Rolling Out Pediatric RSV Immunisation: Lessons from Across Europe and Beyond (Susanna Esposito)

The presentation was delivered and recorded during the 10th Lifecourse Prevention Summit, Paris, December 2025.

Prof. Susanna Esposito, Professor of Pediatrics at the University of Parma and President of the World Association for Infectious Diseases and Immunological Disorders, presents the current landscape of pediatric RSV prevention, reviewing the evidence behind available immunization strategies and the real-world data emerging from countries that have already rolled them out.

RSV is one of the leading causes of hospitalization, ICU admission, and death in infants during their first year of life, with no specific treatment available beyond hydration and oxygen support. Prevention is therefore the only meaningful lever, and three approaches are currently available: infant vaccination, maternal vaccination, and monoclonal antibodies. No RSV vaccine is yet approved for use in infants, and maternal vaccination faces coverage challenges in countries where uptake of other pregnancy vaccines remains low. Monoclonal antibodies, particularly nirsevimab, have become the primary tool in most European countries, offering around 80% efficacy in reducing RSV-related lower respiratory tract infections and hospitalizations, with results confirmed across all infant subgroups, including preterm babies and those with low birth weight.

Real-world data from Galicia, Spain, where nirsevimab coverage reached 88% for out-of-season births and 95% for in-season births, demonstrates the level of impact achievable with high uptake: significant reductions in hospitalizations, ICU admissions, and outpatient visits. Comparable results have been reported in Tuscany. The data consistently show that coverage above 80% is necessary to see meaningful reductions in ward pressure.

For countries where maternal immunization programs are well established, the pre-F vaccine has shown strong results. Argentina achieved coverage above 60%, with a 78% reduction in RSV-related hospitalizations in the first three months of life. Data from the UK and Scotland point to similar benefits, particularly for preterm infants.

Luxembourg's experience with a combined strategy, offering both maternal vaccination and monoclonal antibodies, is particularly instructive. Moving from monoclonal antibodies alone in the first season to a combined approach in the second raised coverage from 81% to 92.5% and increased the reduction in RSV burden by an additional 44.5%. The message the briefing closes with is unambiguous: all infants need protection, and the strategy adopted should be shaped by each country's existing infrastructure, costs, and population attitudes toward prevention.