How often is the Respiratory Syncytial Virus (RSV) vaccine recommended for individuals over 65 years old?

RSV Vaccination Recommendations for Adults Over 65 Years Old

The Advisory Committee on Immunization Practices (ACIP) recommends a single 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. 1

Current Recommendations by Age and Risk

Adults ≥75 years:

• A single dose of any FDA-approved RSV vaccine is recommended for all adults in this age group, regardless of health status 1
• This recommendation applies to all available RSV vaccines: Arexvy (GSK), Abrysvo (Pfizer), or mResvia (Moderna) 1

Adults 60-74 years:

• A single dose is recommended only for those with increased risk factors for severe RSV disease 1
• Risk factors include:
  • Chronic medical conditions (cardiovascular disease, chronic lung/respiratory disease, end-stage renal disease, diabetes, neurologic/neuromuscular conditions, chronic liver disease, chronic hematologic conditions) 1
  • Moderate or severe immunocompromise 1
  • Residence in a nursing home or long-term care facility 1
  • Severe obesity (BMI ≥40 kg/m²) 1

Administration Guidelines

• Only a single lifetime dose is recommended - adults who have previously received an RSV vaccine should not receive another dose 1
• The vaccine can be co-administered with seasonal influenza vaccine at different injection sites 2, 3, 4
• Preferably administered between September and November, before or early in the RSV season 2, 5

Evidence Supporting Recommendations

• RSV causes significant disease burden in older adults, with an estimated yearly incidence of 3-7% in adults aged 60+ years in high-income countries 6
• Adults hospitalized with RSV are typically older (most ≥60 years) and have more comorbidities, more respiratory symptoms, and are frequently without fever 6
• Estimated RSV-associated hospitalizations, intensive care unit admissions, and deaths preventable over two consecutive RSV seasons per 1 million RSV vaccine doses administered exceed estimated numbers of potential vaccine-attributable Guillain-Barré syndrome cases 1

Country-Specific Variations

• Recommendations vary by country, with some recommending vaccination for all adults ≥60 years (Austria, Spain) while others focus on specific age groups and risk factors 1
• France recommends seasonal RSV vaccination for people aged ≥75 years and people aged ≥65 years with chronic respiratory or cardiac disease 1
• Ireland recommends RSV vaccination in all adults aged ≥65 years 1
• Italy recommends vaccination for all subjects aged ≥75 years and in subjects aged ≥60 years with chronic conditions 1

Important Clinical Considerations

• Patient attestation is sufficient evidence of the presence of a risk factor; extensive medical documentation should not be required 1, 5
• Natural RSV infection does not confer long-lasting immunity, and reinfection throughout life is common 2
• The vaccine has been shown to be effective in preventing RSV-associated lower respiratory tract disease, with RSVPreF3 showing 82.6% efficacy in the first season 2
• Patients with inflammatory bowel disease who are 60 years of age and older should receive an RSV vaccine due to their 30% higher risk of hospitalization due to RSV compared with non-IBD control subjects 1

Pitfalls to Avoid

• Do not administer multiple doses of RSV vaccine - only a single lifetime dose is recommended 1
• Do not delay vaccination for adults ≥75 years while waiting for medical documentation of risk factors - age alone is sufficient indication 1
• Do not miss opportunities for co-administration with other vaccines like influenza, as studies have shown noninferiority of immune responses when co-administered 3, 4