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RSV Guidance and State/Territory Funding Information

RSV protection is evolving — know the right product for the right patient.

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Key Summary

  • Different products, different groups: Arexvy (older adults), Abrysvo (pregnancy + older adults), Nirsevimab (infants), Palivizumab (high-risk infants).
  • Funding varies: Abrysvo funded in pregnancy (NIP); Nirsevimab funded for eligible infants in all states/territories; Arexvy funded in VIC aged care; Palivizumab not funded.
  • ATAGI advice: Pregnant women, adults ≥75, Aboriginal and Torres Strait Islander adults ≥60, and at-risk infants should receive RSV protection.
  • Errors reported: Wrong product given to wrong group — stressing the need for clear verification and storage.
  • Strong protection: New RSV vaccines and antibodies significantly reduce hospitalisations in infants and older adults.

Overview

The recent introduction of multiple RSV prevention products in Australia has led to administration errors in clinical settings. These products are approved for different populations and function through different immunological mechanisms. Clear understanding of their indications, administration schedules, and patient eligibility is essential to prevent error, protect patients, and maintain public trust in immunisation.

RSV Prevention

Vaccines

  • Arexvy is a recombinant RSV pre-fusion F protein vaccine with an adjuvant. It is indicated for individuals aged ≥60 years, and adults 50–59 years with risk factors1. Administered as a single 0.5 mL intramuscular dose (preferably in the deltoid), the need for revaccination has not been established1.
  • Abrysvo is also a recombinant RSV pre-fusion F protein vaccine2. It is funded under the National Immunisation Program (NIP) for pregnant women between 28–36 weeks’ gestation to protect infants from birth to 6 months. It is also approved for individuals aged ≥60 years2.

Monoclonal Antibodies

  • Palivizumab is a humanised IgG1 monoclonal antibody given monthly by intramuscular injection3. It is used to prevent serious RSV disease in high-risk infants, including preterm babies and those with chronic heart, lung, or immune conditions3.
  • Nirsevimab (Beyfortus) is a long-acting monoclonal antibody providing protection for at least 5 months after a single intramuscular dose4. It is indicated for all infants during or entering their first RSV season and children under 24 months at risk of severe disease in their second RSV season4.

Key Differences, Indications, and State/Territory Funding Information

ProductTypeApproved ForRouteNIP/State Funded
ArexvyVaccineAdults ≥60 years (or 50–59 years with risk factors)0.5 mL IMVIC – residents aged 60 and over in public and Aboriginal community-controlled aged care services.
AbrysvoVaccinePregnant women (28–36 weeks gestation), Adults ≥60 years0.5 mL IMNIP funded during pregnancy
NirsevimabMonoclonal AntibodyInfants and children <24 months at risk during RSV seasonSingle IM doseACT – 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 conditionsMonthly IMNot funded

Australian Immunisation Handbook 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

Adults aged ≥75 years are recommended to receive RSV vaccine

Adults aged 60-74 years can consider RSV vaccination

Aboriginal and/or 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

Pregnant women are recommended to receive an RSV vaccine during pregnancy to protect the infant

Administration Error Trends (2025)5

Due to overlapping rollout and differing indications, there has been a rise in administration errors:

• 24 reports of Arexvy given to pregnant women

• 24 reports of Abrysvo given to infants

• 36 reports of Beyfortus given to women aged 15–54 years

Consequences include inadequate protection, patient distress, and reduced confidence in immunisation. Most reports did not involve serious adverse events, but some included fatigue, fever, rash, and breathing changes.

Recommendations for Health Professionals

Preventing Administration Errors

The Therapeutic Goods Administration recommends the following to prevent administration errors:

• Verify the product name, patient group, and indication before administration

• Educate all staff about the differences between products

• Label and store separately: Use fridge baskets, shelf stickers, or colour-coded labels

• Prescribe clearly using both brand and generic names

• Plan workflows with risk mitigation strategies from your state/territory

If an Error Occurs

• Access clinical guidance from NCIRS for repeat dose advice

• Report via your state health department or directly to the TGA

• Record all doses in the Australian Immunisation Register

See advice on the management of a range of possible RSV immunisation product administration errors

Effectiveness of RSV Immunisation

• Beyfortus (nirsevimab): 88.2% effectiveness against RSV hospitalisation in WA (2024)6

• Queensland: 69% reduction in hospitalisations among infants under 6 months7

• Abrysvo: 81.8% effective in preventing medically attended severe RSV disease in infants in the first 90 days of life and 69.4% effective in the first 180 days of life.7

• Galicia, Spain: 89.8% reduction in infant RSV admissions with >90% Beyfortus coverage7

Further Reading & Resources

• Australian Immunisation Handbook

• Maternal Vaccination Resources

• TGA

• NCIRS

References

  1. Kaczmarek MC, Jayasinghe S, Macartney K. Respiratory syncytial virus preventives for children in Australia: the current landscape. Med J Aust [Internet]. 2025 Jun 17 [cited 2025 Jul 11];222(11):466–9. Available from: https://www.mja.com.au/journal/2025/222/11/respiratory-syncytial-virus-preventives-children-australia-current-landscape
  2. Therapeutic Goods Administration. Australian Product Information: AREXVY (Respiratory Syncytial Virus Vaccine, recombinant, adjuvanted) [Internet]. Canberra (AU): Department of Health and Aged Care; 2024 May 3 [cited 2025 Jul 11]. Available from: https://www.tga.gov.au/sites/default/files/2024-05/auspar-arexvy-240503-pi.pdf
  3. Therapeutic Goods Administration. Australian Product Information: ABRYSVO (Respiratory Syncytial Virus Vaccine, bivalent) [Internet]. Canberra (AU): Department of Health and Aged Care; 2024 May 2 [cited 2025 Jul 11]. Available from: https://www.tga.gov.au/sites/default/files/2024-05/auspar-abrysvo-240502-pi.pdf
  4. MedsInfo. Australian Product Information: Beyfortus (nirsevimab) [Internet]. Australia: MedsInfo; c2024 [cited 2025 Jul 11]. Available from: https://rss.medsinfo.com.au/ap/pi.cfm?product=appsynag11221
  5. Therapeutic Goods Administration. Australian Product Information: BEYFORTUS (nirsevimab) [Internet]. Canberra (AU): Department of Health and Aged Care; 2024 Apr 12 [cited 2025 Jul 11]. Available from: https://www.tga.gov.au/sites/default/files/2024-04/auspar-beyfortus-240412-pi.pdf
  6. Therapeutic Goods Administration. Correct administration of RSV vaccine and antibody products [Internet]. Canberra (AU): Department of Health and Aged Care; 2024 Jun 13 [cited 2025 Jul 11]. Available from: https://www.tga.gov.au/news/safety-updates/correct-administration-rsv-vaccine-and-antibody-products
  7. Wong JY, Wu P, Ho A, Tsang TK, Chu DKW, Leung GM, et al. Epidemiological characteristics of RSV-associated hospital admissions in Hong Kong, July–December 2023. J Infect [Internet]. 2025 Jun 21 [cited 2025 Jul 11]; Available from: https://www.journalofinfection.com/article/S0163-4453(25)00060-X/fulltext

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