Evidence and expert-based recommendations for maternal, infant, and adult immunisation against RSV

RSV Expert Meeting

10 June 2025

Held at the CDIC, 10-12 June, Adelaide Convention Centre

Evidence and expert-based recommendations for maternal, infant, and adult immunisation against RSV

Link to RSV expert meeting recording

Link to maternal vaccination and infant immunisation panel discussion recording

Summary

This report presents the key findings and recommendations from a RSV expert meeting held on the 10th of June at the Communicable Diseases and Immunisation Conference (CDIC), Adelaide Convention Centre, Adelaide. The meeting was chaired by Professor Paul Griffin with presentations by Associate Professor Hannah Moore, Dr Ushma Wadia and Professor Paul Van Buynder. This was followed by a multidisciplinary healthcare profession panel discussion, chaired by Dr Sarah Chu.

The panel discussion focused on RSV vaccination and immunisation strategies for maternal, infant and older adults. The panel discussed the complexities of implementing an effective RSV prevention program across Australia’s diverse geographical area and to consider seasonal changes, timing of immunisation interventions, state and territory-based eligibility criteria variation and practical, simplified approaches to maximising coverage against RSV infection.

This report is a summary of discussion points raised across 3 key populations: pregnant women, babies and young infants, and older adults aged 60 years and over. The different immunisation options were discussed including Abrysvo for maternal vaccination (NIP listed, February 2025) and Beyfortus (nirsevimab) through state funded programs from early 2024. RSV vaccination for older adults is available but at this stage available only through the private script market. Readers are encouraged to listen to the recording as this is a summary report.

The purpose of the meeting and this report is to highlight to Healthcare Professionals (HCPs) how best to navigate the practicalities of RSV immunisation whilst following government recommendations.

The panel discussion concluded the following:

• Make the RSV immunisation process simple and non-complicated in order to maximise newborn babies and young infants against RSV.
• Provide educational resources fitting different HCPs touch points. This ensures HCPs are adequately upskilled to raise and discuss with expecting and new parents, maternal vaccination and infant immunisation options; and that HCPs are aware of different immunisation scenarios depending on the patients age, eligibility criteria and RSV seasonality (where it applies).
• The addition of nirsevimab to the NIP would remove the complexity of the different state and territory eligibility criteria, and the need for updates to these as required.
• Pregnant women, babies and young infants that have or have not been immunised against RSV, patient data can be quickly and easily extracted through AIR to be able to check immunisation status, to ensure patients are not missed.

Introduction

RSV represents a significant public health challenge in Australia, particularly for infants under 6 months of age and older adults 60 years and over. Australian deaths in babies and young infants are rare, but RSV hospitalisations can affect up to 1 in 30 children under 6 months and are 8 times greater than influenza in those under 5 years.¹ The emergence of new TGA approved vaccines, including maternal vaccination and monoclonal antibody immunisation, has created both opportunities and complexities to HCPs. However, there is now an opportunity to reduce RSV disease burden in both children and older adults and lower hospital admission rates through a coordinated national strategy.

The RSV meeting was spilt into two sections:

Session 1 – short presentations (see link to each recording)

A/Prof Hannah Moore set the scene by providing a broad context of RSV burden in Australia including the incidence, prevalence, under-ascertainment of hospitalisation rates, risk factors for hospitalisation, Australian RSV seasonal variations, infection rates by age including older adults from 60 years old and RSV hospital burden in adults 75 years and over.

Next, Dr Ushma Wadia gave an overview of the WA experience of the RSV Immunisation Program from 2024 and early insights into 2025. From 1 April 2024 to 30 September 2024, 24,000 children were immunised by 1,153 Providers.² These were mostly performed in general practice (38%), hospitals (38%) and through child health nurses (21%).² Calculated saving based on $13,695 per infant hospitalisation was projected to be around $7 million.^2,10 The findings from the WA experience are summarised as follows:

• A successful RSV maternal vaccine and monoclonal antibody immunisation program will have significant impact on infant health in 2025
• Achieving high coverage for maternal vaccination and immunisation of high-risk children may be challenging
• A coordinated approach between jurisdictions, health providers and hospitals with clear communication to families should be a key focus
• Continuing efforts to increase public and health care provider awareness are needed to maintain high vaccination uptake rates

Wrapping up the session was Professor Paul van Buynder. His focus was on protecting adults 60 years and older. Prof Buynder emphasised that older adults are at high risk of severe RSV infection.³ Those with certain co-morbidities are at even greater risk and that RSV can lead to serious conditions such as pneumonia⁴, cardiovascular conditions⁵ and hospitalisation⁶. He identified key risk factors such as age (60 years and over)³, certain comorbidities (asthma, COPD, HF, CKD and diabetes)⁴ and weakened immune systems⁷. 

Prof Buydner presented data from the US showing significantly more older adults were hospitalised and died compared to children under 5 years old.⁸ Recent Australian data showed a median LOHS of 6 days after being admitted with LRTI caused by RSV and that 59% of all RSV-associated in-hospital deaths in Australia occurred in adults ≥65 years (82 out of 138 in-hospital RSV-associated deaths).¹ Approx 5% of all RSV admissions in older adults led to in-hospital mortality.¹ This emphasised the need for funded RSV vaccines in Australia. Three vaccines are available in Australia Arexvy, Abrysvo and mRESVIA with Arexvy only recently announced (pending effective date) to be funded for adults 60 years and over in Victorian public aged care facilities.

The timing of the panel discussion is important as Australia has implemented a hybrid (NIP and state/territory funded program) approach to RSV immunisation in babies and young infants up to 2 years old. This is welcomed and a significant step forward. But there have been a few challenges regarding the speed of the roll out and geographical expansion into new states and territories for nirsevimab. Over the last 6-12 months, there has been a significant volume of RSV information made available to HCPs through various platforms (websites, webinars, podcasts and other media forums). Whilst it is difficult to execute, the education and training component has not reached all touch points which has resulted in missed opportunities for immunisation and the reporting of administration errors during vaccination. There has also been some feedback on supply issues and stock order restrictions depending on where the order has come, e.g. Hospitals vs GP Practice vs local Councils). These challenges will no doubt be addressed over time.

Key Challenges Identified by the Panel

Timing and Seasonal Considerations

Professor Peter Richmond highlighted the fundamental complexity of optimising protection across Australia’s diverse seasonal patterns. The epidemiology is very different, seasonality varies depending on where you are in Australia, and funding varies State to State, Territory to Territory. He emphasised that while maternal vaccination provides protection from birth to approximately six months, optimal protection varies significantly based on when infants are born relative to local RSV seasons.⁹

Professor Richmond noted that for health providers, we should be able to give people a choice between maternal vaccination and newborn immunisation, as both are highly efficacious immunisations that provide protection for at least six months. This flexibility is particularly important given Australia’s varied seasonal patterns, where RSV circulation differs significantly between northern tropical regions and southern temperate areas.

Program severity and coverage challenges

Dr Rod Pearce emphasised the tension between optimised timing and achievable coverage rates, If the process is overly selective and offers too many options, it will lead to dilution of the message and increased confusion, resulting in people falling through the cracks. This concern is supported by data showing coverage variations across different cohorts. In Western Australia’s 2024 program, birth cohort coverage reached 79%,¹⁰ while year one catch-up coverage was 65%, and concerningly, year two medical risk and First Nation cohorts only achieved 30% coverage.¹¹

Healthcare provider education and error prevention 

Sonja Elia identified critical gaps in healthcare provider knowledge that have led to administration errors. We’ve already had reports of infants having received the maternal vaccine, including a four-month-old infant who had received the maternal vaccination from a practice where two infants from the same practice received incorrect vaccines. The concerning aspect identified by families was not just the error itself, but that the practice didn’t acknowledge the error or apologise. The concern was mainly around what the practice was going to do to make sure it doesn’t happen for other infants as well. This highlights the need for a comprehensive healthcare provider education framework with different real-life scenario’s that HCPs face. This should also include examples specific to state and territory eligibility criteria. This will instil confidence, help minimise missed patients and reduce system errors.

Program Implementation Variations

State-by-state differences

The panel discussion revealed significant variations in program implementation across Australian jurisdictions. There are differences in eligibility criteria between states and territories, and in some cases supply issues (of nirsevimab).  These create challenges for both healthcare providers and families, particularly those that move between jurisdictions. Professor Peter Richmond noted that in some states, if a mother hasn’t been vaccinated during pregnancy and the infant hasn’t had nirsevimab as a newborn, they may have missed out unless they have a risk condition and have been flagged. We need to ensure consistency of monitoring pre-birth and at birth to ensure all babies are screened and not missed.

Coverage decline in catch-up cohorts

A concerning trend identified in the 2025 Western Australia data showed declining coverage in catch-up cohorts with nirsevimab. Catch-up coverage dropped from 36% in 2024 to 22% in 2025 for the same period.¹² This suggests that the introduction of maternal vaccination may have inadvertently reduced attention to infants whose mothers did not receive vaccination, highlighting the need for systematic approaches to identify and protect these vulnerable groups.

Maternal Vaccination Considerations

First-time vs experienced mothers

Kassie Daw provided insights into maternal vaccination acceptance patterns. First time mothers are often a little more cautious and understandably so, having questions that need productive conversations to answer those questions and unpack assumptions. Women in subsequent pregnancies are often, though not always, more relaxed and accepting, especially when they’ve had vaccinations in previous pregnancies. This observation suggests the need for tailored communication strategies that account for maternal experience levels and provide adequate time for informed decision-making. Recommendations for multiple pregnancy eligibility criteria will also soon need to be made as we are at the beginning of the second RSV season since the introduction of nirsivimab.

Integration with antenatal care

The importance of integrating RSV vaccination recommendations within established antenatal care pathways was emphasized by the panel. There is real value in integrating these recommendations within antenatal care, as this gives people a sense of clarity, coherence, and a lot of trust in what those recommendations are. This integration approach appears more effective than standalone vaccination programs.

Economic and Cost-effectiveness considerations

The panel addressed questions about program cost-effectiveness, particularly given the substantial investment required. When questioned about the economic justification for Western Australia’s $11 million investment against $7 million in direct hospital cost savings, the panellists emphasised unmeasured benefits. What hasn’t been measured is the indirect costs including the impacts that RSV hospitalisation aversion would have on the family, the days that parents can go to work rather than having to miss work, the days that children can attend daycare rather than having to miss daycare because of illness, and the impact on primary care. These broader economic impacts, including reduced healthcare system pressure and improved family functioning, suggest that the true economic benefits extend well beyond direct hospitalisation cost savings.

Recommendations for program optimisation

Simplification and standardisation

The panel strongly advocated for program simplification to improve coverage. Dr Rod Pearce noted that Australia has done well by having a childhood immunisation program that provides clear guidance at 2, 4, 6, 12 months and school entry, and that the schedule is well established and everyone knows the schedule. It’s got to be that simple for RSV programs too.

Professor Peter Richmond supported this approach, stating that Australia has always been very proud of its NIP delivering health benefits to a population, and this artificial separation of monoclonal antibodies and vaccines hopefully will be corrected in due time. Simple always works, complexity does not and only creates additional work, confusion and errors.

Enhanced healthcare provider support

The panel identified the need for comprehensive healthcare provider education and support systems. Providers need to have key information especially when there are state and territory funded variations. Because of these variations, HCPs need to be across their jurisdictional RSV program, and be up-to-date with changes as they occur. These changes should be communicated in an effective and timely manner.

National program integration

Multiple panelists advocated for including RSV prevention within the NIP. This is evident from Prof Helen Marshall’s published work demonstrating that when you recommend an unfunded vaccine, the uptake is always poor.¹³ This integration would provide consistency, improve coverage, and reduce the complexity currently facing healthcare providers and families.

All panelists agreed that it would be easier if monoclonal antibodies that provide passive immunisation against infectious diseases could be added to the NIP. Currently, NIP legislation limits drugs to vaccines. This should be examined and considered to address the complexity of state and territory funded programs and simplify where possible in the interests of prevents disease burden in high-risk groups. There is an argument for a NIP schedule including monoclonal antibodies as a central schedule that is recognised and easily updated and communicated.

Conclusion and future direction

The panel discussion focused mainly on RSV maternal and infant immunisation as these are currently funded. Adult RSV vaccines are not yet funded (excluding the recent Victorian government announcement for public aged care). It’s likely further states and territories will follow a funding program until it is listed on the NIP similar to Shingrix). Until this time, the strategy for RSV vaccines for older adults, mainly in aged care, is through the private script patient-paid path. The scope for uptake using this path is limited to individuals that are willing to pay.

A two-step process for protecting newborn babies and infants up under 2 years old is welcomed. Maternal vaccination is the priority, and all efforts should focus on pregnant women between 28-36 weeks. The range gives flexibility for HCPs to organise patients for vaccination. Nirsevimab is both a primary and secondary step depending on several scenarios, e.g. time of maternal vaccination before birthing, mother was not vaccinated, seasonality, patient risk criteria for severe RSV disease from birth up until 2 years old, and several other scenarios. What’s important is the process of when to immunise regardless of where the patient is in Australia.

Maternal vaccination is straight forward and is centralised on the NIP. State and territory variations to nirsevimab eligibility is a little more complex with some subtle differences that may potentially cause confusion and errors. However, the two-step process should provide optimal effectiveness and protection for all new babies and young infants at greatest risk of severe RSV disease. The consensus is for a more straight forward, streamlined process ideally through a national standardised approach. This is more likely to achieve better population-level protection across all age groups.

To improve coverage and upskill HCPs involved in immunising pregnant women, infants and older adults, consideration should be given to the following: 1. providing a centralised online education program including examples and tactics on how to reduce administration errors, 2. review the Australian Immunisation Register to make it more user friendly to identify vaccinated and non-vaccinated individuals and 3. consider including monoclonal antibodies onto a national immunisation schedule.

These would help to both maximise protection against RSV and also reduce hospital admission rates.

Drafted and approved by the Immunisation Coalition CEO and Chairman of the Board 

August 2025

Distributed to:

The Ministers Office: Department of Health, Disability and Aging

The Shadow Minister for Health and Aged Care

The National Immunisation Division: Department of Health and Aged Care

State and Territory Chief Health Officers

The Office of the Chief Medical Officer

References

1. Saravanos G et al. Respiratory syncytial virus‐associated hospitalisations in Australia, 2006–2015. Med J Aust 2019; 210 (10): 447-453. Available from: https://www.mja.com.au/journal/2019/210/10/respiratory-syncytial-virus-associated-hospitalisations-australia-2006-2015
2. Effler P. Abrysvo and Beyfortus. WA Health Immunisation Education, Jan 2025. Available from: https://www.health.wa.gov.au/~/media/Corp/Documents/Health-for/Immunisation/Immunisation-education/2025/Abrysvo-and-Beyfortus—Paul-Effler.pdf
3. Nam HH & Ison MG. Respiratory syncytial virus infection in adults. BMJ 2019; 366:l5021. Available from: https://www.bmj.com/content/366/bmj.l5021.abstract
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8. Centers for Disease Control and Prevention (CDC). RSV in Older Adults and Adults with Chronic Medical Conditions. 2023. Available from: https://www.cdc.gov/rsv/adults/index.html (accessed Oct 2023)
9. Nazareno AL et al. Modelling the epidemiological impact of maternal respiratory syncytial virus (RSV) vaccination in Australia. Vaccine 2024; 42(33): 5593-5602. Available from: https://pubmed.ncbi.nlm.nih.gov/39423452/
10. Bloomfield L et al. Nirsevimab immunisation in infants and respiratory syncytial virus (RSV)–associated hospitalisations, Western Australia 2024. Med J Aust 2025; 222 (11): 468-470. Available from: https://www.mja.com.au/journal/2025/222/11/nirsevimab-immunisation-infants-and-respiratory-syncytial-virus-rsv-associated
11. Richmond P. RSV maternal vaccination and neonatal immunisation. Presentation at the 26th Annual Scientific Meeting, Immunisation Coalition; Sept 2024. Available from: https://www.immunisationcoalition.org.au/wp-content/uploads/2024/09/RSV_-maternal-vaccination-and-neonatal-immunisation-Prof-Peter-Richmond-26th-ASM.pdf
12. Vaccine Update 433: RSV immunisation reminder (4th June 2025; Personal communication Prof Effler)
13. Marshall H et al. Varicella immunisation practice: Implications for provision of a recommended, non-funded vaccine. J Paediatr Child Health 2009 May; 45(5):297-303. Available from: https://pubmed.ncbi.nlm.nih.gov/19493123/