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Respiratory Syncytial Virus

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Respiratory Syncytial virus (RSV)

Respiratory Syncytial virus (RSV) is a virus that affects the airways and lungs, resulting in cold like symptoms. Its very contagious and spreads easily. Most people recover in a week or two, but some cases can be serious. Infants and older adults are more likely to develop sever RSV that requires hospitalisation.

Surveillance

RSV became notifiable to the National Notifiable Diseases Surveillance System (NNDSS)in Australia in 2021. Since then, RSV annual rate recordings have been progressively increasing with reports of 225, 275 between 2021 – 2024 (to date).

In Australia, cases and hospitalisation are more common in winter, however they can occur year-round; for example, in 2024 we have seen 70,866 cases with a national spike in March. Seasonal spikes are less noticeable in northern parts of Australia.

Transmission

RSV is spread through droplets from an infected person’s cough or sneeze. The droplets can be inhaled or land in the eyes, nose, or mouth; direct contact can also transmit i.e. via kissing; or from touching a surface/equipment that has been contaminated by the droplet and then touched eyes, mouth or nose attending to hand hygiene.

Prevention

RSV vaccination and immunisation is recommended in certain population groups- access and eligibility vary across Australian jurisdictions and is not part of the National Immunisation Program (NIP).

Practice good hygiene, i.e. cover the cough/sneeze, perform hand hygiene, clean frequently touched surfaces. Ventilation, i.e. open windows, purify indoor air, gather outdoors. Stay home if sick. Additional measures can also be used masks, physical distancing, and testing.

Symptoms

Symptoms usually start within 4-6 days of being infected, these include: runny nose decrease in appetite, coughing, sneezing, fever, wheezing. The symptoms generally appear in stages.

People with RSV are usually contagious for 3-8 days and may be contagious for a couple of days before symptoms show. Some infants and people with weakened immune systems can continue to spread the virus for up to 4 weeks- without showing any signs or symptoms.

RSV can survive on hard surfaces for many hours, however survives on soft surfaces i.e. tissues and hands for shorter periods.

Management

Antiviral medication is usually not recommended.

Relieve symptoms: manage fever and pain with paracetamol or anti-inflammatory, drink fluids to prevent dehydration, visit healthcare provider for advice.

RSV can cause more serious infections such as bronchiolitis (inflammation of the small airways in the lungs), or pneumonia (lung infection).

Healthy adults and children with RSV do not usually require hospitalisation, but some older adults and infants less then 6 months may require hospital support if they are having trouble breathing or are dehydrated. In the most severe cases oxygen and IV fluids or incubation (with mechanical ventilation), may be required.

RSV in infants and young children

RSV can be dangerous for infants and young children. At greatest risk include premature infants, infants 6-12mths, children younger than 2yrs with chronic lung disease and congenital heart disease, children with weak immune systems or neuromuscular disorders – including swallowing difficulties.

Preventative options include passive immunisation: RSV vaccine (Abrysvo vaccine) during pregnancy (recommended at 32-36 weeks, antibodies passed on to the infant via the mother). Alternatively, RSV monoclonal antibodies can be given directly to infants and babies under 24 months. Both are TGA registered, Beyfortus (nirsevimab) is long acting and administered as a single dose and Synagis (palivizumab) which is administered monthly.

Infant symptoms: runny nose, eat/drink less, cough and wheezing – symptoms progress over a couple of days. Very young infants (< 6mths old) will always present with symptoms and may include irritability, decreased activity, eat/drink less, apnoea (pause in breathing), +/- fever.

Virtually all children will have had RSV by age 2yrs. 2-3 / 100 cases may need hospitalisation. Most improve with supportive care and are discharged in a couple of days.

RSV in older adults or those with chronic medical conditions

At greatest risk are older adults, or adults with heart and lung disease, weakened immune systems, underlying medical conditions or those living in long term care facilities.

In Australia, the RSV vaccine is only available for older adults, it is recommended for people 75yrs and over, people 60-74yrs with medical conditions associated with RSV risk and First Nation people 60-74yrs. Arexvy and Abrysvo, are both non-live vaccines currently TGA registered and approved for use in Australia. A 3rd vaccine is currently being evaluated for registration.

Adult RSV infection typically presents as a cold, but some older adults develop pneumonia or experience worsening of other conditions such as asthma, chronic obstructive pulmonary disease and congestive heart failure. Older adults who become very sick may require hospitalisation and even die.