RSV

Question 1

What is your opening statement for RSV?

Answer 1

RSV is a nationally notifiable, vaccine-preventable disease caused by one of two RSV subtypes. It is transmitted primarily through respiratory droplets and the typical clinical presentation is bronchiolitis in children and pneumonia in adults. The maternal RSV vaccine (Abrysvo) is free under the NIP while nirsevimab (Beyfortus) is state/territory funded.

Question 2

Is RSV nationally notifiable?

Answer 2

Yes

Question 3

What is the RSV infectious agent?

Answer 3

RNA virus with two major subtypes (RSV A, RSV B)

Question 4

What are the clinical features of RSV?

Answer 4

• Fever
• Rhinorrhoea
• Sore throat
• Cough
• Otitis media

Babies under 6mo: wheezing, dyspnoea, irritability, poor feeding

Question 5

What are the complications of RSV?

Answer 5

• Pneumonia
• Acute respiratory distress
• CCF
• Myocarditis (rarely)
• Seizures / encephalopathy (< 1%)
• Exacerbation of chronic conditions

Question 6

What is the public health importance of RSV?

Answer 6

Leading cause of LRTI in young children and older adults.

Aboriginal/Torres Strait Islader children - 2x rate of RSV-associated hospitalisations.

Question 7

Epidemiology: when do seasonal outbreaks of RSV occur?

Answer 7

Autumn and winter
(peaks April and July)

Question 8

Epidemiology: what proportion of children have had RSV infection by 2 years?

Answer 8

Almost all children.

Question 9

How is RSV transmitted?

Answer 9

Person-person transmission through respiratory droplets, direct contact with secretions or fomites.

Question 10

What is the incubation period of RSV?

Answer 10

2-8 days

Question 11

What is the infectious period of RSV?

Answer 11

Before symptoms start until recovery (usually up to 10 days)

Question 12

Priority populations: which groups are at greater risk for severe illness?

Answer 12

• Babies and young children (< 5 yrs), especially preterm
• Older adults (> 65 years)
• Aboriginal / Torres Strait Islander people
• Immunocompromised
• Chronic disease

Question 13

Priority populations: who are at greater risk of becoming infected?

Answer 13

• Close and prolonged contact (e.g. living in same house)
• Infants from infected siblings
• Live or work in settings at increase risk of spread

Question 14

Priority populations: which settings are at increased risk of spread?

Answer 14

• Early childhood care centres
• Schools
• Residential care facilities

Question 15

Who is RSV vaccination recommended for?

Answer 15

• Pregnant (to protect newborns)
• Aged > 75
• Chronic conditions
• Aboriginal / Torres Strait Islanders > 60 yrs

Question 16

Who are RSV monoclonal antibodies recommended for?

Answer 16

• Young infants whose mother / birthing parent did not receive RSV vaccine in pregnancy or who were vaccination < 2 weeks before delivery
• Young infants increased risk of severe RSV disease (regardless of mother / birthing parent vaccination status)
• Young children with medical risk factors for severe RSV disease in second RSV season

Question 17

Apart from vaccination, how can RSV be prevented?

Answer 17

• Hand hygiene
• Respiratory hygiene
• Cleaning frequently touched objects and surfaces
• People with acute resp symptoms to stay home and avoid gatherings, settings high-risk for spread

Question 18

How is RSV diagnosed?

Answer 18

Nasopharyngeal PCR

RATs also available but not as sensitive as PCR.

Question 19

What is the clinical management of RSV?

Answer 19

Normally self-limiting and most people recover in 1-2 weeks.

Question 20

What is the surveillance case definition for RSV?

Answer 20

1. Isolation by culture
2. PCR
3. Antigen detection
4. Seroconversion

Question 21

What is the public health management of cases?

Answer 21

No public health investigation or response required.

Question 22

What is the public health management of contacts?

Answer 22

Not required for individual cases.

Question 23

What is the response to an RSV outbreak?

Answer 23

Generally focuses on high-risk settings.

• Encourage vaccination
• Tailor health education / messaging
• Isolating / grouping people with RSV symptoms
• Increasing infection control - hand hygiene, PPE, surface cleaning, laundering/throwing out soiled articles

Question 24

Which special situations and high-risk settings might require extra infection and control actions?

Answer 24

• RACF
• Other residential settings e.g. disability facilities
• Healthcare facilities
• Early childhood care centres