Protecting a baby from RSV (respiratory syncytial virus) now involves a combination of immunization and everyday hygiene measures that, together, can dramatically reduce the risk of serious illness. RSV sends tens of thousands of infants to the hospital each year in the United States, with the season typically starting in fall and peaking in winter. The good news: options available today can cut hospitalization risk by more than 80% in some cases.
Immunization: The Most Effective Protection
Two major immunization strategies now exist for infants, and understanding the difference matters. One is a single-dose antibody shot given directly to the baby. The other is a vaccine given to the pregnant parent, which passes protective antibodies to the baby before birth. Most infants need only one of these, not both.
Antibody Shot for Infants
Nirsevimab is a long-acting monoclonal antibody, meaning it gives your baby ready-made protection rather than asking their immune system to build its own. It’s recommended for all infants entering their first RSV season. In a large clinical trial published in the New England Journal of Medicine, nirsevimab reduced RSV-related hospitalizations by 83.2% compared to standard care. Only 0.3% of infants who received the shot were hospitalized for RSV, versus 1.5% in the group that didn’t.
The shot is given as a single injection and provides protection throughout RSV season. It’s also recommended for certain young children at increased risk heading into their second RSV season. If your baby is born during RSV season (roughly October through March), they can receive the shot shortly after birth, often before leaving the hospital. Babies born outside the season typically get it in the fall, just before RSV begins circulating.
Maternal Vaccine During Pregnancy
The maternal RSV vaccine (Abrysvo) is given as a single dose between weeks 32 and 36 of pregnancy, during the September through January window. The vaccine prompts the pregnant person’s immune system to produce antibodies that cross the placenta and protect the newborn from birth. This is especially useful for babies who will be very young during peak RSV months, since they arrive with antibodies already on board.
In its phase 3 clinical trial, the maternal vaccine reduced the baby’s risk of RSV hospitalization by 68% within the first three months of life and by 57% within six months. Protection against severe outcomes, including dangerously low oxygen levels, the need for mechanical ventilation, or ICU admission, was even stronger: 82% within three months and 69% within six months. The protection does wane over time, but it’s designed to cover the baby’s first RSV season.
Your provider will typically recommend either the maternal vaccine or the infant antibody shot, depending on timing. A baby whose mother received the vaccine close to delivery generally won’t also need the antibody shot, unless they have specific risk factors.
Coverage and Cost
Nirsevimab is included on the CDC’s recommended pediatric immunization schedule, which means it’s covered under the Vaccines for Children (VFC) program. Children who are uninsured, underinsured, Medicaid-eligible, or American Indian/Alaska Native qualify for VFC coverage. Most private insurance plans also cover recommended childhood immunizations without a copay.
Everyday Measures That Reduce Exposure
RSV spreads through respiratory droplets and contaminated surfaces. The virus is hardy enough to survive on hard surfaces like countertops for up to six hours, on rubber gloves for about 90 minutes, and on fabric or paper tissues for 30 to 45 minutes. On skin, it lasts around 20 minutes. Infectious virus can transfer from a contaminated surface to your hands and remain viable there for up to 25 minutes, which is plenty of time to touch a baby’s face.
Practical steps that make a real difference:
- Handwashing before touching the baby. Anyone who holds, feeds, or plays with your infant should wash their hands with soap and water for at least 20 seconds. This is the single most effective hygiene measure because of how easily the virus moves from surfaces to hands to faces.
- Cleaning high-touch surfaces. Wipe down countertops, doorknobs, toys, and changing tables regularly during RSV season, especially if anyone in the household is sick.
- Limiting close contact with sick people. RSV often looks like a common cold in older children and adults, with runny nose, cough, and mild fever. Ask people with any cold symptoms to wait before visiting, or at minimum to avoid kissing the baby and to wash hands thoroughly.
- Avoiding crowded indoor spaces. During peak season, limiting your newborn’s exposure to crowded environments reduces the chance of encountering the virus.
Breastfeeding and Passive Protection
Breast milk contains antibodies that provide some protection against respiratory infections, including RSV. Research has shown that maternal antibodies transferred through both the placenta and breast milk may help protect babies against severe bronchiolitis, the lower airway infection RSV commonly causes in infants. Breastfeeding isn’t a substitute for immunization, but it adds a layer of immune support, particularly in the early weeks of life when babies are most vulnerable.
Which Babies Are at Highest Risk
RSV can be dangerous for any infant, but certain babies face a significantly higher chance of severe illness. Premature infants, especially those born before 29 weeks, have smaller airways and less developed lungs. Babies with chronic lung disease or congenital heart conditions are also at elevated risk. So are infants with weakened immune systems or neuromuscular disorders that make it harder to cough and clear mucus from their airways.
For these high-risk babies, an older monthly injection called palivizumab has been used for decades. However, it is being phased out and will no longer be available after December 31, 2025, as nirsevimab now provides similar protection with a single dose rather than monthly shots throughout the season. If your baby has a condition that increases their RSV risk, talk to their pediatrician about the best timing for the antibody shot.
Signs of RSV to Watch For
Even with prevention measures in place, knowing what RSV looks like in an infant helps you act quickly. It typically starts with mild cold symptoms: runny nose, decreased appetite, and a cough. In young babies, the illness can progress to wheezing and visible difficulty breathing within a few days.
The specific warning signs that signal a baby needs medical attention include rapid or labored breathing, flaring nostrils, visible rib contractions with each breath (the skin between or below the ribs pulls inward), and pauses in breathing lasting more than 10 seconds, known as apnea. Babies under two months old and premature infants can deteriorate quickly, so any breathing difficulty in a very young infant warrants prompt evaluation. A baby who is breathing hard, refusing to eat, or seems unusually lethargic needs to be seen right away.