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Respiratory Syncytial Virus (RSV)

Respiratory Syncytial Virus, or RSV, is a virus that usually causes mild cold-like symptoms in most people. However, it can be serious for certain groups, including older adults, young children, people with weak immune systems, those with lung or heart problems, and premature babies.

Anyone can get RSV, but many babies catch it in their first year. Even if you've had RSV before, you can still get it again later in life.

 

Signs and Symptoms

Signs and symptoms of RSV can range from mild cold symptoms to severe respiratory distress and can include:

  • fever
  • loss of appetite
  • runny nose
  • cough
  • wheezing
  • sore throat
  • headache
  • general feeling of being sick

Premature babies may not have respiratory symptoms and instead be very tired, irritable, feed poorly and may have short periods of interrupted breathing. Infection with RSV can make medical conditions such as asthma and chronic lung disease worse. Sometimes severe illness can result in pneumonia, bronchiolitis, ear infections and tonsillitis.

Symptoms generally begin 4-6 days after exposure. An ill person can spread the virus for up to 8 days and sometimes longer. It can take 1-2 weeks to feel better.


How is RSV Spread?

RSV spreads by respiratory droplets in infected persons through coughing, sneezing or talking. It is also spread through contact with surfaces contaminated with RSV, such as toys, eating utensils, and unwashed hands. The virus can live on surfaces for many hours and on unwashed hands for a half hour. RSV is not spread though the air.

You can lower the chance of getting sick with RSV by doing the following:

Wash your Hands

Make sure hands are properly washed after wiping a child’s nose, coughing, sneezing, blowing the nose, shaking hands, before eating, before touching the eyes, nose or mouth. If your hands are not visibly dirty, an alcohol-based hand rub can be added to your hand hygiene routine.

Cover your cough or sneeze

Coughing and sneezing can spread germs to others. Cough or sneeze into a tissue and throw it away. If you don’t have a tissue, cough or sneeze into your sleeve. Always clean your hands after coughing or sneezing.

Clean surfaces

Frequently clean and disinfect surfaces and objects that are touched a lot like doorknobs, keyboards, counter tops, sink taps, toys, light switches, hand railings, remote controls, phones etc.

Stay home if you are sick

Staying home when you are ill is important to help reduce the spread of illness.


How is RSV Treated?

Most cases of RSV do not require any treatment and the ill person recovers on their own. For severe cases, oxygen and/or an antiviral medication may be prescribed. It is important to drink lots of fluids to avoid dehydration and to watch for increased difficulty in breathing.


RSV Vaccines and Monoclonal Antibody Product for Healthcare Providers

For the 2024-2025 respiratory season, Ontario’s publicly funded RSV prevention programs are targeting the following two populations who are at increased risk for illness and severe outcomes:

Older High-risk Adults

The chart below outlines Ontario’s 2024-2025 RSV Prevention Program targeting older high-risk adults and includes details of who is eligible for the program, which prevention product is recommended, and where eligible individuals will be able to access services.

  • Click on the name of the prevention product for a link to the product monograph.
  • For additional information and resources for Healthcare Providers, visit the Ministry webpage.
  • Individuals who are 60 years and older who do not qualify for this publicly funded prevention program can purchase the vaccine at a pharmacy with a prescription from their healthcare provider.

Eligibility Criteria

Prevention Product

Where can eligible individuals access services?

Adults aged 60 years and older who are also:
  • Residents of long-term care homes, Elder Care Lodges, or Retirement Homes
  • Patients in hospitals receiving alternate level of care (ACL) including similar settings (e.g. complex continuing care, hospital transitional programs)
  • Patients receiving hemodialysis or peritoneal dialysis
  • Recipients of hemodialysis or peritoneal dialysis
  • Recipients of solid organ or hematopoietic stem cell transplants
  • Individuals experiencing homelessness
  • Individuals who identify as First Nations, Inuit, or Métis

 

Currently, only a single dose is recommended by Health Canada and the National Advisory Committee on Immunization. Individuals who previously received a dose of RSV vaccine are not eligible for a dose as part of Ontario’s 2024-2025 RSV Prevention Program.

Arexvy (vaccine)

OR

Abrysvo (vaccine)

• One dose

  • Long-term care homes
  • Retirement homes
  • Hospitals
  • Healthcare Provider offices

 

Pharmacists will NOT be administering RSV vaccine for publicly funded individuals.


Infants and High-risk Children

The chart below outlines Ontario’s 2024-2025 RSV Prevention Program targeting all infants and high-risk children up to 24 months of age.

  • In order to provide RSV protection to an infant, a pregnant individual could receive Abrysvo vaccine between 32-36 weeks gestation, OR the infant can receive Beyfortus (Nirsevimab monoclonal antibody) at birth or within the eligible age range below.
  • The National Advisory Committee on Immunization (NACI) recommends the monoclonal antibody product, Beyfortus®, over the vaccination of the pregnant individual based on its efficacy (i.e., how well it works), duration of protection, and safety profile.
  • Click on the name of the prevention product for a link to the product monograph.
  • For additional information and resources for Healthcare Providers, visit the Ministry webpage.
Eligibility Criteria – During RSV Season Prevention Product Where can eligible individuals access services?
Abrysvo vaccine
  • For pregnant individuals between 32-36 weeks gestation (during RSV season)
  • This vaccine can be chosen if the gestational parent is not planning to have the infant product administered to their child after birth
Abrysvo (vaccine)
  • Health care providers (doctor, nurse practitioner, nurse)
Infants:
  • Born in 2024 before the 2024-2025 RSV season (infants 8 months of age or younger)
  • Born during the 2024-2025 RSV season
Children up to 24 months with:
  • Chronic lung disease of prematurity (CLD), including bronchopulmonary dysplasia, requiring ongoing assisted ventilation, oxygen therapy or chronic medical therapy in the 6 months before the start of RSV season
    • Note: Children who were < 12 months of age and approved for coverage in the previous RSV season for chronic lung disease and bronchopulmonary dysplasia remain eligible.
  • Hemodynamically significant congenital heart disease (CHD) requiring corrective surgery or are on cardiac medication for congestive heart failure or diagnosed with moderate to severe pulmonary hypertension
  • Severe immunodeficiency
  • Down Syndrome/Trisomy 21
  • Cystic fibrosis with respiratory involvement and/or growth delay
  • Severe congenital airway anomalies impairing the clearing of respiratory secretions
*Beyfortus (Nirsevimab monoclonal antibody)
  • Infants born during the 2024-2025 RSV season can receive vaccine in hospital after birth. Following this timeframe, it may also be available from health care providers while the infant is still eligible.
  • The Health Unit also provides this product for babies whose healthcare provider does not offer it, those who did not receive it at birth, or those under 2 years old in their second RSV season and considered high-risk. For more information and to discuss eligibility, please call 519-663-5317.
  • The London Health Sciences Centre (LHSC) also provides this service for babies in similar situations. Families can book an appointment by calling 519-685-8500 ext. 50071.

*See Ministry’s guidance for information and dose calculations:

Notes:

  • Arexvy RSV vaccine is NOT licensed for use during pregnancy.
  • Administration of both Abrysvo (vaccine) during pregnancy and Beyfortus (Nirsevimab monoclonal antibody) is not needed except under the following situations:
    • The infant was born within 2 weeks of the gestational parent receiving the Abrysvo vaccine
    • OR a child who is born with any of the health conditions noted as high risk in the chart above

Co-administration of RSV Prevention Products with Vaccines

  • Arexvy and Abrysvo (vaccines) can be administered on the same day as or any time before or after other vaccines.
  • Beyfortus (Nirsevimab monoclonal antibody) can be administered on the same day as or any time before or after childhood vaccines, including live vaccines.

Ordering

  • RSV vaccines are available to order now.
  • Monoclonal antibodies will be available to order mid-October.
  • All HCPs who order vaccines (excluding pharmacies) must use the online Public Health Ordering System (PHOS).
 
Date of creation: January 18, 2016
Last modified on: November 27, 2024

References

1Centers for Disease Control and Prevention (2005). Respiratory Syncytial Virus. Retrieved January 12, 2016 from Retrieved from
www.cdc.gov/Features/RSV/
2Pickering, L. K. (Ed.). (2012). Respiratory syncytial virus. In 2012 Red Book: Report of the committee on infectious diseases (29th ed; pp. 609-618). Elk Grove Village, IL: American Academy of Pediatrics.