What is RSV?

Respiratory syncytial virus (RSV) is the most common cause of respiratory infections in children. Almost all children get an RSV infection before they turn 2 years old. The virus is mainly seen in winter. Most children only have a nasal cold, but RSV can lead to serious illness in babies. They could develop shortness of breath caused by an infection of the small airways (bronchiolitis), or possibly even pneumonia. About 1–2% of all children become so seriously ill from RSV that they have to go to hospital. Premature babies, children with congenital heart defects, and children with Down’s syndrome have a higher risk of serious illness. However, most of the children admitted to hospital with RSV were healthy before that. Not many children die from RSV in the Netherlands.

There are two types of RSV: RSV-A and RSV-B. These types can occur simultaneously among the population and cause exactly the same symptoms.

What are the symptoms of RSV infection?

The time between exposure to the virus and the first symptoms of illness is 2 to 8 days. On average, it takes 5 days to develop symptoms. The most common symptoms are:

• nasal cold
• coughing

RSV may also cause more serious symptoms:

• shortness of breath
• fever
• pneumonia
• ear infection (especially in children)

You can get RSV more than once. Previous infection does not prevent illness. However, the symptoms are usually milder if you have had it before.

How common is RSV in the Netherlands?

RSV is common in the Netherlands, especially in winter (November to March). Almost all children get the virus before they turn 2 years old. In the Netherlands, it is estimated that about 1 in 10 children visit their GP with RSV (and possibly as many as 1 in 5). Approximately 1 or 2 in 100 babies have to be admitted to hospital. Some children are put on respiratory support in intensive care.

Among older people and people with heart or lung conditions, there is an increased risk of complications. For example, they could develop pneumonia. All over the world, RSV outbreaks are common in residential care facilities and nursing homes.

How does RSV spread?

The respiratory syncytial virus (RSV) is present in the nose and throat of a person who is infected. The infected person can transmit RSV by droplets released during coughing, sneezing and talking. Other people can ingest or inhale these droplets through the nose, eyes or mouth. This is how they can be exposed to the virus. A person with RSV can infect others before showing any symptoms of illness. Once a person with RSV is fully recovered, they are no longer contagious. Adults are contagious for about 5 to 7 days. The contagious period can be much longer for people with impaired immunity. Children under 2 years old are also contagious for longer: about 3 to 4 weeks after the onset of the infection. Breastfeeding can help protect babies against RSV infections, but it is not an alternative to vaccination.

Is there any treatment for RSV?

An RSV infection usually goes away on its own. This can take several days, but may last as long as a week. If your child is showing signs of respiratory distress (wheezing, panting, drowsiness, greyish-blue around the mouth), contact your GP or the out-of-hours medical centre immediately. The Thuisarts website offers more details in Dutch. It also offers more information (in Dutch) for adults about when to contact the GP if you have pneumonia.

Babies who have a higher risk of serious illness if they get RSV can receive preventive treatment with a medicine containing antibodies (known as palivizumab®) until the age of 12 months, as prescribed by a paediatrician. This medicine is given in the form of an injection, which must be repeated once a month for 5 months, and works immediately. This approach is known as passive immunisation.

Preventing RSV infections

In October 2022, the European Medicines Agency (EMA) approved a new antibody medicine for use in Europe: nirsevimab. Like palivizumab®, this medicine is given in the form of an injection. This approach is known as passive immunisation. Like palivizumab^®, the medicine may help children to become less seriously ill. It works better and longer than palivizumab^®. 

Two vaccines against RSV were also approved by the EMA in 2023. One vaccine is intended for people aged 60 years and older. The other vaccine has been approved for people aged 60 years and older and for pregnant people (maternal RSV vaccination). The RSV vaccination during pregnancy is intended to protect babies against RSV as soon as they are born. You will need to pay for this vaccination yourself. To arrange RSV vaccination, please contact your GP or the Municipal Public Health Services (GGDs). 

Advisory opinion of the Health Council on RSV protection for children

On 14 February 2024, the Health Council of the Netherlands issued an advisory opinion on protecting babies against RSV. The Health Council recommends offering antibodies (nirsevimab) to all children under 12 months old through the National Immunisation Programme.  The antibodies are administered by means of an injection in the baby’s thigh. The State Secretary adopted this advisory opinion on 8 October 2024. The aim is to offer the RSV antibody injections to all children within the first 12 months of life through the National Immunisation Programme, starting in autumn 2025. Giving antibodies against RSV is expected to protect more children than by giving an RSV vaccination during pregnancy. The Health Council therefore preferably advised protecting babies with nirsevimab rather than vaccinating against RSV during pregnancy. More information is available on the RIVM page about RSV antibody injections for babies.

Research on RSV infection

RIVM is monitoring how many people in the Netherlands have respiratory symptoms (in Dutch), and how much RSV is circulating (in Dutch) in the Netherlands. This is achieved by conducting surveillance of respiratory infections. Various organisations work together on this topic. RIVM is also researching the virus itself and levels of protection against the virus. This includes laboratory research (virology and immunology) and research on who becomes ill from RSV (epidemiology).