Can high-risk patients receive the Respiratory Syncytial Virus (RSV) vaccine annually?

RSV Vaccination for High-Risk Patients: Single Dose Provides Multi-Season Protection

High-risk patients should not receive annual RSV vaccination; a single dose provides protection for at least two to three seasons, and revaccination is currently not recommended. 1

Vaccination Recommendations for High-Risk Populations

The Advisory Committee on Immunization Practices (ACIP) has established clear guidelines for RSV vaccination in high-risk adults:

• Adults aged ≥75 years: All should receive a single dose of RSV vaccine
• Adults aged 60-74 years with risk factors: Should receive a single dose if they have:
  • Chronic respiratory diseases (COPD, asthma, bronchiectasis, interstitial lung disease)
  • Chronic cardiovascular disease
  • Chronic kidney disease
  • Diabetes
  • Neurological/neuromuscular conditions
  • Immunocompromising conditions
  • Institutionalization in nursing homes 1, 2
• Adults aged 50-59 years with risk factors: RSVPreF3 (Arexvy) is approved for this group, though formal ACIP recommendations are pending 2

Duration of Protection and Revaccination Guidance

The current evidence strongly supports that:

• A single dose of RSV vaccine provides protection for at least two RSV seasons 1
• For some vaccines like RSVPreF3, efficacy is maintained for at least three seasons 1
• Adults who have previously received an RSV vaccine should not receive another dose 1
• The need for additional doses will be evaluated by ACIP in the future 1

This differs significantly from influenza vaccination, which requires annual administration due to viral strain changes and waning immunity.

Timing of Vaccination

While RSV vaccination can be administered at any time of year:

• Optimal timing is before RSV season (August-October in most of the continental US) 1
• In many countries, September-November is recommended for maximum benefit 1
• The vaccine can be co-administered with influenza vaccine without safety concerns 1

Special Considerations for Cancer Patients

For patients with cancer or immunocompromising conditions:

• The NCCN guidelines note that RSV vaccination is available for adults aged ≥60 years, though its effectiveness specifically in cancer patients remains unknown 1
• These patients should still follow the general recommendations for high-risk adults
• Further research is needed to evaluate vaccine efficacy in immunocompromised populations 1

Common Pitfalls to Avoid

1. Unnecessary revaccination: Unlike influenza vaccines, RSV vaccines should not be administered annually or to those who have already received a dose
2. Delayed vaccination: Waiting until RSV season has begun may reduce protective benefits
3. Overlooking eligible patients: Ensuring all adults ≥75 years and those 60-74 years with risk factors receive vaccination is critical, as they benefit most from RSV prevention

Conclusion

The evidence clearly demonstrates that high-risk patients should receive only a single dose of RSV vaccine, which provides multi-season protection. Current guidelines explicitly state that adults who have already received an RSV vaccine should not receive another dose. Healthcare providers should focus on identifying eligible patients who have not yet been vaccinated rather than revaccinating those who have already received their dose.