REVIVE-ing RSV Care: New Prevention Tools and Real-World Data
A look at RSV, the vaccines available, and Western Australia’s (WA) game-changing study
I’ve recently had the opportunity to speak about Respiratory Syncytial Virus, or RSV (twice!) – a virus we’ve all heard of, many of us have seen or experienced firsthand, and some in this very community have dedicated their research careers to understanding it.
Today, I want to unpack this old yet persistent viral foe. It’s a virus that nearly everyone will get at some point, yet its impact on infants and vulnerable groups remains a significant concern.
What is RSV, and Who Does it affect?
For the microbiology enthusiast, RSV is an enveloped virus classified under the Pneumovirus genus within the Paramyxoviridae family. It carries a single-stranded, negative-sense RNA genome, which encodes 11 different proteins. Unlike influenza, RSV has a non-segmented genome, meaning it cannot undergo genetic reassortment. As a result, it lacks the ability to make dramatic genetic shifts—like those that lead to large-scale flu pandemics—though it can still mutate over time.
RSV is one of the most common and important causes of viral pneumonia, bronchiolitis, and lower respiratory tract infections (LRTI) worldwide (1). It also tops the list of hospitalisations from viral LRTI in children — just ahead of rhinovirus.
Globally, RSV leads to an estimated 3.2 million hospitalisations (2) every year. The true burden is likely even higher — around half of RSV-related deaths occur outside of hospitals.
Despite its broad reach, the highest risk group is very young infants – especially under 3 months of age, with an estimated incidence as high as 3000 per 100,000 child-years (3, 4).
But here's something important:
83% of hospital admissions are in previously healthy individuals.
That’s right. RSV doesn’t only impact those with chronic illness or immunosuppression — it hits the healthy, too.
Seasonality and the COVID Effect
In Australia, RSV tends to peak during late spring and summer. However, recent history (yes, we’re looking at you, COVID-19) has shown that non-pharmaceutical interventions like lockdowns, hand hygiene, and border closures can shift RSV seasonality in unexpected ways — as noted by Dr D Foley and team (5).
How RSV Infects – The F-Protein Key
A major breakthrough in RSV science was understanding the role of the F protein (Fusion protein), the viral component that allows RSV to enter human cells. It exists in two forms (5,6):
Pre-fusion (Pre-F)
Post-fusion (Post-F)
Why does this matter?
Because the Pre-F conformation offers better immunogenicity, it has a longer half-life (T1/2, 70-85 days) that will provide protection for approximately 5 months, covering the entire winter season. It also avoids the risks of enhanced disease seen in earlier vaccine attempts (like the infamous formalin-inactivated RSV vaccine from the 1960s). Different antigenic sites have different binding affinities and neutralising potency (7), so it is important to target the right ones.
So, when the clever scientists asked, "How do we stop RSV?", the answer was clear: Target the Pre-F protein!
Protecting Our Babies: Two Modern Options
Today, two major tools are available to protect infants:
Abrysvo (RSVpreF vaccine) – given to pregnant women to passively protect newborns
Nirsevimab (monoclonal antibody) – given directly to infants
Here’s how they compare:
Real-World Evidence: Global Studies, and WA’s Breakthrough
Abrysvo – Passive Immunity from Mum
The BERNI Study (8) in Argentina (2024) looked at infants <6 months hospitalised for LRTI.
Showed vaccine effectiveness against RSV-associated LRTI leading to infant hospitalisation was 78·6% (95% CI 62·1–87·9) from birth to age 3 months.
Importantly, all (n=3) RSV-related infant deaths occurred in babies whose mothers did not receive the vaccine.
Other trials, including a Phase 3 RCT (Kampmann 2023), demonstrated 81.8% efficacy against severe LRTI.
Concerns about preterm birth have since been allayed — preterm delivery rates among vaccinated mothers were within baseline population rates.
Nirsevimab – Direct Infant Protection
Global data from Spain (Galacia, Catalonia), Luxembourg, and the USA show major reductions in hospitalisations and ICU admissions. Nirsevimab is especially helpful in <6 month olds, where the burden is highest (10-13).
But now, let’s zoom in…
🧪 Spotlight: The REVIVE Study – WA’s Own Real-World Data
A standout moment for the Southern Hemisphere came with Wadia et al. and the REVIVE study (14). Conducted across Perth Children’s Hospital (PCH), Joondalup Health Campus (JHC), and Fiona Stanley Hospital (FSH), the study found:
88.2% effectiveness of Nirsevimab against RSV-associated hospitalisation
A separate WA population-based study by Bloomfield et.al. also found:
57% reduction in cumulative RSV hospital admissions
Estimated cost savings? Nearly $7 million in hospitalisation costs alone
These findings offer strong real-world validation for RSV prevention strategies right here in Western Australia.
As Dr Ushma Wadia, lead author of the REVIVE study, explains, we are entering an exciting new chapter in RSV prevention. For the first time, two safe and effective RSV immunisations—Abrysvo and Beyfortus—are available in Australia through government-supported programs.
“The National RSV Mother and Infant Protection Program (RSV-MIPP) commenced on 3rd February 2025,” Dr Wadia shares. “Abrysvo is available for pregnant women under the National Immunisation Program, while Beyfortus has been made available through state and territory-funded programs.”
Western Australia, in particular, is leading the way in RSV research and public health implementation. Through the STAMP-RSV program, WA researchers at The Kids Research Institute Australia and Perth Children’s Hospital are helping lay the groundwork for future national strategies by generating the evidence needed to inform public health policy.
The Bottom Line
RSV is common, and it affects everyone.
Young infants and at-risk groups carry the greatest burden.
Two RSV preventive strategies (Abrysvo and Nirsevimab) now exist, and they’re both safe and effective.
One more thing- The RSV Immunisation Guidance Tool.
If you’re in Western Australia, and do not know if you, your child or your patients are eligible for Abrysvo or Nirsevimab, then use this RSV Immunisation Guidance Tool. Super useful! No more guessing.
References:
Shi T, et.al. RSV Global Epidemiology Network. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017 Sep 2;390(10098):946-958. doi: 10.1016/S0140-6736(17)30938-8. Epub 2017 Jul 7. PMID: 28689664; PMCID: PMC5592248.
Pratt MTG, Abdalla T, Richmond PC, Moore HC, Snelling TL, Blyth CC, Bhuiyan MU. Prevalence of respiratory viruses in community-acquired pneumonia in children: a systematic review and meta-analysis. Lancet Child Adolesc Health. 2022 Aug;6(8):555-570. doi: 10.1016/S2352-4642(22)00092-X. Epub 2022 May 28. PMID: 35636455.
Saravanos GL, Sheel M, Homaira N, Dey A, Brown E, Wang H, Macartney K, Wood NJ. Respiratory syncytial virus-associated hospitalisations in Australia, 2006-2015. Med J Aust. 2019 Jun;210(10):447-453. doi: 10.5694/mja2.50159. Epub 2019 May 7. PMID: 31066061.
Foley DA, Minney-Smith CA, Tjea A, Nicol MP, Levy A, Moore HC, Blyth CC. The Changing Detection Rate of Respiratory Syncytial Virus in Adults in Western Australia between 2017 and 2023. Viruses. 2024 Apr 23;16(5):656. doi: 10.3390/v16050656. PMID: 38793538; PMCID: PMC11125702.
Coultas JA, Smyth R, Openshaw PJ. Respiratory syncytial virus (RSV): a scourge from infancy to old age. Thorax. 2019 Oct;74(10):986-993. doi: 10.1136/thoraxjnl-2018-212212. Epub 2019 Aug 5. PMID: 31383776.
THe University of Texas at Austin. Experimental Vaccine Against Respiratory Syncytial Virus (RSV) Elicits Strong Immune Response, 2019. https://news.utexas.edu/2019/08/01/experimental-vaccine-against-respiratory-syncytial-virus-rsv-elicits-strong-immune-response/
Nuttens C, Moyersoen J, Curcio D, Aponte-Torres Z, Baay M, Vroling H, Gessner BD, Begier E. Differences Between RSV A and RSV B Subgroups and Implications for Pharmaceutical Preventive Measures. Infect Dis Ther. 2024 Aug;13(8):1725-1742. doi: 10.1007/s40121-024-01012-2. Epub 2024 Jul 6. PMID: 38971918; PMCID: PMC11266343.
Pérez Marc G, et.al. BERNI study working group. Real-world effectiveness of RSVpreF vaccination during pregnancy against RSV-associated lower respiratory tract disease leading to hospitalisation in infants during the 2024 RSV season in Argentina (BERNI study): a multicentre, retrospective, test-negative, case-control study. Lancet Infect Dis. 2025 May 5:S1473-3099(25)00156-2. doi: 10.1016/S1473-3099(25)00156-2. Epub ahead of print. PMID: 40339585.
Kampmann B, et.al.; MATISSE Study Group. Bivalent Prefusion F Vaccine in Pregnancy to Prevent RSV Illness in Infants. N Engl J Med. 2023 Apr 20;388(16):1451-1464. doi: 10.1056/NEJMoa2216480. Epub 2023 Apr 5. PMID: 37018474.
Nirse-gal follow up report on immunisation with nirsevimab in Galicia 17 Mar 2024: https://www.sergas.es/Saude-publica/Documents/7512/Report_RSV_week9.pdf
Coma E, et.al. Effectiveness of nirsevimab immunoprophylaxis against respiratory syncytial virus-related outcomes in hospital and primary care settings: a retrospective cohort study in infants in Catalonia (Spain). Arch Dis Child. 2024 Aug 16;109(9):736-741. doi: 10.1136/archdischild-2024-327153. PMID: 38857952; PMCID: PMC11347209.
Ernst C, et.al . Impact of nirsevimab prophylaxis on paediatric respiratory syncytial virus (RSV)-related hospitalisations during the initial 2023/24 season in Luxembourg. Euro Surveill. 2024 Jan;29(4):2400033. doi: 10.2807/1560-7917.ES.2024.29.4.2400033. PMID: 38275017; PMCID: PMC10986653.
Moline HL, et.al. Early Estimate of Nirsevimab Effectiveness for Prevention of Respiratory Syncytial Virus-Associated Hospitalization Among Infants Entering Their First Respiratory Syncytial Virus Season - New Vaccine Surveillance Network, October 2023-February 2024. MMWR Morb Mortal Wkly Rep. 2024 Mar 7;73(9):209-214. doi: 10.15585/mmwr.mm7309a4. PMID: 38457312; PMCID: PMC10932582.
Wadia U, Moore HC, Richmond PC, Levy A, Bell L, Pienaar C, Harvey J, Finucane C, van der Helder E, Bloomfield L, Cheng A, Effler P, Blyth CC. Effectiveness of nirsevimab in preventing RSV-hospitalisation among young children in Western Australia 2024. J Infect. 2025 Apr;90(4):106466. doi: 10.1016/j.jinf.2025.106466. Epub 2025 Mar 10. PMID: 40074179.
Bloomfield LE, Pingault NV, Foong RE, French S, Morgan JA, Wadia U, Moore HC, Blyth CC, Richmond PC, Armstrong PK, Effler PV. Nirsevimab immunisation of infants and respiratory syncytial virus (RSV)-associated hospitalisations, Western Australia, 2024: a population-based analysis. Med J Aust. 2025 Apr 28. doi: 10.5694/mja2.52655. Epub ahead of print. PMID: 40293046.