The Victorian Government has pledged free respiratory syncytial virus (RSV) vaccination for the state’s newborns and infants in 2025 to help prevent respiratory and ear infections.
RSV, which doctors say is likely the number one cause of hospitalisation among young children, can cause earache and predispose children to ear infections such as otitis media (OM).
It can also cause potentially serious respiratory infections in the airways and lungs such as bronchiolitis and pneumonia. In 2023-2024, there were more than 3,800 infant RSV-associated emergency department presentations in Victoria, with about 85 per cent of those requiring hospital admission.
The illness is especially common in infants and young children, with most infected by the age of two years.
Victorian Minister for Health Ms Mary-Anne Thomas announced $18.7 million on 2 October 2024 to deliver a new long-acting monoclonal antibody as part of a coordinated national prevention program for unprotected newborns and eligible infants up to eight months of age.
The vaccine will be available for Victorian babies and infants whose mother was unable to be immunised or was immunised less than two weeks before delivery. It provides protection for about five months, which covers the winter peak of RSV infections from April to September.
Thomas said the initiative, part of a free hybrid immunisation program, would help reduce pressure on emergency departments and keep Victorian babies healthy.
Maternal vaccine expected
It will complement an expected Commonwealth-funded maternal vaccine as part of the coordinated national program – ensuring as many babies are protected from RSV as possible, she added.
A dedicated catch-up program will also be offered for eligible Victorian infants aged up to two years who are vulnerable to severe RSV and entering their second RSV season.
In most cases, immunisations will be administered in a hospital setting as part of standard post-birth care, helping parents avoid any additional healthcare costs and time spent attending appointments.
For the 2024 RSV season, Victoria secured doses of the antibody for infants and children at the most severe risk from the virus.
“We have worked closely with the Federal Government and other jurisdictions to ensure we can deliver a lifesaving RSV immunisation program for all eligible women and babies regardless of their postcode or bank balance.” Thomas said.
“We look forward to continuing to work with the Federal Government to ensure the National Immunisation Program is up to date and responds to newer forms of treatment such as monoclonal antibodies.”
Doctors applaud move
The Royal Australian College of GPs (RACGP) which previously called on Victoria to fund the immunisation applauded the announcement.
RACGP Victoria deputy chair Dr Aadhil Aziz said: “This is a fantastic initiative from the Victorian Government, and one GPs have been calling,” he said. “Going back into hospital with a sick baby is a big fear for new parents. Immunisation is the best way to prevent infants from being hospitalised due to RSV, and to prevent parents having to go through that.
“We’re glad the Victorian Government has listened to patients and GPs and acted.
“RSV among young children is far more serious than many people expect. RSV infections cause over 6,000 hospitalisations each year in Australia. Around half of RSV notifications are in children under five, and infants under six months are at greatest risk.
“It’s likely the number one cause of hospitalisation among young children, and up to a quarter need intensive care treatment. That’s an absolute nightmare for a young family to go through.
“The safety data for monoclonal antibodies for newborns has been very reassuring. Most infants tolerate immunisation very well, and where they have a reaction, it’s usually mild and short.”
Australia’s National Notifiable Disease Surveillance System shows there have been more than 159,000 cases of RSV so far in 2024 with most, about 79,000, being in children under age four.
Infection experts, Dr Jane Tuckerman and Dr Danielle Wurzel from The Murdoch Children’s Research Institute (MCRI) said recently that earlier in 2024, the long-acting monoclonal antibody was made available to infants and young children through state-based programs in Western Australia, Queensland and New South Wales.
They said another RSV vaccine, Abrysvo, was registered in Australia in 2024 for use during pregnancy, to protect the baby once it’s born. It’s available for pregnant women to buy privately with a prescription from their doctor, while South Australia recently announced it would provide Abrysvo to pregnant women for free next year.
“Research also indicates severe RSV infection in infancy may increase the risk of children developing asthma,” they wrote in an MCRI blog. “While the association between RSV and asthma is well established, causation has not yet been proven. “A recent study of more than 1,700 children in the US showed avoiding RSV infection during infancy could prevent up to 15% of childhood asthma.”
Links to ear infection
Australian health authorities state some people with RSV get an ear infection such as otitis media or otitis externa and ear infections are common with RSV.
One study in the New England Journal of Medicine concluded RSV was the virus most likely to predispose a child to acute OM. It aimed to determine rates of middle ear invasion by common respiratory viruses in children with acute OM and concurrent virus infections in the upper respiratory tract.
Of 456 children aged two months of age and seven years of age with acute OM, 186 were diagnosed with viral respiratory tract infection. RSV was isolated from middle ear fluid in 74% of children with a viral illness.
“The rates of middle ear invasion vary significantly during acute otitis media. The most common of these invasions is RSV,” researchers concluded. “This finding is consistent with data from several other published studies, which have indicated that RSV is the virus most likely to predispose a child to acute otitis media.”
Iowa ENT Center in the US said that several years ago, a ‘massive spike’ in cases of influenza and RSV led to overflowing paediatric departments at hospitals as record numbers of children became seriously ill.
“In the weeks and months that followed, that spike contributed to a surge in ear, nose, and throat (ENT) illnesses among kids,” the ENT doctors said. “Ear infections, in particular, skyrocketed—both in frequency and severity.
“And it wasn’t only one- and two-year-olds who suffered. A surprising number of older kids—who are typically past the ear infection age—also came down with ear infections.”
The doctors said studies had shown that children who had a flu or RSV infection were more likely to develop an ear infection in the following weeks or months.
“One of the biggest reasons is what’s called an ‘immunity gap’,” they explained. “The flu and RSV both weaken the immune system, making it easier for bacteria to infect the middle ear.
“The cough and congestion associated with these illnesses can also make it harder for fluid to drain from the middle ear, leading to an increased risk of ear infections.
“Also, flu and RSV are both viral infections that attack the respiratory system, leading to inflammation and fluid buildup in the middle ear. When this fluid becomes infected, it can cause an ear infection.”
