RSV Vaccination
Eligibility Checker

Vaccine: Arexvy (GSK) — the only RSV vaccine listed under the widened NIP for older adults. Abrysvo is NOT interchangeable for this cohort under the NIP.

Dose: Single dose 0.5 mL IM injection. Reconstitute immediately before use; use within 4 hours.

Duration: Evidence supports protection for up to 3 RSV seasons (PBAC July 2025). No booster dose currently recommended — further monitoring ongoing.

Where: Eligible patients may attend a pharmacy, GP clinic or Aboriginal Health Service from 15 May 2026.

Adults aged 60–74 years (non-Indigenous, no risk factor): Lower risk than ≥75 group but still benefit from vaccination. Can receive either Abrysvo or Arexvy (no brand preference). Not NIP-funded in this subgroup without a risk factor.

Adults aged 50–59 years with a medical risk factor: Arexvy is the only vaccine registered in this age group. Consider vaccination and discuss cost (~$300 private). Not NIP-funded.

Recommended window: 28–36 weeks gestation. If not given by 36 weeks, vaccinate as soon as possible.

Critical: If infant born <2 weeks after vaccination, protection is significantly reduced. Consider nirsevimab (Beyfortus) for the infant.

Co-administration: Abrysvo may be given at the same time as dTpa, influenza, COVID-19 vaccines and Rh(D) immunoglobulin (Anti-D). Minor reduction in anti-pertussis antibodies noted — no clinical significance; no extra dTpa dose needed.

Purpose: Maternal immunisation reduces severe RSV in infants <6 months by ~70% via transplacental antibody transfer.

Subsequent pregnancies: Re-vaccinate in each pregnancy (even closely spaced) for maximal infant protection.

RSV vaccines (Abrysvo/Arexvy) must NOT be given to infants or children. Passive immunisation via monoclonal antibodies applies.

Nirsevimab (Beyfortus) — preferred:

• Neonates/infants <8 months entering 1st RSV season whose mother was NOT vaccinated ≥2 weeks before birth
• Infants with risk conditions for severe RSV (regardless of maternal vaccination)
• Children 8–<24 months with risk conditions entering 2nd+ RSV season

Dosing: <5 kg → 50 mg; ≥5 kg → 100 mg; 2nd RSV season → 200 mg (2 × 100 mg IM at separate sites)

Palivizumab (Synagis): Short-acting alternative. Monthly injections up to 5 doses per season. Reserve for high-risk infants if nirsevimab unavailable. State/territory hospital guidelines apply.

Administration (both brands): 0.5 mL IM injection. Must be reconstituted — add diluent syringe to powder vial, swirl gently (do NOT shake). Use within 4 hours of reconstitution (Abrysvo: store up to 30°C; Arexvy: up to 25°C after reconstitution).

Storage: +2°C to +8°C. Protect from light. Do not freeze.

ATAGI recommended safety measures:

• Clearly label fridge storage areas and trays for specific populations (pregnant people vs older adults)
• Store infant/child vaccines in dedicated, separate fridge sections
• Display reminders or warning signs in consultation rooms and storage areas
• Implement procedural checklists — confirm correct vaccine for patient demographics before drawing up
• Update clinical systems and enable alert functions for automated safety nets

GBS monitoring: Post-market surveillance shows slightly elevated GBS rates after RSV vaccination (Arexvy: 5–7 excess/million; Abrysvo: 9–18 excess/million within 42 days). Counsel patients to seek urgent review if weakness/tingling develops post-vaccination. TGA has updated product information.

Document discussions about GBS risk for patients with prior GBS history — refer to GP for shared decision-making.

What is RSV? A common respiratory virus. Most adults get mild cold-like illness, but in people aged ≥75 years or those with underlying conditions, it can cause pneumonia, hospitalisation and death. RSV season peaks June–July in temperate Australia.

About the vaccine:

• One injection in the upper arm. Takes a few weeks to build protection.
• Best given before winter (May–June ideal). Can be given year-round.
• Protection lasts multiple RSV seasons — no booster currently needed.
• Mild side effects common: arm soreness (up to 61%), fatigue (34%), headache, muscle aches. Usually resolve within a few days.

Rare risks to mention:

• Guillain–Barré syndrome (GBS) — very rare (<10 cases/million doses). Seek urgent medical review if weakness or numbness develops after vaccination.
• Atrial fibrillation — rare; no confirmed causation.

Previous RSV infection: Vaccination can still be given once fully recovered from an RSV illness.

Co-administration: Can be given same day as flu, COVID-19, pneumococcal and zoster vaccines. Slightly higher chance of arm soreness and fatigue with same-day co-administration — counsel the patient.

All immunisations administered must be reported to the Australian Immunisation Register (AIR) within the required timeframe. This applies for both NIP-funded and private vaccines.

Record in patient file / dispensing system:

• Patient name, DOB, Medicare/IHI number
• Vaccine brand (Arexvy or Abrysvo), batch number, expiry date
• Date, dose, injection site (e.g. left deltoid)
• Eligibility basis (age, Indigenous status, risk factor, pregnancy gestation)
• Consent obtained and any pre-vaccination screening findings
• Counselling provided including AEFIs discussed
• 15-minute post-vaccination observation completed

Adverse event reporting: Report any serious adverse events to the TGA via the Blue Card system. Anaphylaxis — call 000 immediately; manage with adrenaline autoinjector as per ASCIA guidelines.