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.
Immunization
There are several immunization options that protect older adults, infants, and young children from RSV.
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.
If you do not offer RSV vaccination, direct people to find a vaccination site on the NYC Health Map.
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.
Administration of monoclonal antibodies for infants is recommended to align with the local RSV season. 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 during RSV season.
- Due to elevated RSV activity in NYC in 2026, the Health Department recommends continuing monoclonal antibody administration beyond the typical end date of March 31 to protect infants from the ongoing risk of illness.
- Information on RSV activity in NYC can be found on the NYC Respiratory Illness Data webpage, updated weekly.
- This year’s RSV increase in NYC started later than the past two years, and activity may remain elevated through April.
- The Health Department will notify providers via email and update this webpage when monoclonal antibody administration is no longer recommended in NYC for the 2025-2026 season.
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 Morbidity and Mortality Weekly Report.