Overview of Selective National Guidelines and Clinical Recommendations for Childhood Respiratory Syncytial Virus (RSV) Prophylaxis: A Hong Kong Perspective for Asia.

Abstract

Introduction: Respiratory Syncytial Virus (RSV) is a leading cause of lower respiratory tract infections in infants and young children worldwide, with significant morbidity and healthcare burden in Asia. In Hong Kong, RSV seasonality and hospitalization rates underscore the urgent need for effective prophylactic strategies. Recent advances in maternal vaccination and long-acting monoclonal antibodies have expanded the armamentarium for RSV prevention. However, clinical guidelines across Asia remain heterogeneous, and parental hesitancy continues to limit uptake. To address these gaps, selective national guidelines and clinical recommendations were reviewed and a simplified ABC mnemonic framework to integrate antenatal and postnatal prophylaxis with parental counselling were proposed.

Methods: A narrative review of published guidelines, policy documents, and clinical recommendations from Hong Kong and selected Asian countries was conducted. Sources included pediatric society statements, Ministry of Health advisories, and World Health Organization (WHO) regional guidance. Comparative analysis focused on prophylaxis strategies, target populations, and implementation challenges. Based on this synthesis, we developed the ABC mnemonic to facilitate recall and communication among clinicians and families.

Results and discussion: Variability in RSV prophylaxis adoption across Asia, is as follows: Antenatal Vaccine: Maternal immunization during pregnancy, exemplified by Abrysvo, is recommended in several high-income settings but remains under consideration in Hong Kong and neighboring regions. Evidence supports transplacental antibody transfer, reducing RSV hospitalization in newborns. Baby after Birth: Long-acting monoclonal antibodies such as nirsevimab (Beyfortus) provide direct infant protection for up to five months, covering the peak RSV season. While approved in Europe and the United States, access in Asia is limited by cost and regulatory timelines. Counselling: Parental education emerged as a critical determinant of uptake. Misconceptions about vaccine safety and uncertainty regarding timing hinder implementation. Structured counselling strategies can bridge scientific advances with family decision-making, ensuring continuity of care from pregnancy to infancy. The ABC Mnemonic: Antenatal vaccine (e.g., Abresyvo), Baby after Birth (e.g., Beyfortus), Counselling (e.g., Clesrovimab as an alternative to Beyfortus), offers a concise, memorable framework that aligns clinical interventions with communication needs. It emphasizes the continuum of protection and highlights the indispensable role of parental engagement.

Conclusion: RSV prophylaxis in Hong Kong and Asia is at a pivotal juncture, with maternal vaccination and infant monoclonal antibodies poised to transform prevention strategies. Yet, fragmented guidelines and limited awareness impede progress. The ABC mnemonic provides a practical tool for clinicians and policymakers to harmonize recommendations, improve recall, and strengthen parental counselling. By integrating antenatal and postnatal interventions within a simple communication framework, the ABC approach bridges science and public health messaging, fostering broader acceptance and uptake. This model may serve as a template for other regions seeking to balance innovation with implementation in RSV disease prevention.