Respiratory Syncytial Virus

Overview

Respiratory syncytial virus (RSV) is a major cause of respiratory illness, particularly among infants, young children, and older adults, affecting the lungs and airways. RSV is the most common cause of bronchiolitis, a common chest infection that affects infants and toddlers. Immunization is available to help prevent serious outcomes, such as hospitalization, caused by the virus.

All infants up to 12 months old, and children up to 24 months who are at high risk of severe illness from RSV are eligible for immunization. The National Advisory Committee on Immunization (NACI) specifically recommends that infants less than 8 months of age be immunized. Immunization of infants is the recommended approach to protect them from RSV, however, a vaccine for pregnant individuals is also available, based on discussion with a health care provider.

Certain high-risk adults aged 60 years and older may be eligible for the vaccine. Adults aged 60 years and older who don’t qualify for the publicly funded program can still purchase the vaccine with a prescription from their family doctor or other primary care provider.

Signs and symptoms of RSV

Most children will have at least one RSV infection by the age of 2. The infection is most severe in young babies and older adults and can cause serious lung infections that may require hospitalization.

Most infants and children infected by RSV typically experience mild symptoms that last a few days. Older children and adults also get RSV but symptoms are typically mild, similar to a common cold.

Symptoms of RSV are similar to those of the cold or flu, including:

• coughing
• a runny nose
• fever
• wheezing
• a decrease in appetite and energy
• irritability in children

Because these are common symptoms, it is easy to mistake RSV for other respiratory illnesses, such as the flu or COVID-19. While most RSV symptoms will go away in a few days, seek medical attention if you or your child have trouble breathing, are not drinking enough fluids or are experiencing worsening symptoms.

Key facts

• most people who get an RSV infection will have mild illness and will recover within a week or 2 without the need for medical attention or treatment
• for some people, RSV may result in severe infections, particularly among infants, young children and older adults (RSV can also make chronic health problems worse)
• people are most likely to catch RSV from late fall to early spring, when the virus is most active

How RSV is spread

RSV is very contagious and spreads the same way as a common cold by:

• touching droplets containing the virus after someone coughs or sneezes
• being close (less than 2 metres apart) to someone with the infection who is coughing or sneezing

After exposure to the virus, it can take 2 to 8 days before becoming sick. People are usually contagious for up to 3 to 8 days. Children are often exposed to and infected with RSV outside the home, such as in school or childcare centers, and can then transmit the virus to other members of the family.

How to treat someone with RSV

In most cases, you can take care of someone with RSV at home as long as they are breathing comfortably, their skin does not look blue and they are drinking and urinating as usual. Most people get better within a week or 2.

Because RSV is a virus, antibiotics will not help someone get better faster.

What you can do to help

Manage fever and pain:

• use over-the-counter acetaminophen or ibuprofen
• do not give ibuprofen to babies under 6 months old without first talking to your doctor or other primary care provider
• never give aspirin to children

Hydrate:

• it is important to drink enough fluids to prevent dehydration (loss of body fluids)
• if your baby is having trouble drinking, try to clear nasal congestion gently with a bulb syringe or with saline (salt water) nose drops

Bathing:

• a lukewarm bath or wet face cloths will not change someone’s body temperature, but may help them feel more comfortable
• avoid cold baths because they are uncomfortable and can make the person shiver, raising their temperature
• alcohol baths or rubs are not recommended

Clothing:

• dress in light clothing, to allow the body to cool down and help increase comfort
• if the person starts to shiver, add warmer clothing — remove them when the shivering stops

Talk to your health care provider:

• before combining natural or herbal supplements with medicine, as some of ingredients may interact
• some medicines, like over-the-counter cough and cold medicines, contain ingredients that are not good for children

When to go to an emergency department

Some people can develop a severe form of RSV, which may result in pneumonia or, in infants and children, bronchiolitis. These illnesses can be serious and may require a visit to a health care provider or to the emergency department.

Go to an emergency department if someone:

• has trouble breathing (working hard to breathe, breathing faster than normal), pale skin, lips that look white or blue, asthma or wheezing
• has any of the following symptoms:
  • fever or is very sleepy/difficult to wake
  • repeated vomiting and unable to keep any liquids down for 8 hours or more
  • vomiting or diarrhea containing a large amount of blood
  • signs of dehydration with dry mouth or no urination for 8 hours or more

Severe RSV infections can result in lung infections or pneumonia in some older adults and those with underlying health conditions. RSV can also lead to worsening of:

• asthma
• Chronic Obstructive Pulmonary Disease (COPD) — a chronic disease of the lungs that makes it hard to breathe
• congestive heart failure — when the heart can’t pump enough blood and oxygen through the body

Adults who experience difficulty breathing should seek immediate medical attention.

How to protect yourself and others from RSV

• Stay home: Stay home if you or someone you’re caring for are sick and until you/they have no fever and symptoms are improving for at least 24 hours (or 48 hours if there was nausea, vomiting and/or diarrhea). Wear a mask when you are outside your home and in public places for 10 days from when your symptoms started.
• Clean surfaces: Clean surfaces in your home that are touched often on a regular basis.
• Wash your hands: Wash your hands often to reduce the spread of germs. Ask others to do the same.
• Use your arm: Coughing or sneezing into your arm instead of your hands and putting used tissue into the garbage right away.
• Breastfeed your baby: Breast milk contains antibodies and other immune factors that help prevent and fight off illness.
• Don’t smoke: Make sure nobody is around cigarette smoke, especially in your car or home.

If your child is under the age of 2 years and at high risk of severe illness from RSV, they may be eligible for an injection used to help prevent a serious lower respiratory tract infection caused by the virus. Please see eligibility below and discuss this option with your child’s health care provider.

Infant and high-risk children RSV prevention program

Monoclonal antibody

Through the infant and high-risk children RSV prevention program, the Ministry of Health covers the full cost of immunization to help prevent serious infection caused by RSV in infants and high-risk young children.

This immunization is only provided just prior to and during the active RSV season to infants and high-risk children who meet the ministry’s eligibility criteria for funding. The active season is generally from November to April, with some variations across some seasons and regionally.

Eligibility criteria

Monoclonal antibody immunization is currently funded for RSV prevention in infants and children who are residents of Ontario and meet any of the following criteria:

• born in 2024 prior to the RSV season (the National Advisory Committee on Immunization specifically recommends that infants less than 8 months of age or less be immunized)
• born during the 2024–25 RSV season
• children up to 24 months of age who remain vulnerable from severe RSV disease through their second RSV season, following discussion with a health care provider, including:
  • chronic lung disease (CLD), including bronchopulmonary dysplasia/chronic lung disease
  • hemodynamically significant congenital heart disease (CHD)
  • severe immunodeficiency
  • Down Syndrome/Trisomy 21
  • cystic fibrosis with respiratory involvement and/or growth delay
  • neuromuscular disease
  • severe congenital airway anomalies impairing the clearing of respiratory secretions

If you are unsure whether your child is eligible, contact a health care provider to discuss.

Vaccination in pregnancy

Giving the monoclonal antibody to an infant is the recommended approach over vaccination in pregnancy to protect infants. This is based on the:

• efficacy (how well it works)
• duration of protection
• safety profile of the monoclonal antibody, Beyfortus®
• recommendations from the National Advisory Committee on Immunization (NACI)

An RSV vaccine, Abrysvo™, may be recommended for pregnant people who do not wish to or are not able to protect their infant using the monoclonal antibody.

Generally, only 1 product is recommended to protect infants. In alignment with the National Advisory Committee on Immunization, Beyfortus® is the preferred product to protect infants. Receiving both Abrysvo™ and Beyfortus® is not expected to provide additional benefit.

The RSV vaccine will be available to people who are 32 to 36 weeks pregnant and who will deliver near the start of or during the RSV season. Being vaccinated during pregnancy helps your immune system create antibodies that protect the baby from RSV from birth until 6 months old.

You must be a resident of Ontario to be eligible for the publicly funded program.

Pregnant people should consult with their health care provider before receiving Abrysvo™.

Where you can get a free RSV immunization for your infant

The RSV immunization product, Beyfortus®, for infants will be available through:

• hospitals
• primary care offices
• public health units

Additionally, the RSV vaccine, Abrysvo™, may also be available through obstetricians and midwives.

Eligible individuals should speak with their health care provider to discuss the most appropriate product and location to receive this immunization.

High-risk older adult RSV vaccine program

How older adults qualify for a free RSV vaccine

In fall 2023, Ontario introduced its first publicly-funded high-risk older adult RSV vaccine program.

Ontario will continue this program with expanded eligibility in 2024–25. This includes adults aged 60 years and older who are also:

• residents of long-term care homes, Elder Care Lodges, or retirement homes including similar settings (for example, co-located facilities)
• patients in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
• patients receiving hemodialysis or peritoneal dialysis
• recipients of solid organ or hematopoietic stem cell transplants
• those experiencing homelessness
• those who identify as First Nations, Inuit, or Métis

Where older adults can get a free RSV vaccine

During the RSV season, you are eligible for a free RSV vaccine if you are over the age of 60 and:

• live in eligible congregate living residences may receive their vaccine in their residence, or through a health care provider
• are a hospital ALC patient. ALC patients ALC patients will receive their vaccine from their hospital
• receiving hemodialysis or peritoneal dialysis and solid organ or hematopoietic stem cell (HSCT) transplant recipients should speak to their treatment teams
• experiencing homelessness. Please contact a health care provider or local public health unit to receive your vaccine
• identify as First Nations, Inuit, or Métis, including those in urban settings. Please contact a health care provider, local public health unit or local Indigenous health care organization such as an Indigenous Primary Health Care Organization to receive your vaccine

Please note, regardless of your age or eligibility, the ministry does not reimburse people for any vaccines or vaccines purchased from the pharmacy.

Older adults who do not qualify for a free RSV vaccine

During the upcoming 2024–25 RSV season, if you are aged 60 years and older and don’t qualify for the free RSV vaccine, you can still purchase the vaccine with a prescription from your family doctor or other primary care provider.

Once you get a prescription, you would then buy the vaccine at your pharmacy and either get the shot there (if the pharmacy administers the vaccine) or take it back to your doctor or other primary care provider to get the shot.

Administration costs may vary for pharmacists and primary care providers. Before you get your prescription and shot, talk to your pharmacy and primary care provider to understand the clinic policies and related costs and if you wish you receive it at the pharmacy, to confirm they administer the shot.

The ministry does not reimburse people for any vaccines purchased at the pharmacy.

Some private insurers may cover all or part of the cost of the vaccine. Check with your insurance company for more information on your individual coverage.

Vaccine products

There are 2 vaccine products available in Canada to provide protection against lower respiratory tract disease (LRTD) caused by RSV for individuals 60 years of age and older.

Table 1: Authorized RSV Vaccine Products

* Currently, only a single dose is recommended by Health Canada and the National Advisory Committee on Immunization. Studies are ongoing to determine how long the protection lasts with a single dose of vaccine.

Safety and efficacy

Evidence supports the use of a single dose of either Arexvy or Abrysvo™ to help prevent RSV disease in adults 60 years of age and older.

Studies show multi-year protection. As such, if an individual received a dose of RSV vaccine during the 2023–2024 season, they do not need to receive another dose this season. The timing for subsequent doses is unknown at this time. Studies are ongoing to determine how long the vaccines provide protection.

Both vaccines are authorized by Health Canada and recommended by the National Advisory Committee on Immunization (NACI).

Both Arexvy and Abrysvo™ have been shown to be safe and demonstrated high effectiveness in preventing severe disease from RSV.

The RSV vaccine can be co-administered with (received at the same time as) both seasonal and non-seasonal vaccines. Co-administration is encouraged to help mitigate the impacts of the respiratory season.

Contraindications and precautions

If you are sick

If you are sick you may still be able to receive an RSV vaccine, however, it is dependent on the severity of symptoms. Those with a severe acute illness with or without a fever should wait until symptoms have lessened before receiving an RSV vaccine.

A minor illness, such as a cold, should not prevent you from receiving the vaccine. Please speak to a health care provider if you are feeling sick before receiving the vaccine.

If you’ve had a previous RSV infection

If you have had a previous RSV infection there is no specific interval that is recommended between RSV infection and RSV vaccination. However, all your symptoms should go away before you receive the vaccine.

If you've had a transplant

If you have had a transplant (solid-organ or stem cell), it is recommended that patients wait 3–6 months post-transplant to receive an RSV vaccination. However, a minimum of 1 month post-transplant may be used at the discretion of the provider.

Adverse events

Like any other vaccine or medication, the RSV vaccine may have some side effects, which in most cases are mild and last only a few days. Common side effects after the RSV vaccine can include:

• pain, redness and swelling where the shot is given
• fatigue (feeling tired)
• fever
• headache
• nausea
• diarrhea
• muscle or joint pain

It is important to discuss the benefits and risks of RSV vaccination with your health care provider.

In clinical trials and subsequent studies conducted on the vaccine, there were rare reports of serious neurologic conditions, including Guillain-Barré syndrome. It is unclear whether the vaccine caused these events. The safety of these vaccines will continue to be monitored.

Resources

These fact sheets provide basic information on the RSV prevention programs for infants, high-risk children and high-risk older adults.

For questions about these immunization products, book a phone appointment with the VaxFacts Clinic to speak with a trusted physician from the Scarborough Health Network at shn.ca/vaxfacts or speak to a health care provider.