Respiratory syncytial virus (RSV) is a common cause of acute lower respiratory tract infections (ALRI) and hospitalisations among young children and is globally responsible for many deaths in young children, especially in infants below 6 months of age. Furthermore, RSV is a common cause of severe respiratory disease and hospitalisation among the elderly. The development of new candidate vaccines and monoclonal antibodies highlights the need for reliable surveillance of RSV. In the European Union (EU), no up-to-date general recommendations on RSV surveillance are currently available. Based on outcomes of a workshop with 29 European experts in the field of RSV virology, epidemiology and public health, we provide recommendations to develop a feasible and sustainable national surveillance strategy for RSV that will enable harmonisation and data comparison at the European level. We discuss three surveillance components: active sentinel community surveillance, active sentinel hospital surveillance, and passive laboratory surveillance, using the EU acute respiratory infection (ARI) and WHO extended severe acute respiratory infection (SARI) case definitions. Furthermore, we recommend the use of quantitative reverse transcription polymerase chain reaction (qRT-PCR) based assays as the standard detection method for RSV and virus genetic characterisation, if possible, to monitor genetic evolution. These guidelines provide a basis for a good quality, feasible and affordable surveillance of RSV. Harmonisation of surveillance standards at European and global level will contribute to the wider availability of national level RSV surveillance data for regional and global analysis, and estimation of the RSV burden and impact of the future immunisation programmes.