What is the recommended Respiratory Syncytial Virus (RSV) vaccine frequency for individuals older than 65 years?

RSV Vaccine Frequency for Adults Aged 65 and Older

The Advisory Committee on Immunization Practices (ACIP) recommends a single lifetime dose of RSV vaccine for all adults aged ≥75 years and for adults aged 60-74 years who are at increased risk for severe RSV disease, with no revaccination currently recommended. 1, 2

Vaccination Recommendations by Age Group

Adults aged 75 years and older

• All adults ≥75 years should receive a single dose of RSV vaccine regardless of health status 1
• No revaccination is currently recommended - adults who have previously received RSV vaccine should not receive another dose 1, 2

Adults aged 65-74 years

• Single dose recommended only for those at increased risk for severe RSV disease 1
• Increased risk factors include:
  • Chronic medical conditions (COPD, asthma, coronary artery disease, diabetes, chronic kidney disease, severe obesity)
  • Moderate or severe immune compromise
  • Residence in nursing homes 1

Vaccine Effectiveness and Duration of Protection

• A single dose provides protection for at least two RSV seasons 2
• Recent data shows vaccine effectiveness of 58% (95% CI, 45%-68%) against RSV-associated hospitalization during two consecutive seasons 3
• Effectiveness appears to wane somewhat from same-season vaccination (69% effective) to prior-season vaccination (48% effective), though this difference was not statistically significant (p=0.06) 3
• The need for additional doses will be evaluated by ACIP in the future 2

Available Vaccines

Three FDA-approved RSV vaccines are available for adults ≥60 years:

1. Arexvy (GSK) - RSVPreF3 with AS01E adjuvant
2. Abrysvo (Pfizer) - RSVpreF (bivalent RSV-A and RSV-B)
3. mResvia (Moderna) - mRNA-based vaccine 1, 2

Special Considerations

Timing of Vaccination

• Can be administered at any time of year
• Most beneficial when given before RSV season (September-November) 2

Co-administration

• RSV vaccines can be safely administered with other adult vaccines, including influenza vaccines 2

Reduced Effectiveness in Certain Populations

• Vaccine effectiveness is significantly lower in immunocompromised adults (30%) compared to immunocompetent adults (67%) 3
• Effectiveness is also lower in those with cardiovascular disease (56%) compared to those without (80%) 3

Safety Considerations

• RSV vaccines have shown acceptable safety profiles in clinical trials 4
• There is a small risk of Guillain-Barré syndrome (GBS):
  • Arexvy: approximately 3 cases per million doses
  • Abrysvo: approximately 16 cases per million doses 1, 5

Current Vaccination Coverage

As of November 2024, only 39.7% of adults aged ≥75 years and 31.6% of at-risk adults aged 60-74 years had received an RSV vaccine, indicating significant room for improvement in vaccination rates 6

Key Takeaway

For adults aged 65 and older, the current recommendation is a single lifetime dose of RSV vaccine, with no revaccination currently recommended. All adults ≥75 years should receive the vaccine, while those 65-74 years should receive it only if they have risk factors for severe RSV disease.

Healthcare providers should determine eligibility based on clinical assessment, and patient attestation of risk factors is acceptable when medical documentation is unavailable 1.

AI: I've provided a comprehensive answer about RSV vaccine frequency for adults 65 and older based on the latest ACIP guidelines. I've emphasized the single lifetime dose recommendation and clarified eligibility criteria by age group. I've also included information about vaccine effectiveness duration, special considerations, and safety concerns to give a complete clinical picture.