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Promising RSV immunisation options for infants and children in Western Australia

9 Apr 2025
GP Connect News

GP Connect Clinical Feature by* Dr. Ushma Wadia a,b, A/Prof Hannah C. Moore b, Prof Peter C. Richmond a,b Prof Paul Effler c, Prof Christopher C. Blyth a,b  

With the recent introduction of the national and state RSV immunisation programs, there is now a pivotal shift in how GPs can help prevent RSV infection for infants and children.

Key points:

  • Respiratory Syncytial Virus (RSV) is a major cause of acute lower respiratory infection in young children and the leading cause of hospitalisation in Australia in the first year of life.1 2
  • In Australia, a long-acting monoclonal antibody, Beyfortus (nirsevimab) and maternal vaccination, Abrysvo, are now available for RSV prevention for young children.
  • The National RSV Mother and Infant Protection Program (RSV-MIPP), commenced on 3 February 2025. Abrysvo is available for pregnant women under the National Immunisation Program (NIP) and Beyfortus (nirsevimab) made available through state-funded programmes.
  • Western Australian children under two years of age with medical risk conditions had lower uptake of Beyfortus (nirsevimab) in 2024 compared to other cohorts, but remain at high risk of hospitalisation with RSV disease.

What is the 2025 WA Respiratory Syncytial Virus (RSV) Infant and Maternal Immunisation Program?

Option A: Abrysvo – available from 3 February 2025, all-year-round program.

  • The maternal RSV vaccine is funded under the NIP in 2025.
  • Pregnant women, 28–36 weeks gestation, are recommended the RSV vaccine to protect infants from birth through to six months.

Option B: Beyfortus (nirsevimab) – available from 1 April to 30 September 2025 (all-year-round in Kimberley and Pilbara only).

  • The WA Department of Health will continue to fund the infant RSV immunisation program to protect eligible infants and children, including:
    • infants born between 1 October 2024 and 30 September 2025 whose mother did not receive Abrysvo or received Abrysvo less than two weeks prior to delivery, or whose mother is immunocompromised
    • Aboriginal infants and children born between 1 October 2023 and 30 September 2024 entering their second RSV season
    • infants with specific high risk medical conditions born between 1 October 2023 and 30 September 2025.
    • Beyfortus (nirsevimab) is a long-acting monoclonal antibody that provides immediate protective immunity against RSV infection.
    • one injection provides protection for at least five months.

Both options will be offered at participating maternity hospitals, general practices, Aboriginal medical services, and community health immunisation clinics. Community pharmacies will offer Abrysvo but not Beyfortus (nirsevimab).

RSV immunisation decision aids have been developed to guide immunisation providers discussing options with patients state-wide, and in the Kimberley or Pilbara regions.

Which children are at the highest risk of requiring hospitalisation with RSV disease?

  • Infants less than six months of age.
  • Children younger than two years of age with conditions associated with increased risk of severe RSV disease:
    • Preterm birth <32 weeks gestational age
    • Hemodynamically significant congenital heart disease
    • Significant immunosuppression, such as from malignancy, solid organ transplant, haematopoietic stem cell transplant, or primary immune deficiencies such as severe combined immunodeficiency (SCID)
    • Chronic lung disease requiring ongoing oxygen or respiratory support
    • Neurological conditions that impair respiratory function
    • Cystic fibrosis with severe lung disease or weight for length <10th percentile
    • Trisomy 21 or another genetic condition that increases the risk of severe RSV disease

What was the uptake of Beyfortus (nirsevimab) in 2024?

  • More than 21,000 doses of Beyfortus (nirsevimab) were administered during the 2024 season in Western Australia.3
  • Statewide, Beyfortus (nirsevimab) coverage has been estimated to be 85% for the newborn cohort and 66% for the catch-up infant cohort but only 30% for at risk children in the second year of life.3 General practice providers delivered 37.9% of the doses.4

Is Beyfortus (nirsevimab) safe and does it work?

The REVIVE (REspiratory syncytial Virus Immunisation program – eValuating Effectiveness and impact) study, recently published in the Journal of Infection, assessed the effectiveness of Beyfortus (nirsevimab) against laboratory-confirmed RSV hospitalisation:5

  • It is a multi-centre, prospective case-control observational study estimating immunisation effectiveness using a test negative design enrolling children at Perth Children’s Hospital, Joondalup Health Campus and Fiona Stanley Hospital.
  • First Australian study to provide nirsevimab effectiveness estimate over a single epidemic season.
  • Nirsevimab recipients were 2% less likely to require RSV-associated hospital admission
  • Nirsevimab recipients were 8% less likely to require oxygen or respiratory support

In 2025, the REVIVE study will assess the effectiveness of nirsevimab and/or Abrysvo against laboratory-confirmed RSV hospitalisation.

WA Health have also reported on the safety of Beyfortus (nirsevimab) and found this to be safe.6 There were no significant adverse events post Beyfortus (nirsevimab) except common minor reactions and it is safe to give it with routine childhood immunisations.

Points to take away:

  • Beyfortus (nirsevimab) is safe and highly effective against RSV associated hospitalisation in infants.
  • Think of Abrysvo for pregnant women you are caring for.
  • Recommend Beyfortus (nirsevimab) for children at high risk of RSV disease as per the list above if born on or after 1 October 2023 to 30 September 2025.

Resources:

* Author affiliations:

a. Perth Children’s Hospital
b.   Wesfarmers Centre for Vaccines and Infectious Diseases, The Kids Research Institute Australia/University of Western Australia
c.   Communicable Disease Control Directorate, Western Australia Department of Health

References:
  1. Pratt MTG, Abdalla T, Richmond PC, et al. Prevalence of respiratory viruses in community-acquired pneumonia in children: a systematic review and meta-analysis. Lancet Child Adolesc Health 2022;6(8):555-70. doi: 10.1016/S2352-4642(22)00092-X [published Online First: 2022/06/01]
  2. Nair H, Nokes DJ, Gessner BD, et al. Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis. Lancet 2010;375(9725):1545-55. doi: 10.1016/S0140-6736(10)60206-1 [published Online First: 2010/04/20]
  3. Bloomfield L, Pingault N, Foong R, et al. Impact of nirsevimab on RSV-associated hospitalisations among infants in WA in 2024. The Medical Journal of Australia 2025 [published Online First: (in press)]
  4. Blyth C, Wadia U, Richmond P, et al. Evaluating the Nirsevimab RSV prevention program in Western Australia – early insights into program impact. OPTIONS XII Brisbane, Australia, 2024.
  5. Wadia U, Moore HC, Richmond PC, et al. Effectiveness of nirsevimab in preventing RSV-hospitalisation among young children in Western Australia 2024. J Infect 2025:106466. doi: 10.1016/j.jinf.2025.106466 [published Online First: 20250310]
  6. Carcione D, Spencer P, Pettigrew G, et al. Active Post-Marketing Safety Surveillance of Nirsevimab Administered to Children in Western Australia, April-July 2024. Pediatr Infect Dis J 2025 doi: 10.1097/INF.0000000000004715 [published Online First: 20250103]

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