Respiratory Syncytial Virus (RSV) is an enveloped negative-sense, single-stranded RNA virus belonging to the Orthopneumovirus genus of the Pneumoviridae family in the order Mononegavirales. It is one of the common viruses responsible for respiratory tract infections, particularly during autumn and winter. While RSV infections can occur year-round, they are most prevalent between October to March, with most infections occurring in a relatively short epidemic of about six weeks.
RSV infection causes symptoms like those of a cold, including rhinitis (runny nose, sneezing or nasal congestion), cough, shortness of breath, wheezing, lethargy and sometimes fever.
RSV spreads from respiratory secretions through close contact with an infected person via respiratory droplets or contact with contaminated surfaces or objects. The virus can survive on surfaces or objects for about four to seven hours. The incubation period ranges from two to eight days, and the infectious period lasts from three to eight days.
RSV infection is usually mild and resolves by itself. However, infants and older adults are at higher risk for acute lower respiratory tract infection (LRTIs). In all ages, LRTIs can include pneumonia. In infants, it can lead to bronchiolitis and may cause decreased oral intake. Additionally, RSV can cause croup and otitis media in children. Globally, RSV infects up to 90% of children within the first two years of life and frequently reinfects older children and adults.
Most RSV hospital admissions involve infants born at full term without underlying risk factors. However, infants born between August and November are younger during peak RSV season and are at greater risk of hospitalisation, as are those born prematurely.
Predisposing clinical risk factors for severe RSV disease in infants include:
congenital heart disease
chronic lung disease
chromosomal abnormalities
neuromuscular disorders
large airway abnormalities, and
immunodeficiency (especially those with multiple health conditions).
RSV LRTIs significantly impact older adults. The LRTI can worsen chronic obstructive pulmonary disease (COPD) or heart disease. The weakened immune system in older adults (immunosenescence) may contribute to their vulnerability to severe RSV infections.
The Joint Committee on Vaccination and Immunisation JCVI) acknowledges the significant impact of RSV on the UK population and the strain it places on NHS services during winter. In 2023, the JCVI recommended implementing RSV immunisation programmes to protect infants and older adults.
From 1 September 2024, Wales will introduce a maternal programme to protect infants, and an older adult programme to protect older adults.
The vaccine used in both the maternal programme and the older adult programme is Abrysvo®.
Summary of product characteristics
More information about the vaccine can be found in the Green Book Chapter 27a Green Book on immunisation - Chapter 27a Respiratory Syncytial Virus (RSV) (external site)
Guidance in the Green Book Chapter 27a RSV supersedes the SmPC.
The Complete Routine Immunisation Schedule for Wales includes information about routine and non-routine vaccinations.
The national programme for infant protection is offered year-round to all pregnant women between 28 and 36 weeks gestation. The vaccine can be offered off label after 36 weeks gestation, however this may not offer as high level of passive protection to the baby.
Ideally the vaccine should be given in week 28 or soon after. This allows sufficient time for the mother to make high levels of antibodies, which can then transfer across the placenta. This also increases the potential for babies who are born prematurely to benefit.
It is also clinically reasonable for women who have not been vaccinated during pregnancy to receive the vaccine after delivery until they have been discharged from maternity services. However, the emphasis is on offering the vaccine from week 28 weeks gestation as vaccination post-delivery does not offer transplacental antibody transfer. It may however protect the mother from contracting RSV or make her less infectious. There may also be antibody transfer to the baby from breastmilk.
Maternal vaccination has shown to be effective against RSV LRTI in infants from birth to beyond six months. A trial showed that vaccinating pregnant women between weeks 24 and 36 significantly reduced RSV LRTI and severe RSV LRTI in infants.
In a clinical trial looking at adverse reaction to Abrysvo®, there were slightly more premature babies in the vaccine group (2.4%) than the placebo group (1.9%). This was not statistically significant and there was no temporal relationship between premature births and the RSV vaccination.
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Vaccine |
When should each vaccine be administered? |
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Licenced between 16 and 32 weeks gestation (however, may be given up to eight weeks following birth) |
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Licenced between 28 and 36 weeks gestation (* can be given off licence until discharge from maternity services) |
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Any time during pregnancy |
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Any time during pregnancy |
It is important to have vaccines at the right time in pregnancy. Pregnant women should receive their vaccines as soon as they become eligible.
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Vaccines |
Can they be administered together? |
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Abrysvo® and anti-D immunoglobulin |
✔ |
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Abrysvo® and pertussis-containing vaccine |
✔* |
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Abrysvo® and seasonal influenza vaccine |
✔ |
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Abrysvo® and seasonal COVID-19 vaccine |
✔ |
* There is some evidence that giving the RSV vaccine with pertussis-containing vaccines may slightly reduce the immune response to pertussis. The clinical impact is unclear and likely small. To avoid this potential issue, it is recommended to administer the pertussis vaccine from 16 weeks and the RSV vaccine from 28 weeks. However, if a woman has not received the pertussis vaccine when she is due for the Abrysvo® RSV vaccine, both vaccines can and should be given at the same appointment to ensure timely protection for the infant.
The side effects from vaccines given together are expected to be similar to the side effects of each vaccine when given alone.
For further information about vaccine co-administration with Abrysvo®, see the Green Book on immunisation - Chapter 27a Respiratory Syncytial Virus (RSV) (external site)
The RSV vaccination older adult programme is a year-round programme for individuals turning 75 years. During the first year there is a catch-up programme for those aged 75 to 79 years (until 31 August 2025). The table below shows which older adults are eligible for the RSV vaccine.
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Age on 1 September 2024 |
Date of birth |
When can the RSV vaccine be administered? |
Eligibility period |
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74 |
From 1 September 1949 |
On or after 75th birthday |
Until 80th birthday |
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75 - 78 |
2 September 1945 to 1 September 1949 |
Between 1 September 2024 and 31 August 2025 |
Until 80th birthday |
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79 |
2 September 1944 to 1 September 1945 |
Between 1 September 2024 and 31 August 2025 |
Until 31 August 2025 |
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Vaccines commonly administered to older adults |
Can they be administered together? |
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Abrysvo® and Zostavax® or Shingrix® |
✔ |
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Abrysvo® and Pneumovax 23® |
✔ |
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Abrysvo® and influenza vaccine |
✔* |
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Abrysvo® and COVID-19 vaccine |
✔* |
*Abrysvo® should not be routinely scheduled on the same day as the influenza or COVID-19 vaccine in older adults. Giving Abrysvo® with the seasonal influenza vaccine may reduce the immune response to both the RSV and influenza (H3N2) components, which may increase the risk of severe respiratory disease in older adults. Additionally, co-administering the COVID-19 vaccine may diminish the immune response to the RSV vaccine. However, if it is thought that the individual is unlikely to return for their influenza or COVID-19 vaccine, they can be given at the same time.
The side effects from vaccines given together are expected to be similar to the side effects of each vaccine when given alone.
For further information about vaccine co-administration with Abrysvo®, see the Green Book on immunisation - Chapter 27a Respiratory Syncytial Virus (RSV) (external site)
Vaccination programme recommendations from the Joint Committee on Vaccination and Immunisation (JCVI) and Welsh Government policy can be found at the links below.
Joint Committee on Vaccination and Immunisation - GOV.UK (external site) (read JCVI publications and statements; search e.g., ‘Respiratory Syncytial Virus’; ‘RSV’)
Welsh Health Circulars and Welsh Government letters
Health circulars: 2024 to 2027 | GOV.WALES (external site)
Online courses and training materials can be accessed via the E-learning page.
Further immunisation training information and resources are provided on the Training Resources and Events page.
PGD templates for vaccines can be found on the Welsh Medicines Advice Service page (external site)
Vaccinations in pregnancy: What every midwife needs to know (Video) (external site)