Who should not receive the Respiratory Syncytial Virus (RSV) vaccine?

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: September 11, 2025 • View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

Who Should Not Receive the RSV Vaccine

The RSV vaccine is contraindicated for persons with a history of severe allergic reaction, such as anaphylaxis, to any component of the vaccine or to a previous dose of any RSV vaccine. 1, 2

Absolute Contraindications

  • Previous significant hypersensitivity reaction to RSV vaccine components

    • Individuals who have experienced anaphylaxis or anaphylactic shock to a previous dose of any RSV vaccine
    • Those with severe allergic reactions to any component of the vaccine

  • Moderate or severe acute illness

    • RSV vaccination should be delayed for persons experiencing moderate or severe acute illness with or without fever (precaution) 1

Age-Related Considerations

  • Adults younger than 60 years without specific risk factors are not currently recommended to receive RSV vaccination 1
  • Adults aged 60-74 years without risk factors for severe RSV disease should not receive the vaccine, as ACIP concluded that the benefits of RSV vaccination did not clearly outweigh the potential harms in this population 1

Special Populations with Precautions

Pregnant Women

  • For maternal RSV vaccination (RSVpreF/Abrysvo), vaccination is only recommended between 32-36 weeks' gestation to protect infants 1
  • Pregnant women outside this gestational window should not receive the vaccine

Immunocompromised Individuals

  • While immunocompromised adults ≥60 years are eligible for vaccination, there may be reduced vaccine effectiveness
  • Healthcare providers should consider the potential for inadequate immune response when determining vaccination strategy 1

Patients with Bleeding Disorders

  • As with any intramuscular injection, RSV vaccines should be given with caution to individuals with thrombocytopenia or any coagulation disorder 2
  • This is a precaution rather than a contraindication, requiring clinical judgment

Risk-Benefit Assessment

For adults aged 60-74 years, vaccination is only recommended for those with specific risk factors for severe RSV disease, including:

  • Chronic cardiovascular disease (excluding isolated hypertension)
  • Chronic lung or respiratory disease
  • End-stage renal disease
  • Complicated diabetes mellitus
  • Neurologic conditions affecting airway clearance
  • Chronic liver disease
  • Chronic hematologic conditions
  • Severe obesity (BMI ≥40 kg/m²)
  • Moderate or severe immune compromise
  • Residence in a nursing home
  • Frailty or other conditions determined by healthcare providers to increase risk 1

Revaccination Considerations

  • Adults who have already received RSV vaccination should not receive another dose, as a single dose provides protection for at least two RSV seasons 1, 3
  • The need for additional doses will be evaluated by ACIP in the future

Monitoring and Reporting

Adverse events after vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS), particularly for:

  • Severe allergic reactions
  • Guillain-Barré Syndrome (GBS), which has been identified as a potential risk with protein subunit RSV vaccines 1
  • Any clinically significant adverse event, even if uncertain whether the vaccine caused it

By carefully screening patients for contraindications and precautions before administering RSV vaccines, healthcare providers can maximize the benefits while minimizing potential risks of vaccination.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

Respiratory Syncytial Virus Vaccination Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

Related Questions

At what age is the RSV (Respiratory Syncytial Virus) vaccine recommended for high-risk infants?
Can Abrysvo (Rabies Immune Globulin) and flu vaccine be administered together?
What are the recommendations for administering an influenza vaccine to a patient with a history of hives from eggs and egg products, but no history of anaphylaxis?
What are the current Centers for Disease Control and Prevention (CDC) guidelines for receiving the Covid-19 vaccine?
What are the key components of a well-child visit for an 8-month-old female?
What is the initial workup for a patient presenting with dizziness?
What are the treatments for excessive daytime sleepiness and cognitive fog?
What is the recommended treatment for a urinary tract infection (UTI) in an 89-year-old patient with impaired renal function?
What are the dosing recommendations for ticagrelor (antiplatelet agent) in patients with hepatic impairment?
How to manage potassium, calcium, and phosphorus levels in diabetic ketoacidosis (DKA)?
What is the recommended dosage of tirzepatide (glucagon-like peptide-1 (GLP-1) receptor agonist) for patients with type 2 diabetes?

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.

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