Under pressure: lessons learnt from rapid implementation of the respiratory syncytial virus maternal vaccine and infant nirsevimab in Sydney, Australia

Objective To share lessons learnt from the Sydney Local Health District (SLHD) rollout of respiratory syncytial virus (RSV) prevention products, and present data on immunisation uptake for mothers and babies in two maternity hospitals. Type of service Rollout of the RSV maternal vaccine and the injectable, long-acting monoclonal antibody nirsevimab for newborn infants to protect them from RSV infection and hospitalisation. Methods Deidentified summary data from the electronic medical record on RSV immunisation status in two SLHD maternity hospitals were analysed descriptively as counts and proportions. The Consolidated Framework for Implementation Research was used as a lens to reflect on the rollout process. Results RSV vaccination coverage in women giving birth in two SLHD hospitals improved from 4% in the first month of rollout (February 2025) to a range of 70–74% from June to September 2025. As antenatal coverage improved, the number of live born babies requiring nirsevimab decreased. Among eligible newborns, 36% of families declined nirsevimab, with reason for refusal not recorded. Documentation of RSV immunisation status improved as the rollout progressed. Lessons learnt Engaging multidisciplinary leaders and clinicians is critical for a coordinated response and program rollout success. Leveraging existing education structures, staff meetings and using online prerecording can optimise clinician education. New programs take time to embed into routine clinical practice, and programs that involve delivering multiple immunisation products for distinct groups require clear messaging and systemic safeguards to prevent errors. Integrating immunisation into medical record workflows as standard practice can support program adoption and uptake.