Prevention of RSV bronchiolitis

Infant monoclonal antibody vaccination

Consider providing monoclonal antibody prophylaxis (nirsevimab or palivizumab) during the RSV season to infants at increased risk of severe complications from bronchiolitis (due to the presence of chronic lung disease, congenital heart disease, or birth at <32 weeks’ gestational age). (Evidence quality: moderate; recommendation strength: conditional)

Nirsevimab provides long-acting protection (6 months) from one dose. Palivizumab provides short-acting protection (1 month) and requires 5 to 6 monthly doses during the RSV season.

Consider universal nirsevimab as a population-based approach to reduce morbidity due to RSV bronchiolitis. (Evidence quality: moderate; recommendation strength: conditional)

Maternal active RSV immunisation

Consider universal maternal antenatal immunisation with an RSV prefusion F protein-based vaccine as a population-based approach to reduce morbidity from RSV bronchiolitis. (Evidence quality: moderate; recommendation strength: conditional)

Infant active RSV immunisation

This recommendation refers to the use of active RSV vaccines for infants and excludes passive vaccines (e.g., monoclonal antibodies, as above). 

Do not routinely use universal infant RSV immunisation. (Evidence quality: low; recommendation strength: weak)

At the time of publication, there is no approved active vaccine candidate for RSV in infants in Australasia.