Respiratory Syncytial Virus (RSV)

Respiratory viruses are primarily spread to others by respiratory droplets and aerosols that travel through the air when an infected person breathes, speaks, sings, coughs, or sneezes. They can also be spread by contact – either with the infected person (like kissing or shaking hands), or by touching contaminated surfaces and then touching your mouth, nose, or eyes. These viruses can survive on surfaces for many hours.

People infected with RSV are usually contagious for three to eight days. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as four weeks.

Children are often exposed to and infected with RSV outside the home, such as in school or child-care centers. They can then transmit the virus to other members of the family.

People infected with RSV usually show symptoms within four to six days after getting infected. Symptoms may include:

Runny nose
Cough
Sore throat
Fever
Decrease in appetite
Wheezing

There is no specific treatment for illnesses caused by RSV. Most people will recover on their own. You can relieve your symptoms by:

Taking pain or fever medications (note: never give aspirin to children)
Using a room humidifier or taking a hot shower to help ease a sore throat and cough
Drinking plenty of liquids to stay hydrated
Staying home and resting

If you are concerned about your symptoms, contact your health care provider.

For RSV protection the CDC (Centers for Disease Control and Prevention) recommends:

Adults - Adults 60 years and older get one dose of Arexvy or Abrysvo vaccine.

Infants and children–Infants and children can get protected through either maternal RSV vaccination or the monoclonal antibody (nirsevimab). Both products are not needed for most infants.

Maternal RSV vaccination

Pregnant people get one dose of the Abrysvo vaccine between 32 and 36 weeks and six days of pregnancy. Abrsyvo is administered during September–January and provides protection to the infant during RSV season. Learn more about the American College of Clinicians and Gynecologists (ACOG) recommendation for maternal RSV vaccination.

OR

Monoclonal antibody (nirsevimab)

Infants younger than 8 months born during, or entering, their first RSV season get one dose of the monoclonal antibody (nirsevimab). Nirsevimab is administered October through March.
Children 8-19 months old who are at increased risk for severe RSV disease should also receive the monoclonal antibody (nirsevimab).

Find out if you or your children are protected from RSV. Check our Wisconsin Department of Health Services (DHS) Wisconsin Immunization Registry.

If you’re worried about cost, your family may be eligible for free vaccines. Read about our Vaccines for Children  program and Vaccines for Adults program.

DHS maintains several respiratory illness data dashboards that include RSV-related data from multiple data sources.

Visit Respiratory Illness Data Snapshot to view RSV-related data in Wisconsin.

When is the RSV season?

In Wisconsin, the RSV season starts in the Fall and goes until the Spring (typically October through March). RSV infections are most common in the fall and winter. The Advisory Committee on Immunization Practices (ACIP) recommends the maternal vaccination (Abrysvo) be administered September 1–January 31 while the long-acting infant monoclonal antibody immunization (nirsevimab) should be administered October 1–March 31.

Can unexpired nirsevimab from last season be used this season?

Yes, nirsevimab has a shelf life of 18 months. Unexpired doses from last season may be used in the subsequent RSV season as long as they have been properly stored.

Can Abrysvo and nirsevimab be administered with other vaccines?

Yes, Abrysvo can be administered at the same time as other vaccines, such as flu, COVID-19, and Tdap. Note that Abrysvo is the only approved RSV vaccine for pregnant people. Nirsevimab can also be administered with infant vaccines, such as the birth dose Hepatitis B vaccine and other routine childhood vaccines.

Does the infant need nirsevimab if the birthing person got Abrysvo?

Most infants born to a birthing person who received Abrysvo do not need nirsevimab. However, if the infant is born less than 14 days after the birthing person received Abrysvo, the infant should receive nirsevimab. Learn about the rare circumstances in which infants should receive nirsevimab even if the birthing person received Abrysvo.

Which 8-19 month old children are eligible for nirsevimab?

Children 8-19 months old who are at an increased risk of severe RSV disease should receive nirsevimab during their second RSV season, regardless of prior maternal and infant immunizations received. High risk 8-19 month olds should receive two 100 mg doses, regardless of weight. High risk children include the following groups:

American Indian and Alaska Native children
Children who are severely immunocompromised
Children with cystic fibrosis with severe disease
Children with chronic lung disease of prematurity who require medical support during the six months before the start of their second RSV season

For more information, visit Nirsevimab Recommendations for Infants and Young Children.

How do we protect infants born outside of the RSV season?

Infants born April–September to a birthing person who didn’t receive Abrysvo and are younger than 8 months of age are recommended to receive nirsevimab at the start of the subsequent RSV season; per the Advisory Committee on Immunization Practices, administration should begin October 1 in Wisconsin.

How can providers clearly indicate the birthing person’s receipt of Abrysvo to inform infant immunization needs?

Providers should make a clear note in the birthing person’s chart upon receipt (or confirmation of receipt of Abrysvo and encourage patients to bring a hard copy of their vaccination records to the birthing facility to inform infant immunization needs.

If it is unknown whether or not the birthing person got Abyrsvo, what steps should be taken to determine nirsevimab eligibility?

Efforts to determine the birthing person’s vaccination status should be made by seeking the information from the electronic health record (EHR) or the birthing person, if able. Alternatively, search the Wisconsin Immunization Registry (WIR) upon receiving consent from the birthing person. If the birthing person’s status remains unknown, CDC recommends administering nirsevimab.

What should birthing facilities do if they do not administer nirsevimab during the birthing stay and the birthing person did not receive Abrysvo?

ACIP recommends that all infants younger than 8 months of age receive nirsevimab within seven days of birth. For some, this will be in the hospital, while for others, it will be at the infant’s first health care provider visit. If nirsevimab is not administered at the birthing hospital, a clear note should be made in the infant’s chart to ensure they receive nirsevimab at their first health care provider visit.

What information should I include when referring a pregnant person to a vaccine provider if I don't carry the vaccination?

When referring patients to other vaccine providers, it is recommended to indicate the pregnant patient’s gestational age and positive pregnancy status, alongside the vaccine(s) to be administered.

Should Abrysvo be given to pregnant people during every pregnancy?

There is currently no recommendation for pregnant people to receive the RSV vaccine during any subsequent pregnancy after initial RSV vaccination. Infants should receive nirsevimab during their first RSV season.

If both nirsevimab and palivizumab are available for eligible high-risk patients, which should they receive?

All infants eligible for nirsevimab should receive nirsevimab. Palivizumab should be administered to eligible high-risk patients if nirsevimab is unavailable.

Should patients who don't qualify for nirsevimab, but do qualify for palivizumab based on the 2014 AAP policy statement receive palivizumab, nirsevimab, or neither?

Neither. According to the 2024 Red Book the only instance when palivizumab should be administered is when nirsevimab is recommended, but is not available and the patient is eligible to receive palivizumab.

FAQ resources

Nirsevimab Frequently Asked Questions | American Academy of Pediatrics
Maternal RSV Vaccination Frequently Asked Questions | American College of Obstetricians and Gynecologists
Frequently Asked Questions About RSVpreF (Abrysvo) Vaccine for Pregnant People | CDC

Respiratory Syncytial Virus (RSV)

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