Recommended Prophylaxis Measures for Adults at High Risk of Severe RSV Infection
RSV vaccination is recommended for adults aged ≥75 years and adults aged 60-74 years with specific risk factors for severe RSV disease, as these populations benefit most from vaccination to prevent RSV-associated morbidity and mortality. 1
Primary Vaccination Recommendations
Age-Based Recommendations:
- Adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities 1
- Adults aged 60-74 years should receive RSV vaccination if they have one or more risk factors for severe disease 1
- Adults aged 50-59 years with risk factors may be considered for vaccination with RSVPreF3 (Arexvy), which is the only vaccine approved for this age group 2
Risk Factors That Warrant Vaccination in Adults Aged 60-74:
- Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, congenital heart disease) 1
- Chronic lung or respiratory disease (e.g., COPD, emphysema, asthma, interstitial lung disease) 1
- End-stage renal disease or dependence on dialysis 1
- Complicated diabetes mellitus (with chronic kidney disease, neuropathy, retinopathy, or requiring insulin/SGLT2 inhibitors) 1
- Neurologic/neuromuscular conditions affecting airway clearance 1
- Chronic liver disease (e.g., cirrhosis) 1
- Chronic hematologic conditions (e.g., sickle cell disease, thalassemia) 1
- Severe obesity (BMI ≥40 kg/m²) 1
- Moderate or severe immunocompromise 1
- Residence in a nursing home or long-term care facility 1, 3
- Frailty or other conditions that a healthcare provider determines increase risk of severe RSV disease 1
Vaccine Selection and Administration
Three RSV vaccines are currently available (as of 2025):
The vaccines have shown similar efficacy in reducing RSV-associated hospitalizations and medically attended RSV respiratory tract infections in adults ≥60 years 3
RSVPreF3 has demonstrated maintained efficacy for at least three seasons, while RSVpreF has shown maintained efficacy for at least two seasons 1
Timing and Co-administration
- RSV vaccination is preferably administered between September and November, although it can be given at any time of year 2
- RSV vaccines can be co-administered with seasonal influenza vaccines at different injection sites 2
Special Considerations
Implementation Notes:
- Patient attestation is sufficient evidence of risk factors; extensive medical documentation should not be required 1, 2
- Healthcare providers should use clinical judgment for patients who may have undiagnosed chronic conditions that increase RSV risk 1
Safety Considerations:
- Post-licensure safety surveillance has suggested a potential increased risk for Guillain-Barré Syndrome (GBS) after protein subunit RSV vaccination (Arexvy and Abrysvo) 1
- No GBS signal was observed with mRNA-based vaccine (mResvia) in clinical trials, but post-licensure safety data is still limited 1
Burden of Disease Context:
- RSV causes approximately 10,000 all-cause deaths annually among persons >64 years in the US 4
- The impact of RSV in older adults may be similar to non-pandemic influenza, with attack rates in nursing homes of approximately 5-10% per year, pneumonia rates of 10-20%, and mortality of 2-5% 4
- Adults hospitalized with severe RSV disease are typically older (≥60 years), have more comorbidities, more respiratory symptoms, and are frequently without fever compared to those with influenza 5
International Perspective
- Recommendations vary by country but consistently prioritize older adults (≥75 years) and those with chronic conditions 1
- Some countries like Austria consider vaccination for adults as young as 18 years with severe underlying conditions 1
Given the lack of specific treatments for RSV infections in adults, vaccination represents the most effective prophylactic measure for preventing severe RSV disease in high-risk populations 5, 6.