RSV

A literature review (ref 1) published in 2025 summarising evidence on the burden of RSV in adults with asthma or COPD highlighted that:

• A population-based study in New Zealand reported that the adjusted risk of RSV hospitalisation increased by 6.7; 7.6 and 8.2 folds in people with asthma aged 18-49; 50-64 and 65-80 respectively, compared to people without asthma.(ref 1, 2)
• Two studies reported that 49-65% of patients 60 years and older with asthma hospitalised with RSV experienced asthma exacerbations.(ref 1)

– RSV vaccination is new, and has not been considered yet with the Australian Asthma Handbook guidelines.
– ATAGI recommends a single dose of Arexvy RSV vaccine for: (ref 1)
* all adults aged 75 and over
* Aboriginal and Torres Strait Islander peoples aged 60-74
* adults aged 60-74 with a medical condition increasing their risk of severe disease due to RSV, including severe asthma (defined as requiring frequent medical consultations or the use of multiple medicines)
– Arexvy can be co-administered with other vaccines, although this may increase mild-to-moderate adverse events.
– The need for further doses in the future has not yet been established. Recommendations on the need for subsequent doses will be provided when evidence is available.
– Abrysvo, another RSV vaccine, has been registered with the TGA in March 2024 for use in pregnant women and in adults 60 and over, however it is not available in Australia yet (as of 14 May 2024) (ref 2)

To protect infants/young children:(ref 2)
– monoclonal antibodies against RSV are currently available in Australia to immunise young infants and children up to 2 years. These are only available through certain states/territories programs (WA, QLD and NSW are funding nirsevimab for infants, see reference 2 for specifics of the programs)
– a RSV vaccine to immunise pregnant women: Abrysvo was registered by the TGA in March 2024 for use in pregnant women, however it is not available yet (as of 14 May 2024)

In childhood:
According to the Australian Asthma Handbook: (ref 1)
– severe respiratory viral infections during infancy, including with respiratory syncytial virus (RSV) and rhinovirus, are a risk factor associated with childhood asthma
– early life lower respiratory tract infections with RSV or Rhinovirus are strongly associated with allergic asthma in childhood.
– it is estimated that the attributable risk of asthma due to RSV is 13-22% in children 5 years and under, 11-27% in children 5-11 and 32% in children 12 and over. (This means that 13-22% of asthma occuring in 0-5 yo is thought to be due to RSV infection, etc)

In adulthood:
– Some medical conditions are associated with an increased risk of complications from RSV disease, including COPD and severe asthma (defined as requiring frequent medical consultations or multiple medicines). (ref 2)
– Older adults (particularly aged over 65), people with heart and lung disease, or people with weakened immune system are at higher risk of complication and hospitalisation. They may develop pneumonia, worsening asthma or COPD and congestive heart failure. (ref 3)
– adults that get an RSV infection typically have mild cold-like symptoms, however they may also develop a lung infection or pneumonia. RSV can also sometimes lead to worsening asthma, COPD and congestive heart failure.(ref 3, 4)

– RSV is a virus transmitted by respiratory secretions, and commonly causes upper and lower respiratory tract infection. Repeated infections are common throughout life because natural infection does not confer long-lasting immunity.
– in adults, RSV usually causes upper respiratory tract infection symptoms (cough, sore throat, nasal congestion etc). Lower respiratory tract infection can also cause wheezing and breathing difficulty.
– in children, the first RSV infection usually occurs by 2 years of age.
– The highest burden of RSV disease is among very young children and elderly people.
– RSV is the leading cause of hospitalisation due to lower respiratory tract infection and bronchiolitis in infants aged under 6 months. Most hospitlisations occur in children that are otherwise healthy.
– Hospitalisation rates decline with age after early childhood, then increase again from 50 to 65 years of age.
– Aboriginal and Torres Strait Islander adults have an increased risk of severe disease and hospitalisation due to RSV.

– so far 32k notifications in Quarter 1 which far exceeds the 15K notified in Q1 2023
– 37,002 cases up to 9/04/2023

– About 128,000 RSV lab-confirmed cases were notified in 2023, with the highest numbers in NSW (46,533; rate 90 per 100,000), QLD (28,787; rate 85 per 100,000) and VIC (25,232; rate 25 per 100,000)
– notifications were the highest in quarter 2 2023: 15K cases in Q1; 57K in Q2; 43K in Q3; 13K in Q4
– highest number of notifications in children 0-4 (64K) then 5-9 year olds (7k) and people aged 85+