Respiratory Syncytial Virus

In January 2024, the Therapeutic Goods Administration (TGA) approved the first respiratory syncytial virus vaccine – Arexvy®. ATAGI (Australian Technical Advisory Group on Immunisation) issued guidelines recommending the vaccine for all people ≥ 75 years of age. ATAGI has also recommended the vaccination for people 60-74 years of age with medical conditions (RSV infection increases risk of severe disease) and Aboriginal and Torres Strait Islander people over the age of 60 years.

Arexvy® is highly effective as it reduces the incidence of lower respiratory tract infections by 83% and severe RSV infections by 94%. Arexvy® is currently not available on the Pharmaceutical Benefits Scheme (PBS). However, there is an expectation that it will be added to the National Immunisation Program, in time.

RSV is a common respiratory disease that causes cold-like symptoms. In severe cases, infection can spread and cause pneumonia or bronchiolitis. It is very common in children. Virtually all children are infected before the age of two. However, in recent years there has been a greater awareness of RSV infection in adults, particularly those over the age of 60. Immunocompromised individuals regardless of age are also at a higher risk of getting RSV and having a more severe infection requiring hospitalisation.

RSV has been around for a long time, but it’s been under recognised and only became a notifiable disease in 2021. It is a very contagious virus. Infected individuals are likely to infect three other people. Natural immunity to RSV is very short lived and hence repeated infections are typical throughout life. The virus is spread through aerosol droplets formed from coughs or sneezes.

Most adults over 60 would probably have had RSV 6-10 times. But it may have been interpreted as a common cold or influenza as their symptoms may have been mild.
Triple combination rapid antigen tests (RATs) incorporating influenza A and B, RSV and COVID-19 are available at pharmacies. Polymerase chain reaction (PCR) tests for influenza A and B, RSV, COVID 19, adenovirus, and others are also available.

Like the common cold, there is no specific medication for RSV. Treatment is symptom based. In temperate and colder climates, RSV has a late autumn to winter season, similar to influenza. In subtropical areas, it can be earlier because of the warmer weather. In Northern Territory, it can be in the wet season. However, anytime is a good time to get vaccinated against RSV. A need for revaccination has not been established yet as per the product information.

RSV infections can exacerbate existing medical conditions. For older Australians with co-morbidities like asthma, diabetes, chronic obstructive pulmonary disease (COPD), heart failure, chronic kidney disease, and coronary artery disease, vaccination is particularly important as they are more likely to be hospitalised. Among patients with COPD, 80% experienced an exacerbation during an RSV associated hospitalisation.

About 25% of people aged over 60 who are hospitalised with RSV will require home care when discharged. And about 25% will be readmitted to hospital within 3 months. About 33% of people aged 75 years and older will die within one year of admission to hospital with RSV. Many people do not get back to their normal function level. It can really impact on people’s quality of life, their emotional, physical and cognitive functioning, and their sleep. It’s a bit similar to the long-term effects we’re seeing after COVID 19 infection.