Respiratory syncytial virus preventives for children in Australia: current landscape and future directions.

Respiratory syncytial virus (RSV) is a major cause of acute lower respiratory tract infections, and a leading cause of hospitalisation in children under 6 months of age. Previously, palivizumab, a costly, short-acting monoclonal antibody, was the primary preventive option. The recent introductions of nirsevimab (Beyfortus), a long-acting monoclonal antibody, and Abrysvo, a maternal RSV vaccine, have brought about significant advances in RSV prevention for children. Western Australia, Queensland and New South Wales launched state-managed nirsevimab programs targeting infants and high risk groups for the 2024 RSV season. International data support nirsevimab's effectiveness in reducing RSV-related hospitalisations and severity of disease in real-world settings. In 2025, Australia's national RSV prevention program includes free maternal vaccination with Abrysvo and targeted infant protection with nirsevimab for high risk or newborns whose mothers did not receive Abrysvo at least 2 weeks before delivery, funded by individual jurisdictions. Real-world efficacy data derived from Australian states and territories and the national prevention program will be pivotal in evaluating and refining the integration of maternal immunisation with Abrysvo and infant passive immunisation with nirsevimab. Key logistical considerations include ensuring timely access and equitable distribution, particularly for First Nations populations who face increased risk from RSV infection. Coordinated efforts are essential to overcome health care disparities and deliver effective prevention strategies to these prioritised groups.