Respiratory Syncytial Virus (RSV): Information for Providers
Testing
With multiple co-circulating respiratory viruses during the fall and winter, diagnostic testing for RSV, influenza, COVID-19, and other respiratory viruses can help guide treatment and clinical management. Consider diagnostic testing for patients with suspected respiratory virus infections, particularly hospitalized patients, those with severe or progressive illness, and those with factors placing persons at high risk for severe outcomes from RSV, influenza, and COVID-19.
Several laboratory tests are available for confirming RSV infection, including:
- Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), which is more sensitive than culture and antigen testing
- Antigen testing, which is highly sensitive in infants and young children but not as sensitive in older children and adults
Less commonly used tests include:
- Viral culture
- Serology, which is usually only used for research and surveillance studies
Providers should consult experienced laboratorians for more information on testing and interpretation of results.
Treatment
Most cases of RSV will resolve without treatment. For supportive care, inform patients and parents to:
- Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give aspirin to children.)
- Drink plenty of fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration.
Prevention
There are several immunization options that protect against RSV in older adults, infants, young children.
Older Adults
RSV vaccination is recommended for everyone ages 75 years and older and people ages 50 to 74 years with risk factors for severe RSV disease, if they have not been vaccinated before.
Older adults should receive one dose of any RSV vaccine:
- RSVPreF (Abrysvo, manufactured by Pfizer)
- RSVPreF3 (Arexvy, manufactured by GSK)
- Respiratory Syncytial Virus Vaccine (mResvia, manufactured by Moderna)
Eligible adults can get an RSV vaccine at any time, but the best time to vaccinate patients is in late summer and early fall before RSV usually starts to spread in the community.
- The RSV vaccine is currently not an annual vaccine. People who have already received one dose (including last year) have completed their vaccination and should not receive another dose at this time.
Infants Younger than 8 Months of Age
All infants should be protected against RSV disease through one of these options:
- Vaccine (Abrysvo) administered to pregnant people during 32 to 36 weeks of gestation who have not received RSV vaccine during a prior pregnancy.
- Monoclonal antibodies (nirsevimab or clesrovimab) given to infants less than 8 months of age.
RSV vaccination for pregnant people in NYC is recommended from September through January.
In NYC, administration of monoclonal antibodies for infants is recommended during October through March. The optimal timing is shortly before RSV season begins or within a baby's first week of life, ideally during the birth hospitalization, if born October through March.
In most cases, only one immunization option is necessary to confer immunity to the infant during their first RSV season (either vaccination of the pregnant person or monoclonal antibodies for the infant). There is no preference for one over the other.
Health care providers of pregnant people should provide information on options for protecting the infant from RSV as part of antenatal care with a strong recommendation for the preferred method of protection, considering patient preferences when determining whether to vaccinate the pregnant patient or rely on the administration of monoclonal antibodies to the infant after birth.
Monoclonal antibodies should be provided after birth in the following situations:
- When the vaccination status of the birthing parent is unknown at the time of the infant’s birth
- When the birthing parent received an RSV vaccine during a prior pregnancy. Repeated RSV vaccination in pregnant persons during subsequent pregnancies is currently not recommended.
- When the birthing parent received an RSV vaccine within 14 days of delivery. The birthing parent may not have mounted an immune response prior to the birth of the infant.
- When the birthing parent is vaccinated, but the healthcare provider judges that the potential incremental benefit of giving monoclonal antibodies is warranted. For example, a provider may recommend monoclonal antibodies when a mother has an immunocompromising condition and may not mount an adequate immune response to RSV vaccination.
Young Children 8 to 19 Months of Age
The monoclonal antibody nirsevimab is recommended for use in children 8 to 19 months who are at increased risk of severe RSV and entering their second RSV season. Nirsevimab is the only RSV immunization product recommended for this age group.
More detailed clinical guidance, including a list of conditions that increase risk of severe RSV in young children is available in the nirsevimab MMWR linked below (see Additional Immunization Information).
Additional Immunization Information
- Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023
- Use of the Pfizer Respiratory Syncytial Virus Vaccine During Pregnancy for the Prevention of Respiratory Syncytial Virus–Associated Lower Respiratory Tract Disease in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023
- Use of Clesrovimab for Prevention of Severe Respiratory Syncytial Virus–Associated Lower Respiratory Tract Infections in Infants: Recommendations of the Advisory Committee on Immunization Practices — United States, 2025