Which respiratory syncytial virus (RSV) vaccines are approved and recommended for adults aged 60 years and older?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: November 10, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

RSV Vaccines for Adults Aged 60 Years and Older

Three RSV vaccines are approved and recommended for adults aged 60 years and older: RSVPreF3 (Arexvy), RSVpreF (Abrysvo), and mRNA-1345 (mRESVIA), all administered as a single intramuscular dose. 1, 2, 3

Approved Vaccines and Their Indications

All three vaccines are FDA-approved for prevention of RSV-associated lower respiratory tract disease (LRTD) in adults ≥60 years:

  • RSVPreF3 (Arexvy, GSK): Recombinant RSV pre-fusion F protein adjuvanted with AS01E. Also approved for adults 50-59 years at increased risk for RSV disease 1

  • RSVpreF (Abrysvo, Pfizer): Recombinant bivalent RSV-A and RSV-B pre-fusion F protein. Additionally approved for maternal immunization during pregnancy 1

  • mRNA-1345 (mRESVIA, Moderna): Single-stranded mRNA encoding RSV glycoprotein F stabilized in prefusion conformation 1, 2

Current Vaccination Recommendations

The 2024 ACIP guidelines provide age-stratified recommendations that prioritize those at highest risk:

Universal Recommendation

  • All adults ≥75 years: Single dose of any approved RSV vaccine 2, 4

Risk-Based Recommendation

  • Adults 60-74 years with increased risk factors: Single dose recommended 2, 4

Risk factors include:

  • Chronic cardiovascular disease
  • Chronic lung/respiratory disease (COPD, asthma, bronchiectasis, interstitial lung disease)
  • End-stage renal disease or chronic kidney disease
  • Diabetes mellitus
  • Chronic liver disease
  • Neurologic/neuromuscular conditions
  • Chronic hematologic conditions
  • Severe obesity (BMI ≥30)
  • Moderate to severe immunocompromise
  • Residence in nursing home or long-term care facility
  • Frailty or dementia 1, 2

Important caveat: Adults who have already received one RSV vaccine should not receive another dose, as duration of protection data support single-dose administration 2

Vaccine Efficacy Data

RSVPreF3 (Arexvy)

Season 1 efficacy in adults ≥60 years:

  • RSV-associated LRTD: 82.6% (96.95% CI: 57.9-94.1%)
  • Severe RSV-associated LRTD: 94.1% (95% CI: 62.4-99.9%)
  • Efficacy maintained for at least 3 seasons 1

Age-specific performance:

  • Ages 60-69: 81.0% efficacy
  • Ages 70-79: 93.8% efficacy
  • Ages ≥80: 33.8% efficacy (wide confidence interval suggests less robust protection in oldest adults) 1

RSVpreF (Abrysvo)

Season 1 efficacy in adults ≥60 years:

  • RSV-associated LRTD (≥2 symptoms): 65.1% (95% CI: 35.9-82.0%)
  • RSV-associated LRTD (≥3 symptoms): 88.9% (95% CI: 53.6-98.7%)
  • Efficacy maintained for at least 2 seasons 1

Real-World Effectiveness

Post-licensure data from 2023-2024 season in Medicare beneficiaries ≥65 years demonstrated:

  • Overall vaccine effectiveness against RSV-related hospitalization: 81.8% (95% CI: 80.0-83.4%)
  • Overall vaccine effectiveness against RSV-related death: 85.0% (95% CI: 75.1-90.9%)
  • Brand-specific effectiveness: RSVPreF3 79.9%, RSVpreF 85.1%
  • Effectiveness in immunocompromised individuals: 72.2% (95% CI: 67.4-76.3%) 5

Clinical Implementation

Timing of Administration

  • Preferably September through November to align with RSV season 1
  • Can be administered year-round if needed

Co-administration

  • RSV vaccine can be given concurrently with influenza vaccine without compromising immune response 1, 6
  • Co-administration improves vaccine adherence and reduces implementation barriers

Safety Profile

All three vaccines demonstrate acceptable safety:

  • Common adverse effects: injection-site pain, myalgia, fatigue, headache 3, 7
  • No difference in serious adverse events compared to placebo (RR 0.96 for protein subunit vaccines, RR 1.09 for mRNA vaccine) 8
  • No effect on all-cause mortality (RR 1.07) 8

Key Clinical Considerations

The shift from shared clinical decision-making to age-based recommendations in 2024 was designed to:

  • Maximize vaccination coverage among those most likely to benefit
  • Reduce implementation barriers
  • Clarify who is at highest risk 2

For adults 60-74 years without risk factors: Vaccination may be considered but is not universally recommended. The decision should weigh individual risk factors, exposure risk, and patient preference 4

For immunocompromised patients: All three vaccines show effectiveness, though slightly reduced compared to immunocompetent individuals (72% vs 82% effectiveness), but vaccination remains strongly recommended 5

International variation exists: Some countries (Austria, Spain) recommend vaccination for all adults ≥60 years, while others (France, UK) set the threshold at ≥75 years or ≥65 years with comorbidities 1

References

6
Research

Respiratory Syncytial Virus Prevention in the Adult Population: State of the Art.

Seminars in respiratory and critical care medicine, 2025

Related Questions

Which of the following statements is true: all three respiratory syncytial virus (RSV) vaccines are indicated to prevent lower respiratory tract disease in individuals aged 60 years and older, or all three RSV vaccines are indicated to prevent lower respiratory tract disease in high‑risk individuals aged 18–59 years?
For a 60‑year‑old adult needing protection against respiratory syncytial virus (RSV) and COVID‑19, should I give Abrysvo (RSV vaccine) or Arexvy (COVID‑19 vaccine)?
What are the current RSV vaccination and prophylaxis recommendations for adults ≥60 years, pregnant individuals, immunocompromised patients, and high‑risk infants?
Should adults aged 65 years and older be recommended to receive the respiratory syncytial virus (RSV) vaccine, and which dosing regimen is appropriate?
Is RSV vaccination recommended for healthy adults aged 55 to 60?
In a term pregnancy with pregnancy‑induced hypertension and a presumed placental abruption, under what conditions is expectant management appropriate?
What non‑controlled‑substance medication can be prescribed for insomnia, and should risperidone be administered in the morning rather than at night?
Which statement about the approved RSV vaccines and monoclonal antibodies is true regarding their indicated age groups, use in pregnant individuals, and active versus passive immunization?
In a patient with cirrhosis, an international normalized ratio of 2.1, and portal vein thrombosis, should therapeutic enoxaparin (low‑molecular‑weight heparin) at 1 mg/kg twice daily be initiated?
Which of the following statements is true: all three respiratory syncytial virus (RSV) vaccines are indicated to prevent lower respiratory tract disease in individuals aged 60 years and older, or all three RSV vaccines are indicated to prevent lower respiratory tract disease in high‑risk individuals aged 18–59 years?
Will risperidone be effective for managing daytime behavioral disturbances?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.