Should RSV (Respiratory Syncytial Virus) vaccination be delayed after a patient finishes treatment for coccidioidomycosis (valley fever)?

RSV Vaccination After Valley Fever Treatment

There is no medical reason to delay RSV vaccination after a patient completes treatment for valley fever (coccidioidomycosis). RSV vaccination can be administered as soon as treatment for valley fever is completed.

Rationale for Immediate RSV Vaccination

The current guidelines do not indicate any need for delay in administering RSV vaccination after treatment for fungal infections such as valley fever. According to the NCCN Guidelines for Prevention and Treatment of Cancer-Related Infections (2024), the RSV vaccine is approved and available for those ≥60 years of age 1. The guidelines do not list any contraindications related to prior or recent fungal infections.

Key considerations:

• No contraindication: There are no specific recommendations in any current guidelines suggesting that RSV vaccination should be delayed following treatment for coccidioidomycosis.

• Timing of vaccination: The NCCN guidelines recommend that in general, "inactivated vaccines may be administered concomitantly with, or at any time before or after, other inactivated vaccines or live vaccines protecting against a different disease" 1.

• RSV protection importance: RSV causes significant respiratory illness that can lead to hospitalizations and substantial healthcare burden, particularly in vulnerable populations 2.

Special Considerations

Immunosuppression Status

If the patient experienced significant immunosuppression during valley fever treatment:

• Assess current immune status before vaccination
• If the patient received high-dose corticosteroids (>10 mg prednisolone daily or equivalent) during valley fever treatment, consider waiting until the patient has been on lower doses for optimal vaccine response 1

Vaccine Type Considerations

For RSV vaccination in adults:

• The recombinant RSV vaccine is available for adults aged ≥60 years
• For infants <24 months, the long-acting RSV monoclonal antibody (nirsevimab) is approved to prevent RSV infection 1

Implementation Guidance

1. Assess current health status: Ensure the patient has fully completed treatment for valley fever and is clinically stable

2. Review medication history: Check if the patient is still on any immunosuppressive medications that might affect vaccine response

3. Administer RSV vaccine: Proceed with vaccination according to age-appropriate recommendations:

   • For adults ≥60 years: Standard RSV vaccine
   • For eligible infants/children: Nirsevimab as appropriate

Conclusion

There is no evidence-based reason to delay RSV vaccination after completing treatment for valley fever. The priority should be ensuring the patient receives appropriate protection against RSV, particularly as they may be more vulnerable to respiratory infections following recovery from valley fever.