Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory infections (ALRTIs) in children under five and poses a persistent threat to child health worldwide. In China, RSV accounted for an estimated 3.5 million ALRTI cases and up to 950,000 hospitalizations in 2019—nearly one-quarter of the global burden. While most cases are mild, RSV can cause severe illness in infants, including respiratory failure, neurological complications, and, in some cases, death. With evolving research and new therapeutic options, China urgently needs standardized clinical approaches grounded in both global evidence and local epidemiology.
A major challenge is the lack of unified guidance for diagnosing, treating, and preventing RSV across China's diverse healthcare settings.
Should clinicians prioritize rapid antigen testing or nucleic acid assays for early detection? When is oxygen therapy warranted, and which methods offer the safest outcomes? How should emerging tools—such as monoclonal antibodies and recombinant interferons—be incorporated into clinical care? And how can long-term complications like recurrent wheezing and asthma be minimized?
In response, a multidisciplinary panel of pediatric, epidemiologic, virologic, and public health experts has developed a new national guideline to improve the diagnosis, treatment, and prevention of RSV infections in children under five. The initiative was led by Professor Kunling Shen of Beijing Children's Hospital. The guideline was published in the journal Pediatric Investigation and made available online on May 19, 2025.
"This is the first RSV guideline in children developed in China using a rigorous international methodology," said Prof. Shen. "We followed the GRADE system and the WHO's guideline development manual while tailoring the recommendations to reflect China's unique burden and regional variation in RSV transmission."
The guideline presents a comprehensive framework built around 12 clinical questions on RSV detection, management, and prevention, identified through a national survey of pediatric clinicians and virologists. These questions cover the full continuum of care—from early diagnosis and oxygen therapy to pharmacological treatment, monoclonal antibody use, and long-term follow-up.
It recommends rapid antigen detection tests as the primary diagnostic tool in outpatient settings, where swift clinical decisions are crucial. Nucleic acid amplification tests (NAATs), such as RT-PCR, are advised when clinical suspicion remains high despite a negative antigen result. Although virus isolation is considered the gold standard, its lengthy turnaround time and need for high-containment labs render it impractical for routine use.
The guideline cautions against the widespread misuse of antibiotics, bronchodilators, and corticosteroids in RSV treatment. These are not recommended for routine use in otherwise healthy children, as they offer no clear benefit in reducing illness duration or preventing complications. "We emphasize supportive care as the cornerstone of treatment," comments Dr. Shen. "This includes hydration, respiratory support, and careful monitoring, while avoiding unnecessary interventions."
Oxygen therapy remains a key intervention for RSV-related lower respiratory tract infections. The guideline advises initiating low-flow, heated, humidified oxygen when blood oxygen saturation falls below 92%. If symptoms worsen, escalation to high-flow nasal cannula (HFNC) or non-invasive ventilation may be necessary. A stepwise approach is encouraged to minimize overtreatment and reduce intensive care admissions.
Notably, the guideline supports the use of nebulized recombinant human interferon-alpha (IFN-α) as an antiviral therapy. "Interferon therapy offers a promising adjunct for RSV, especially when specific antivirals are still limited," said Prof. Shen. "Clinical trials have shown improved respiratory scores, reduced wheezing, and shorter hospital stays in children treated with IFN-α inhalation, without serious adverse events."
The guideline also addresses the role of nirsevimab, a long-acting monoclonal antibody. Recent data shows that nirsevimab reduces RSV-related hospitalizations by up to 90% in infants. The new guideline recommends nirsevimab prophylaxis for all infants entering their first RSV season, especially those born during epidemic months.
The document also suggests non-pharmaceutical interventions for preventing pediatric RSV infections, such as hand hygiene, breastfeeding promotion, surface disinfection, and reducing infant exposure to crowded environments. For hospitals, the paper suggests enhanced infection control, including patient cohorting and personal protective equipment for healthcare staff during the RSV season.
This guideline marks a new chapter in China's pediatric RSV strategy. Updates are planned every 3–5 years to incorporate emerging evidence and new therapies. It is designed to remain practical and relevant for clinicians across all levels of China's healthcare system, from township clinics to tertiary hospitals.
