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. Similar to other viruses that cause respiratory illness, RSV can be passed from one person to another through respiratory droplets (such as from a cough or sneeze).

RSV is the most common cause of bronchiolitis, a common chest infection that affects infants and toddlers.

RSV usually leads to a mild illness. However, some groups are at increased risk for severe outcomes, including infants, children under 24 months of age with certain medical conditions and older adults.

Immunization is available to help prevent serious outcomes, such as hospitalization, caused by the virus.

As part of Ontario’s RSV prevention programs, the province will fully cover the cost of immunization to help protect:

• adults aged 75 and older
• adults aged 60–74 who meet specific high-risk criteria
• infants born on April 1 or after and who are less than 8 months old
• children up to 24 months who are at increased risk
• vaccination during pregnancy  

Read more about symptoms of respiratory illness including RSV, COVID-19 and the flu.

Infant and high-risk children RSV prevention program

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.

RSV immunization is provided to eligible infants and high-risk children just prior to or during the active RSV season.

The active season is generally from November to April, with some variations across some seasons and regions.

Pending product availability, the infant RSV immunization program will begin in October each year.

There are 2 products available to help protect infants and high-risk children against RSV:

• a monoclonal antibody, nirsevimab (Beyfortus®), given just before and during the active RSV season to infants and high-risk children who meet the eligibility criteria
•  the Abrysvo® vaccine, available during pregnancy between 28 and 36 weeks and expected to deliver near the start of, or during, the RSV season
  • Based on available safety and effectiveness evidence, the National Advisory Committee on Immunization (NACI) recommends vaccination between 28 and 36 weeks of pregnancy. Administration before 32 weeks of pregnancy is considered off-label and is at the sole discretion of the health-care provider based on individual clinical circumstances.

With the significant positive outcomes (high uptake and reduced hospitalizations) observed through Ontario's RSV prevention program over the past two respiratory illness seasons, Ontario will continue to offer nirsevimab (Beyfortus®) for eligible infants and high-risk children based on demonstrated effectiveness and duration of protection.

If you are interested in an alternative approach, you also have the option to receive a single dose of the RSV vaccine (Abrysvo®) during pregnancy to help protect your infant from RSV illness after birth. Abrysvo® is another safe and effective option for infant RSV protection and provides protection through antibodies passed during pregnancy to your child before birth. The National Advisory Committee on Immunization (NACI) recommends vaccination between 28 and 36 weeks of pregnancy, based on available safety and effectiveness evidence. Administration before 32 weeks of pregnancy is considered off-label and may be recommended at the sole discretion of a health care provider.

Vaccination with a single dose of the RSV vaccine during pregnancy can help protect infants at birth instead of immunizing the infant with the monoclonal antibody (Beyfortus®). Generally, only one product is recommended. Receiving both nirsevimab (Beyfortus®) and the Abrysvo® vaccine is not expected to provide additional benefit for most infants. You can discuss this with a health-care provider.

Eligibility criteria

During the active RSV season, monoclonal antibody immunization is funded for RSV prevention in infants and children who are residents of Ontario and meet any of the following criteria:

• infants born on or after April 1 and aged less than 8 months at the time of immunization
• children less than 24 months of age who remain vulnerable to severe RSV disease, and following a discussion with their pediatrician or pediatric specialist (for example, health-care provider with a specialization in high-risk pediatrics), including children with:
  • chronic lung disease (CLD), including bronchopulmonary dysplasia
  • hemodynamically significant congenital heart disease (CHD)
  • severe immunodeficiency
  • Down Syndrome/Trisomy 21
  • cystic fibrosis with respiratory involvement and/or growth delay
  • neuromuscular disease impairing clearing of respiratory secretions
  • 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. A health-care provider should be consulted to discuss the most appropriate product.

Where you can get a free RSV immunization for your infant

During the RSV season, the RSV immunization is available to infants through:

• hospitals
• primary care offices
• public health units
• midwives

Additionally, the RSV vaccine, Abrysvo®, administered during pregnancy to help protect an infant at birth, may be available through:

• primary care offices
• public health units
• obstetricians and midwives

Immunization both during pregnancy and of your infant is not recommended except under specific circumstances. If you or your child is eligible, speak to a health-care provider to discuss the most appropriate product and location to receive RSV immunization.

Adult RSV prevention program

How older adults qualify for a free RSV vaccine

All adults aged 75 and older are eligible for the publicly funded RSV vaccine.

The publicly funded RSV vaccine is also available to high-risk older adults aged 60 to 74 who are:

• residents of long-term care homes, Elder Care Lodges, or retirement homes including similar settings (such as co-located facilities)
• patients in hospital receiving alternate level of care (ALC) including similar settings (for example, complex continuing care, hospital transitional programs)
• patients with glomerulonephritis (GN) who are moderately to severely immunocompromised
• patients receiving hemodialysis or peritoneal dialysis
• recipients of solid organ
• recipients of a hematopoietic stem cell transplant within the past two years or with ongoing immunosuppression
• individuals on home oxygen or requiring chronic oxygen therapy, regardless of residence
• individuals who are homeless
• individuals who identify as First Nations, Inuit, or Métis

Currently, only a single dose is recommended by the National Advisory Committee on Immunization (NACI). Studies show protection lasting beyond one RSV season for several years. Ongoing studies are underway to determine the need for one or more booster doses.

Where older adults can get a free RSV vaccine

Currently, pharmacies do not administer RSV immunizations as part of Ontario’s publicly funded immunization program.

If you:

• live in eligible congregate living residences you may receive a vaccine through your residence, or through a health-care provider
• are a hospital ALC patient you can receive your vaccine from the hospital
• are receiving hemodialysis or peritoneal dialysis, or are a solid organ or hematopoietic stem cell (HSCT) transplant recipient, you should speak to your treatment team
• are 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

Some public health units may offer the RSV vaccine. Contact your local public health unit for information on immunization in your community.

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

Older adults who do not qualify for a free RSV vaccine

If you don’t qualify for the publicly funded RSV vaccine, you may be able to purchase the vaccine. You would buy the vaccine at the pharmacy and either get the shot there (if the pharmacy administers the vaccine) or take it 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 shot, talk to your pharmacy and primary care provider to understand the clinic policies and related costs. If you wish to receive it at the pharmacy, 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.

When older adults can get the RSV vaccine

You may receive your RSV vaccine at any time of the year.

Studies show that the RSV vaccine provides multi-year protection. If you received a dose of the RSV vaccine previously, you do not need to receive an additional dose.

For optimal protection, when available you can receive your COVID-19 vaccine, flu shot, and RSV vaccine at the same time to help reduce the impacts of respiratory illness season.

Additional immunization information

This page gives basic information only. It does not take the place of medical advice, diagnosis, or treatment. Always talk to a health-care professional about any health concerns or illness.

If you or a child are sick

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

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

If you or a child had a previous RSV infection

For older adults and pregnant women, if you have had a previous RSV infection there is no specific interval that is recommended between RSV infection and receiving an RSV immunization.

For infants and high-risk children please speak with a health-care provider.

If you've had a transplant

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

For infants and pregnant women please speak with a health-care provider.

Immunization products

There are 3 immunization products available through Ontario’s publicly funded RSV prevention programs to provide protection against lower respiratory tract disease caused by RSV.

For older adults:

• Arexvy (adjuvanted recombinant protein subunit vaccine)
• Abrysvo® (bivalent recombinant protein subunit vaccine)

For infants and high-risk children:

• Abrysvo® (bivalent recombinant protein subunit vaccine) (during pregnancy)
• Nirsevimab (Beyfortus®) (monoclonal antibody)

Safety and efficacy

Vaccines for older adults

Evidence supports the use of a single dose of either Arexvy or Abrysvo® to help prevent RSV disease in adults 50 years of age and older.

Studies show that vaccines provide multi-year protection. As such, if you received a dose of RSV vaccine previously, you 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 received at the same time as both seasonal and non-seasonal vaccines.

Monoclonal antibody for infants and high-risk children

Clinical trials have shown that nirsevimab (Beyfortus®) administered to babies born after at least 29 weeks gestation is safe and very effective in preventing RSV-related illnesses in infants.

Common side effects after nirsevimab (Beyfortus®) include local reactions at the injection site, such as redness, swelling and pain. These are usually mild and last only a few days.

Nirsevimab (Beyfortus®) may be given on the same day as other recommended pediatric immunizations.

If your baby has a severe acute illness, with or without fever, symptoms should disappear before receiving nirsevimab (Beyfortus®) . A minor illness, such as a cold, should not prevent you from having your baby receive the immunization. Please speak to a health-care provider if your baby is unwell before receiving the injection.

Infants who have had an RSV infection this season are not expected to benefit from receiving nirsevimab (Beyfortus®) as their immune system has already been exposed to the virus.

Vaccination during pregnancy

Clinical trial and real-world data show that Abrysvo® is safe and effective during pregnancy to help prevent severe RSV disease in their babies.

Common side effects after the Abrysvo® vaccine include:

• pain at the injection site
• headache
• muscle aches
• nausea

The side effects are typically mild and usually last only a few days.

Abrysvo® may be given on the same day as tetanus, diphtheria, acellular pertussis, COVID-19, and influenza vaccines.

Whether you should receive Abrysvo® during illness depends on the severity of symptoms. If you have a severe acute illness, with or without fever, you should wait until symptoms disappear before receiving Abrysvo®. A minor illness, such as a cold, should not prevent you from receiving the immunization. Please speak to a health-care provider if you are unwell before receiving the injection.

You can receive Abrysvo® even if you have had a previous RSV infection.

No data is available on repeat vaccination with Abrysvo® in subsequent pregnancies. Vaccination during pregnancy should be discussed with a health-care provider.

Adverse events

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

This fact sheet provides information on the immunity, monoclonal antibodies and vaccination for pregnant women, infants and high-risk children.

For additional 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.