This information is for health professionals.
More information about the program is available for consumers at NSW RSV Vaccination Program for older adults. To learn more about RSV prevention, symptoms and treatment, read the Respiratory syncytial virus (RSV) fact sheet.
Find out more about RSV
The following guide has been developed to support the implementation of the NSW Older Adult Respiratory Syncytial Virus (RSV) Vaccination Program which commences 15 May 2026.
The guide is for health professionals administering the older adult RSV vaccine Arexvy®.
Health professionals must administer RSV vaccination in line with this guide and:
The NSW Older Adult RSV Vaccination Program aims to protect older adults from severe RSV-associated lower respiratory tract infection and reduce hospitalisations.
For older adults, RSV vaccination with Arexvy® is funded under the National Immunisation Program (NIP) for:
It is also recommended for people with medical risk factors for severe RSV disease aged ≥60 years, but only available in the private market for this cohort at this time.
The recommendation is currently for a single dose of Arexvy®. This provides protection for at least three RSV seasons, though there is some waning of protection with time. Recommendations for further doses of RSV vaccine may change based on future evidence development.
Arexvy® must not be given to pregnant women. It is not registered for use in pregnancy, and a phase 3 trial of a similar candidate RSV Prefusion F protein-based vaccine was stopped early because of a signal toward preterm birth. An alternative RSV vaccine, Abrysvo®, is safe in pregnancy and funded under the NIP for pregnant women. Information for health professionals about maternal and infant RSV immunisation may be found at NSW RSV Maternal and Infant Immunisation Program - Information for health professionals.
Errors in the administration of RSV immunisation products have occurred. All administration errors and adverse events must be reported to your local public health unit, and clinical guidance should be followed.
Authorised nurse immunisers can independently administer Arexvy® as detailed in the Authority for Authorised Registered Nurse/Midwife Immunisers to Supply Poisons and Restricted Substances and Vaccination Standards
Registered nurses and enrolled nurses can prepare and administer Arexvy® under a medication order from a medical practitioner or nurse practitioner. The medical practitioner or nurse practitioner must be available for supervision or advice if required.
Pharmacist immunisers can administer Arexvy ® under the NSW Pharmacist Vaccination Standards.
Arexvy® can be ordered through the NSW State Vaccine Centre .
Providers are required to have a vaccine account number (VAN) to order the products. For details on obtaining a VAN please review NSW Health - Ordering vaccines. In NSW Health facilities this is generally managed by the pharmacy department however individual services in some cases will have their own account.
An adverse event following immunisation (AEFI) is defined in The Australian Immunisation Handbook as “any untoward medical occurrence that follows immunisation. It does not necessarily have a causal relationship with the vaccine". AEFIs are notifiable conditions under the NSW Public Health Act (Schedule 1) and must be notified to your local public health unit (PHU).
All AEFI notifications are required to be reported to the TGA via your local PHU. To report a suspected AEFI, download the National Adverse Events Following Immunisation (AEFI) Reporting Form and contact your local public health unit on 1300 066 055. Further information regarding AEFIs is available on Adverse events following immunisation (AEFI).
In addition to reporting to the TGA, all AEFIs occurring at the time of immunisation, which occur in NSW Health facilities, e.g. anaphylaxis, must be reported in the NSW Health incident management system IMS+.
All vaccine administration errors, for example the wrong vaccine being given to the wrong patient cohort, or a vaccine being given by an incorrect route, should also be reported to your local public health unit, regardless of whether harm has occurred. Clinical guidance on actions to be taken after an administration error should be followed.
Vaccine safety surveillance in Australia aims to monitor vaccine and immunisation program safety and to detect potential serious adverse events that may not be identified in pre-licensure vaccine trials.
Immunisation providers play an important role in vaccine safety surveillance by reporting serious adverse events to the local public health unit (passive surveillance) and participating in active surveillance systems such as AusVaxSafety.
AusVaxSafety is monitoring the safety of RSV immunisations through the AusVaxSafety vaccine safety surveillance system. To review the most recent safety data visit AusVaxSafety - Safety data.
AusVaxSafety uses two software programs Smartvax and Vaxtracker to monitor the safety of vaccines. These programs send an SMS or email to patients or parents following their vaccination at selected general practitioner and immunisation clinics . De- identified information from SmartVax and Vaxtracker are combined and monitored by AusVaxSafety to detect possible vaccine safety signals.
Consent can be verbal or written and should be documented in the patient's medical record. Documentation should include details of the consent conversation and information provided to any substitute decision maker. If applicable, the presence of an accredited interpreter is recommended.
The TGA recommends that, in addition to more common risks, the rare association of Guillain-Barre syndrome with RSV vaccines should be discussed. This risk is significantly outweighed by the benefits of RSV protection for eligible cohorts. Patients should be advised to seek early medical attention if they experience symptoms such as pins and needles (paraesthesia), numbness, and weakness.
Further information about consenting is available on the Australian Immunisation Handbook and NSW Health Consent to Medical and Healthcare Treatment Manual.
All vaccination encounters must be reported to the Australian Immunisation Register (AIR).
Immunisation providers are required to check an individual's vaccination status on the AIR prior to administering any vaccine. Older adults are eligible for a single dose of Arexvy® only.
Arexvy® was approved by the Therapeutic Goods Administration (TGA) in January 2024. It is the only RSV vaccine both registered and NIP-funded for older adults. A different RSV vaccine, Abrysvo®, is registered for use in older adults but available in the private market only. Arexvy® contains recombinant RSV pre-fusion F protein antigen, adjuvanted with ASO1E. Arexvy® is not recommended during pregnancy and must not be used in pregnant women.
Arexvy® must be protected from light at all times and stored in a purpose-built vaccine refrigerator between +2°C to +8°C at all times and the temperature continuously monitored in accordance with the current edition of the National Vaccine Storage Guidelines: Strive for 5.
The dose of Arexvy® is 0.5 mL, given by intramuscular injection only, preferably in the deltoid region of the upper arm. Arexvy® is not to be administered intravascularly, intradermally or subcutaneously.
Arexvy® is supplied as a powder, which must be reconstituted with a liquid adjuvant suspension diluent. Reconstitution instructions may be found at Administration | AREXVY (Respiratory Syncytial Virus Vaccine, Adjuvanted).
Arexvy® can be co-administered with other vaccinations including influenza, Shingrix, pneumococcal and COVID-19 vaccines. It can also be administered after an individual has recovered from RSV infection.
Arexvy® has proven effectiveness against RSV disease at individual and population levels. In a large clinical trial, adults aged ≥60 years who received Arexvy® were 83% less likely to develop RSV-related lower respiratory tract disease, and 94% less likely to develop severe disease in their first year after vaccination1. At the end of 3 RSV seasons (or 3 years), the vaccine continues to provide protection; vaccine recipients were 63% less likely to develop RSV-related lower respiratory tract disease and 72% less likely to develop severe disease2. Internationally, RSV vaccination programs for older adults have contributed to marked reductions in RSV-associated hospitalisations3.
Mild injection site reactions were the most common adverse effects reported in clinical trials, with pain reported by 61% of participants aged 60 years or older, compared with 9% who received placebo. Other injection site symptoms included redness and swelling.
Fatigue was reported by 34% of participants aged 60 years or older, compared with 16% who received placebo. Myalgia and headache were other systemic adverse events.
There was no difference in the rates of serious adverse events in participants who received Arexvy® compared with placebo.
There is a rare risk of Guillain-Barre Syndrome (GBS) associated with RSV vaccination. This was seen in post-marketing data from the United States, with an additional 7 excess cases per million doses of Arexvy®. In May 2025, the Therapeutic Goods Administration advised health professionals to warn patients of this risk when discussing consent to receive RSV vaccines. Health professionals are also recommended to advise patients to seek medical attention if they experience symptoms of GBS, such as pins and needles, numbness, and weakness, after vaccination.
The only absolute contraindication to Arexvy® is hypersensitivity to the active substances or to any component of the vaccine.
Previous Guillain-Barré syndrome (GBS) following vaccination should be considered a precaution.
People with a history of GBS within 6 weeks of vaccination may have a higher risk of GBS recurrence. They should discuss with their provider the risks and benefits of receiving an RSV vaccine.
People with a history of GBS unrelated to vaccination can receive an RSV vaccine, after discussing risks and benefits, taking into consideration age-related risks, medical risk factors including immunocompromise status, and personal preference.
