Is RSV (Respiratory Syncytial Virus) vaccination recommended for adults over 70?

RSV Vaccination Recommendations for Adults Over 70

For adults aged ≥75 years, a single dose of RSV vaccine is strongly recommended regardless of health status, while adults aged 70-74 should receive the vaccine if they have risk factors for severe RSV disease. 1, 2

Recommendations by Age Group

Adults ≥75 years:

• All adults aged ≥75 years should receive a single dose of any FDA-approved RSV vaccine regardless of underlying health conditions 1
• This recommendation is based on evidence that the benefits of vaccination in this age group significantly outweigh potential risks 1, 2
• Estimated preventable RSV-associated hospitalizations, ICU admissions, and deaths over two consecutive RSV seasons per 1 million vaccine doses significantly exceed potential vaccine-attributable adverse events in this age group 1

Adults aged 70-74 years:

• Adults in this age range should receive RSV vaccination if they have risk factors for severe disease 1
• Risk factors that warrant vaccination include: 1
  • Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, congenital heart disease)
  • Chronic respiratory disease (e.g., COPD, emphysema, asthma, interstitial lung disease)
  • End-stage renal disease or dependence on dialysis
  • Diabetes with complications or requiring insulin/SGLT2 inhibitors
  • Neurologic conditions affecting airway clearance
  • Chronic liver disease
  • Chronic hematologic conditions
  • Severe obesity (BMI ≥40 kg/m²)
  • Moderate or severe immunocompromise
  • Residence in a nursing home
  • Frailty or other conditions that a healthcare provider determines increase risk

Vaccination Administration Guidelines

• Only a single lifetime dose of RSV vaccine is recommended 1, 2
• Adults who have previously received any RSV vaccine should not receive another dose 1
• RSV vaccination can be co-administered with other adult vaccines during the same visit 1
• Vaccination is most beneficial when administered before or early in the RSV season (typically August-October in most of the continental US) 1, 2
• A single dose provides protection for at least two RSV seasons 1

Evidence Supporting Recommendations

• Data from RSV surveillance networks show that 54.1% of adults hospitalized with RSV were aged ≥75 years 3
• Severe outcomes occurred in 18.5% of hospitalized patients aged ≥60 years, with 17.0% requiring ICU admission, 4.8% requiring mechanical ventilation, and 4.7% mortality 3
• The incidence of RSV infections requiring medical attention increases with age and is highest among persons ≥70 years 4
• Risk-benefit analyses show that for adults ≥75 years, the benefits of vaccination substantially outweigh potential risks 1

International Perspective

• Recommendations vary by country, but most prioritize adults ≥75 years and those with underlying conditions 1
• France recommends vaccination for people ≥75 years and those ≥65 years with chronic respiratory or cardiac disease 1
• The UK advises an RSV vaccination program for people ≥75 years 1
• Italy recommends vaccination for all subjects ≥75 years and those ≥60 years with chronic conditions 1

Important Clinical Considerations

• Patient attestation is sufficient evidence of risk factors; extensive medical documentation should not be required 1, 2
• Healthcare providers should inform patients about benefits and risks of vaccination, including the potential risk for Guillain-Barré syndrome with protein subunit RSV vaccines 1
• Current vaccination coverage remains suboptimal, with only 39.7% of adults ≥75 years having received an RSV vaccine as of November 2024 5
• RSV is increasingly recognized as a major health threat for older adults, with global mortality rates in individuals ≥70 years exceeding those in children <5 years in 2019 6

Pitfalls to Avoid

• Do not administer multiple doses of RSV vaccine - only a single lifetime dose is currently recommended 1, 2
• Do not delay vaccination for adults ≥75 years while waiting for medical documentation of risk factors - age alone is sufficient indication 1, 2
• Do not underestimate the impact of RSV in older adults - it accounts for 4-11% of adults hospitalized with respiratory tract infections, with 6-15% of those requiring intensive care 7
• Do not confuse RSV with other respiratory infections - clinical presentation alone cannot reliably distinguish RSV from other viral infections 7