Do individuals who had a Respiratory Syncytial Virus (RSV) infection in the past need the RSV vaccine, such as Palivizumab (Ribavirin), if they are at high risk for severe illness?

RSV Vaccination After Previous Infection

Adults who had an RSV infection three years ago still need the RSV vaccine if they are in a recommended age group or have risk factors for severe disease. 1

Recommendations Based on Age and Risk Factors

• RSV vaccination is recommended for all adults aged ≥60 years, regardless of previous infection history 1
• For adults aged 50-59 years, vaccination is recommended if they have risk factors such as:
  • Chronic respiratory disease (COPD, asthma, bronchiectasis) 1, 2
  • Chronic heart disease (particularly heart failure) 1
  • Chronic kidney disease 1
  • Diabetes 1
  • Immunocompromised status 1
  • Obesity 1
  • Neurological conditions 1
  • Residence in a nursing home or long-term care facility 1

Scientific Rationale

• Natural RSV infection does not confer long-lasting immunity, with protective antibodies waning rapidly 1
• Reinfection with RSV throughout life is common, even in previously infected individuals 1
• RSV infection in older adults and those with comorbidities can lead to severe lower respiratory tract disease, hospitalization, and death 1, 3

Available Vaccines and Efficacy

• Two RSV vaccines are currently available for adults:

  • RSVPreF3 (Arexvy): Approved for adults ≥60 years and adults 50-59 years with risk factors 1, 2
  • RSVpreF (Abrysvo): Approved for adults ≥60 years 1

• Vaccine efficacy against RSV-associated lower respiratory tract disease:

  • RSVPreF3: 82.6% efficacy in first season, with protection maintained for at least three seasons (48.0% in third season) 1
  • RSVpreF: 65.1% efficacy in first season, with protection maintained for at least two seasons (55.7% in second season) 1

Administration Guidelines

• Single intramuscular dose is recommended 1
• Preferably administered between September and November, before or early in the RSV season 2
• Can be co-administered with seasonal influenza vaccine at different injection sites 2
• No need for annual revaccination has been established yet 1, 4

Important Considerations

• Previous RSV infection does not contraindicate vaccination 1
• The highest priority groups if vaccine supply is limited are:
  • Adults aged ≥75 years 1, 4
  • Adults aged ≥60 years with significant comorbidities 1
  • Residents of long-term care facilities 1

Common Pitfalls to Avoid

• Do not confuse pediatric RSV prophylaxis (palivizumab) with adult RSV vaccines - they are different products with different indications 1
• Do not assume that previous RSV infection provides sufficient long-term protection - natural immunity wanes quickly 1
• Do not delay vaccination until the peak of RSV season, as this may reduce the protective benefit 1
• Do not withhold vaccination from eligible individuals based solely on history of prior RSV infection 1