular hand washing and good personal hygiene can stop RSV from spreading.2

RSV Symptoms

RSV starts off with mild cold-like symptoms which may include slight fever, sore throat, headache, and a runny and stuffy nose. Bronchiolitis and pneumonia often follow in young children.

Bronchiolitis is inflammation and congestion of the small airways of the lungs known as the bronchioles. Symptoms may include coughing, wheezing, difficulty breathing and problems eating or drinking.

Pneumonia is an infection that inflames the air sacs of one or both lungs.  Symptoms will also include fever, coughing and trouble breathing.

Death in people under 16 years of age from RSV is rare in high income countries like Australia.

People with RSV are generally contagious for 3 – 8 days. Some infants and people with impaired immune systems may be contagious up to 4 weeks after symptoms subside.3

Most people recover from the infection within 10 days.4

How RSV Spreads

The organism that causes RSV infection is a virus called Respiratory Syncytial Virus.

An infected person can pass the virus onto others by laughing, sneezing, coughing, talking, or touching a surface.

A susceptible person can pick up the virus through the eyes, nose, or mouth from an infected person who has coughed or sneezed into the air. You can also pick up RSV after touching a surface which has the virus on it and then touching your eyes, nose, or mouth.3

RSV Complications

High risk for young children

RSV can cause serious illness in infants under 6 months of age – especially those aged under 3 months. Young children aged under 2 years with chronic lung disease or congenital heart disease are also at greater risk of serious RSV disease. As well as infants and young children aged 2 years and under who were born pre-term or with a low birth weight.5

High risk for some adults

Older adults (especially those aged >65 years of age), First Nations peoples, people with heart and lung disease, or people with weakened immune systems are at higher risk of complications and hospitalisation. They may develop pneumonia, more severe symptoms of asthma, chronic obstructive pulmonary disease (COPD), or congestive heart failure.5

RSV Prevention

Advise patients/carers that the recombinant respiratory syncytial virus (RSV) can be prevented by various hygiene measures:

  • washing your hands with soap and water for at least 20 seconds
  • keeping infected people away from others, especially babies and older people
  • not sharing drinks, or cutlery with people who have colds
  • covering your nose and mouth when sneezing or coughing
  • throwing out tissues as soon as you’ve used them

Vaccines

Arexvy

Arexvy is a recombinant respiratory syncytial virus pre-fusion F protein (adjuvanted) vaccine.

Arexvy is indicated for active immunisation for the prevention of lower respiratory tract disease caused by respiratory syncytial virus (RSV) in:

  • adults 50 through 59 years of age who are at increased risk for RSV disease
  • adults 60 years of age and older

The vaccine is administered as a single dose of 0.5 mL for intramuscular injection only, preferably in the deltoid muscle. The need for revaccination has not been established. 6

Arexvy is free for Victorian residents aged 60 and over in public and Aboriginal community-controlled aged care services.

Abrysvo 

Abrysvo is also a recombinant respiratory syncytial virus pre-fusion F protein vaccine formulated to actively immunise pregnant patients, particularly between 24-36 weeks of gestation, to prevent lower respiratory tract disease caused by Respiratory Syncytial Virus (RSV) in infants from birth through to 6 months of age. It is also indicated for the active immunisation of individuals aged 60 and above to prevent RSV-caused lower respiratory tract disease.7

Abrysvo is administered as a single dose (0.5 mL) in late second or third trimester of pregnancy (24-36 weeks of gestation). For Individuals 60 years of age and older, Abrysvo  is administered as a single dose (0.5 mL). Administration is by intramuscular injection only, preferably in the deltoid region of the upper arm.7

From February 3, 2025, Abrysvo will be available on the National Immunisation Program (NIP) for patients between 28 and 36 weeks of gestation.

Monoclonal antibodies

Prevention in high-risk infants

High-risk infants are those that are more likely to develop complications from RSV. They include premature infants or those with heart or lung problems or those that are immunocompromised (have weakened immune systems).

Palivizumab

Palivizumab is an injectable monoclonal antibody indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in children at high risk of RSV disease. It is given intramuscularly.8 It is directed at a protein in RSV. It has been shown to reduce intensive care unit admission for babies who have been hospitalised for RSV.9

Nirsevimab

Nirsevimab is an injectable, long-acting monoclonal antibody that protects against respiratory syncytial virus (RSV) disease for at least 5 months after a single dose. It is indicated for the prevention of RSV lower respiratory tract disease to protect all infants against severe disease during or entering their first RSV season, and young children aged <24 months who are vulnerable to severe disease during their second RSV season.10, 11

Nirsevimab is available for eligible infants through state-funded programs in ACT, NSW, NT, QLD , SA , TAS ,VIC , and  WA .

Key Differences, Indications, and State/Territory Funding Information

ProductTypeApproved ForNIP/State Funded
ArexvyVaccineAdults ≥60 years (or 50–59 years with risk factors)VIC – residents aged 60 and over in public and Aboriginal community-controlled aged care services.
AbrysvoVaccinePregnant women (28–36 weeks gestation), Adults ≥60 yearsNIP funded during pregnancy
NirsevimabMonoclonal AntibodyInfants and children <24 months at risk during RSV seasonACT – Eligible newborns and infants

NSW – Eligible newborns and infants

NT – Eligible newborn and infants

QLD – Eligible newborns and infants

SA – Eligible newborns and infants from 1 April 2025 to 30 September 2025

TAS – Eligible newborns and infants from 1 April 2025 to 30 September 2025

VIC – Eligible newborns and infants from 1 April 2025 to 30 September 2025

WA – Eligible newborns and infants from 1 April 2025 to 30 September 2025
PalivizumabMonoclonal AntibodyHigh-risk infants—e.g., preterm, cardiac or lung conditionsNot funded

RSV Treatment

Most cases of RSV are mild and can be treated at home with rest and hydration.12,13

For babies with bronchiolitis:

  • Increase the number of breast feeds through the day or give smaller amounts of formula more frequently through the day
  • Saline nasal drops and nasal sprays may help babies with blocked noses

Paracetamol or ibuprofen may be given for fever or pain.

Antibiotics are not helpful for RSV because RSV is a virus and antibiotics work against bacteria.

Take your baby to see a GP or to the emergency department of the hospital if:

  • The cough keeps getting worse
  • They are taking less than half of their regular feeds
  • They have trouble breathing or breathing is fast or irregular
  • They look pale or sweaty or change colour when coughing
  • You are concerned about your baby for any reason

Babies in hospital with bronchiolitis may be given oxygen. They may be given fluids using a special tube from the nose to the stomach or through a drip that goes into the veins.

More RSV Information

RSV in Young Children

RSV is most common amongst infants that are less than twelve months of age. RSV is a very infectious virus, and most children will get it at least once before they turn two years of age.14,15

RSV infection creates around 6000 hospitalisations per year with 95% of the hospitalisations reported in children under 5 years of age.16,17

RSV is associated with increased morbidity amongst preterm infants and babies born with chronic health conditions such as respiratory and/or cardiac complications.18

Recommendations

Neonates and infants aged <8 months whose mothers were not vaccinated at least 2 weeks before delivery, or who are at increased risk of severe disease, are recommended to receive passive immunisation with an RSV-specific monoclonal antibody

Older infants and young children ≥8 to 24 months of age who are at risk of severe RSV disease are recommended to receive RSV-specific monoclonal antibody before their 2nd RSV season

RSV in Adults

RSV symptoms in adults and older healthy children are generally mild and mimic the common cold.

Vaccination before the RSV season is the best defence against catching RSV. Currently, there are two TGA approved RSV vaccines available for adults 60 years and older: Arexvy and Abrsyvo.

Recommendations

Adults aged ≥75 years are recommended to receive RSV vaccine

Adults aged 60-74 years can consider RSV vaccination

Aboriginal and Torres Strait Islander adults aged ≥60 years are recommended to receive RSV vaccine

Adults aged ≥60 years who have medical conditions that increase their risk of severe RSV disease are recommended to receive RSV vaccine

RSV Vaccination During Pregnancy

Vaccine effectiveness

Vaccination during pregnancy reduces the risk of severe RSV disease in infants under 6 months of age by around 70% (see Vaccine information). This protection results from the passive transfer of RSV-specific antibodies from the parent to the fetus during pregnancy via the placenta.19

Timing of vaccination

The recommended time for RSV vaccination during pregnancy is between 28 and 36 weeks gestation. Although Abrysvo is registered from 24–36 weeks gestation, administration from 24–<28 weeks of gestation is not routinely recommended until more safety and efficacy data is available for people at this stage of pregnancy and their newborn infants.19

RSV vaccine can be given at any time of the year, regardless of when you are expected to deliver.

Recommendations

An RSV vaccine is recommended during pregnancy to protect the infant

References

  1. Australian Government Department of Health and Aged Care. Respiratory syncytial virus (RSV). In: Australian immunisation handbook. Canberra: Australian Government Department of Health and Aged Care; 2023. Available from https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/respiratory-syncytial-virus-rsv#overview
  2. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed August 2023
  3. Australian Government Department of Health and Aged Care. Respiratory Syncytial Virus (RSV) infection; last updated 7 May 2024
  4. Centers for Disease Control and Prevention (CDC). Causes and Transmission of RSV Infection. CDC. 2023. Available from: https://www.cdc.gov/rsv/causes/index.html
  5. Government of South Australia SA Health. Respiratory syncytial virus (RSV) infection – including symptoms, treatment, and prevention. Last updated 29 Apr 2024.
  6. National Centre for Immunisation Research and Surveillance (NCIRS). Respiratory Syncytial Virus (RSV): Frequently Asked Questions. NCIRS. 2023. Available from: https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked
  7. Therapeutic Goods Administration (TGA). (2024, January 22). Arexvy | Australian Prescription Medicine Decision Summary . https://www.tga.gov.au/resources/auspmd/arexvy
  8. Australian Product Information – ABRYSVO® (Recombinant Respiratory Syncytial Virus Pre-fusion F Protein) Vaccine. Available from https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent=&id=CP-2024-PI-01489-1[Accessed 18 May 2024]
  9. AstraZeneca Pty Ltd. (2021). Australian product information: SYNAGIS® (palivizumab) solution for injection [Product information]. Retrieved from https://medsinfo.com.au/product-information/document/Synagis_PI
  10. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated August 2021.
  11. Australian Technical Advisory Group on Immunisation (ATAGI). (2024, March 26) Statement On The Use Of Nirsevimab For Prevention Of Severe Disease Due To Respiratory Syncytial Virus (RSV) In Infants https://www.health.gov.au/sites/default/files/2024-03/atagi-statement-on-nirsevimab-2024.pdf
  12. Sanofi-Aventis Australia Pty Ltd. (2023). Australian product information: BEYFORTUS™ (nirsevimab) solution for injection [Product information]. Retrieved from https://medsinfo.com.au/api/documents/Beyfortus_PI?format=pdf
  13. Therapeutic Guidelines [digital]. Melbourne: Therapeutic Guidelines Limited; 2021 Mar. <https://www.tg.org.au>
  14. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed February 2022
  15. Government of South Australia SA Health. Respiratory syncytial virus (RSV) infection – including symptoms, treatment, and prevention. Last updated 02 April 2022
  16. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed February 2022
  17. Brusco N K et al. The 2018 annual cost burden for children under five years of age hospitalised with respiratory syncytial virus in Australia. Communicable Diseases Intelligence; 2022 Vol 26. https://doi.org/10.33321/cdi.2022.46.5
  18. 1Saravanos G L Respiratory syncytial virus‐associated hospitalisations in Australia, 2006–2015; Med J Aust 2019; 210 (10): 447-453. || doi: 10.5694/mja2.50159
  19. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated December 2023