Can a 59-year-old female patient with possible asthma receive the Respiratory Syncytial Virus (RSV) vaccine?

RSV Vaccination for a 59-Year-Old Female with Possible Asthma

A 59-year-old female patient with possible asthma should receive the RSV vaccine (RSVPreF3) as it is recommended for adults aged ≥50 years with risk factors including asthma. 1

Recommendation Basis

Age and Risk Factor Considerations

• RSVPreF3 (Arexvy) is the only RSV vaccine approved for adults aged 50-59 years with risk factors that increase the risk for RSV disease 1
• Asthma is specifically identified as one of the chronic conditions that increases risk for severe RSV infection 1
• The Portuguese Society of Pulmonology and other medical societies recommend RSV vaccination for people aged ≥50 years with risk factors including asthma 1

Vaccine Efficacy in This Population

• The noninferiority of the humoral immune response to RSVPreF3 in adults aged 50-59 years compared with those aged ≥60 years has been demonstrated in phase III clinical trials 1
• Noninferiority was specifically shown for participants 50-59 years old with chronic conditions that increase RSV disease risk, including asthma 1
• The safety profile of RSVPreF3 in adults aged 50-59 years was consistent with that observed in adults aged ≥60 years 1

Evidence for Asthma as a Risk Factor

• Adults with asthma have a high prevalence among RSV-infected patients, especially in inpatient settings (pooled estimate 19.3%, 95% CI 15.0-24.6) 2
• The incidence rate ratios of hospitalization following RSV infection for adults with asthma were 2.0-3.6 (crude) and 6.7-8.2 (adjusted) compared to those without asthma 2
• Exacerbation of asthma is a frequently reported RSV-related complication (up to 64.9% of cases) 2
• In Denmark and Scotland, adults with asthma had a 1.5- to 3-fold increased risk of RSV hospitalization compared to the general population 3

Timing and Administration

• The RSV vaccine should preferably be administered between September and November, although it can be given at any time of year 1
• The vaccine can be co-administered with the seasonal influenza vaccine at different injection sites 1
• When co-administered with influenza vaccines, there may be numerically lower immune responses to both vaccines, but the clinical relevance of these findings is unknown 1

Safety Considerations

• RSVPreF3 is generally well tolerated in adults aged 50-59 years, with mostly transient and mild to moderate adverse effects 1
• Common solicited adverse events include injection-site pain, fatigue, myalgia, and headache, which may be reported at higher rates in adults aged 50-59 years than in those aged ≥60 years 1
• The rates of serious adverse events and potential immune-mediated diseases were similar across age groups (0.5-3.6% for serious adverse events in 50-59 year olds) 1

Important Caveats

• While immunogenicity data supports the use of RSVPreF3 in adults aged 50-59 years with risk factors, efficacy against RSV-associated lower respiratory tract disease has not been directly evaluated in this specific age group 1
• Patient attestation is sufficient evidence of the presence of a risk factor like asthma; extensive medical documentation should not be required 1
• The diagnosis of "possible asthma" should be clarified when feasible, but should not delay vaccination if the patient reports having the condition 1

In summary, given the patient's age (59) and risk factor (asthma), RSV vaccination with RSVPreF3 is recommended based on current guidelines to prevent RSV-associated respiratory disease.