ATAGI Targeted Review 2024: Immunisation strategies for prevention and control of respiratory syncytial virus disease in Australia.

Respiratory syncytial virus (RSV) causes lower respiratory tract infection and severe disease, particularly in infants, and is increasingly recognised as a cause of major morbidity and mortality in the elderly. Several new vaccines aim to address the disease burden at both extremes of the age spectrum. Immunisation using a long-acting monoclonal antibody is also available for infants and young children. In 2025, a comprehensive RSV maternal and infant protection program commenced with a nationally coordinated maternal RSV vaccination in pregnancy on the National Immunisation Program and long-acting monoclonal antibody for infants and children funded by states and territories. This targeted review outlines the Australian Technical Advisory Group on Immunisation's considerations and the evidence informing policy decisions on an RSV prevention strategy for Australia. Review of the burden of RSV disease in Australia indicates specific populations which would derive the most benefit from effective immunisation, including the very young; the elderly; First Nations people; and those with underlying medical risk factors. However, some data gaps exist in our understanding of RSV disease, particularly non-hospitalised disease and disease in adult age groups. The available evidence points to promising efficacy, against severe RSV disease, of three RSV vaccines in older adults, as well as the single available vaccine for use in pregnancy for protecting infants in the first six months of life. A long-acting RSV-specific monoclonal antibody, nirsevimab, has been highly effective in young infants in early assessments; however, there is a need to accumulate more information as these products expand in use. For RSV vaccines, there is a need to monitor duration of protection and safety, to inform the need for repeat vaccine doses in older adults and in subsequent pregnancies. As RSV immunisation involves new vaccines and monoclonal antibodies, it is important that a robust program monitoring and evaluation plan is put in place, to optimise assessment of vaccine uptake, patient acceptance and the impact of the interventions on RSV disease, with appropriate safety monitoring to facilitate public confidence in the immunisation program.