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RSV Guide

Most children catch RSV before age 2 – now, maternal vaccination and infant antibodies are reshaping prevention strategies.

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Key Summary

  • What it is: Respiratory syncytial virus (RSV) is a highly contagious virus that infects the airways and lungs, causing bronchiolitis and pneumonia, especially in infants.
  • Symptoms: Cold-like illness in most; severe disease can cause breathing difficulties, hospitalisation, or death in infants, older adults, and immunocompromised individuals.
  • High risk groups: Infants <6 months, children <5 years, older adults (≥60), pregnant women, Aboriginal and Torres Strait Islander people, and those with chronic or immune conditions.
  • Current vaccines & antibodies:
    • Arexvy: For adults ≥60 years , or 50 – 59 years with risk factors.
    • Abrysvo: For adults ≥60 years and during pregnancy (protects infants).
    • Nirsevimab & Palivizumab: Monoclonal antibodies to protect infants and high-risk children.
  • Prevention: Hand hygiene, avoiding contact with sick individuals, vaccination for eligible groups, and monoclonal antibodies for infants.
  • Vaccine safety: Vaccines are safe and effective; rare risk of Guillain-Barré Syndrome reported.

About RSV

Respiratory syncytial virus (RSV) is a common virus that infects the airways and lungs. It is highly contagious and spreads easily. The main treatment for RSV infection is rest and plenty of fluids. Regular hand washing and good personal hygiene can stop RSV from spreading.[1]

Cause And Transmission

RSV generally causes a mild, cold-like illness but it can cause breathing problems and lung problems like bronchiolitis and pneumonia.

RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age. Viruses (including RSV) are the most common causes of Community Acquired Pneumonia (CAP) in young children.

An infected person can transmit RSV by:[2]

  • Sneezing or coughing
  • Touching a hard surface or a soft surface like the hands or a tissue

RSV can be picked up from an infected person by:

  • Getting the particles from a cough or sneeze into the eyes and mouth
  • Touching a surface with virus on it and then touching the face
  • Having direct contact with someone with the virus by kissing their face

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

Most people recover from the infection within 10 days.[3]

How Is RSV Treated?

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

Bronchiolitis[4]

Most children presenting to the general practitioner with bronchiolitis have mild acute bronchiolitis and can be managed in the community.

Recommended Management

For all children with acute bronchiolitis:

  • Reassure carers
  • Educate carers about minimal handling
  • Advise carers to give patients small, frequent feeds

For children with moderate to severe acute bronchiolitis, provide symptomatic care in hospital, including supplemental oxygen and nasogastric feeds or intravenous fluids.

For children with severe bronchiolitis, non-invasive ventilation (e.g. CPAP), high-flow nasal cannula therapy or invasive ventilation may be required.

Community Acquired Pneumonia (CAP)[4]

If a viral cause is suspected, treat symptoms with:

  • Paracetamol or ibuprofen for fever or pain
  • Fluids to achieve and maintain adequate hydration

RSV Prevention

Advise patients/carers that RSV can be prevented by various hygiene measures:

  • Washing 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 the nose and mouth when sneezing or coughing
  • Throwing out tissues as soon as they’ve used them

Pharmaceutical Interventions

Vaccines

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. [5]

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

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 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.[6]

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

Guillain-Barré Syndrome (GBS) Warning

Updated Product Information for Arexvy and Abrysvo now includes a rare risk of GBS, especially in older adults.

  • Estimated risk: 7–9 excess GBS cases per million doses[15]
  • No confirmed GBS reports in Australia to date[15]
  • Educate patients on GBS symptoms (e.g. muscle weakness, paraesthesia) and encourage prompt reporting

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 humanised IgG1 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, monthly, and as required. It has been shown to reduce intensive care unit admission for babies who have been hospitalised for RSV.[7],[8]

Nirsevimab

Nirsevimab is an injectable, neutralising human IgG1ĸ 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. [9],[10]

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

RSV In Young Children

RSV is a very infectious virus, and most children will get it at least once before they turn 2 years of age.[11]

During 2006–2015, there were 63,814 hospitalisations with an RSV-specific principal diagnostic code; 60,551 (94.9%) were of children under 5 years of age.[12]

Between 2016 and 2019, there were more than 115,000 hospitalisations with an RSV diagnosis in Australia, of which approximately 75% were of children aged <5 years. Most of these children were otherwise healthy. For infants aged <6 months, the annual RSV hospitalisation rate over this period was approximately 6,200 per 100,000 population, with the highest rates in infants aged 0–2 months (approximately 7,200 per 100,000 population).[13]

From when RSV became a notifiable disease in 2021 to 3 July 2025, there have been 490,723 cases reported to the National Notifiable Disease Surveillance System, with 243,491 (49.6%) occurring in children aged <5 years.[14]

RSV is associated with increased morbidity amongst preterm infants and babies born with chronic health conditions such as respiratory and/or cardiac complications.[8] 

Currently, there is one TGA approved vaccine and two TGA monoclonal antibody drugs available for young infants: Abrysvo, Synagis and Beyfortus.

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

For more information on protecting newborn and infants from RSV, as well as State/Territory funding information, view our page on RSV Guidance and State/Territory Funding Information. 

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/or Torres Strait Islander adults aged ≥60 years are recommended to receive RSV vaccine

Adults aged 50–59 years who have medical conditions that increase their risk of severe RSV disease can consider RSV vaccination

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

An RSV vaccine is recommended during pregnancy to protect the infant

For more information on correct administration of RSV vaccines and State/Territory funding, view our page on RSV Guidance and State/Territory Funding Information. 

References

  1. Therapeutic Goods Administration. Updated warnings for respiratory syncytial virus vaccines: Arexvy and Abrysvo [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/updated-warnings-respiratory-syncytial-virus-vaccines-arexvy-and-abrysvo
  2. Australian Government Department of Health and Aged Care. Respiratory Syncytial Virus (RSV) infection; last updated 7 May 2024
  3. Centers for Disease Control and Prevention: RSV transmission page last reviewed 6 September 2023
  4. Government of South Australia SA Health. Respiratory syncytial virus (RSV) infection – including symptoms, treatment, and prevention. Last updated 29 Apr 20244.
  5. Therapeutic Guidelines [digital]. Melbourne: Therapeutic Guidelines Limited; 2023 Mar  https://www.tg.org.au
  6. Therapeutic Goods Administration (TGA). (2024, January 22). Arexvy | Australian Prescription Medicine Decision Summary. https://www.tga.gov.au/resources/auspmd/arexvy
  7. 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].
  8. 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
  9. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated December 2023
  10. 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
  11. Sanofi-Aventis Australia Pty Ltd. (2023). Australian product information: BEYFORTUS™ (nirsevimab) solution for injection [Product information]. Retrieved from https://medsinfo.com.au/product-information/document/Beyfortus_PI
  12. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed August 2023
  13. Saravanos G L Respiratory syncytial virus‐associated hospitalisations in Australia, 2006–2015; Med J Aust 2019; 210 (10): 447-453. || doi: 10.5694/mja2.50159
  14. National Centre for Immunisation Research and Surveillance (NCIRS). Respiratory syncytial virus (RSV): Frequently asked questions (FAQs). Available from https://ncirs.org.au/ncirs-fact-sheets-faqs-and-other-resources/respiratory-syncytial-virus-rsv-frequently-asked [6 June 2024].
  15. National Notifiable Disease Surveillance System. Available from https://nindss.health.gov.au/pbi-dashboard/ [Accessed 3 July 2025].

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