Who are considered high-risk patients for receiving the Respiratory Syncytial Virus (RSV) vaccine?

High-Risk Patients for RSV Vaccination

Adults aged ≥75 years and adults aged 60-74 years with specific risk factors are considered high-risk patients who should receive the RSV vaccine to prevent severe disease, hospitalization, and death. 1

High-Risk Categories Based on Age

• All adults aged ≥75 years should receive RSV vaccination due to significantly higher risk of severe outcomes, regardless of comorbidities 1, 2
• Adults aged 60-74 years with specific risk factors (detailed below) 1, 3
• Some countries recommend vaccination for all adults ≥65 years (Ireland) or ≥60 years (Spain, Austria) 1

High-Risk Medical Conditions (ages 60-74)

Respiratory Conditions

• Chronic obstructive pulmonary disease (COPD) 1, 2
• Asthma 1
• Bronchiectasis 1
• Interstitial lung disease 1
• Chronic respiratory failure 1

Cardiovascular Conditions

• Chronic heart failure 1, 4
• Other chronic cardiovascular diseases 1
• Note: Patients with cardiovascular disease may have lower vaccine effectiveness (56%) compared to those without (80%) 4

Other Chronic Conditions

• Chronic kidney disease, especially end-stage renal disease 1
• Diabetes, particularly with complications 1
• Chronic liver disease 1
• Chronic neurological or neuromuscular diseases 1
• Severe obesity 1

Immunocompromised Status

• Solid organ transplant recipients 1
• Hematopoietic stem cell transplant recipients 1
• Patients with solid tumors or hematological malignancies 1
• Patients on immunosuppressive medications 1
• HIV-positive individuals 1
• Note: Vaccine effectiveness may be lower (30%) in immunocompromised adults compared to immunocompetent adults (67%) 4

Living Situation

• Residents of nursing homes or long-term care facilities 1, 2
• Institutionalized individuals 1

Clinical Considerations

• RSV infection in high-risk adults can lead to severe outcomes with 15% requiring intensive care and 8% mortality, similar to influenza despite high influenza vaccination rates 5
• Among hospitalized RSV patients ≥60 years, 17% require ICU admission, 4.8% need mechanical ventilation, and 4.7% die 2
• Immunosenescence (age-related immune decline) is a recognized risk factor for severe RSV disease, with comorbidities further increasing susceptibility 1
• The burden of RSV in older adults has been underrecognized; it accounts for 10.6% of hospitalizations for pneumonia and 11.4% for COPD exacerbations 1, 6

Vaccination Approach

• A single intramuscular dose is recommended, preferably administered before or early in the RSV season (September-November) 3
• Vaccination can be co-administered with seasonal influenza vaccine at different injection sites 3
• If vaccine supply is limited, prioritize adults ≥75 years, those with multiple comorbidities, and residents of long-term care facilities 1, 3, 7
• Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination 3, 6

Pitfalls to Avoid

• Do not assume RSV is only serious in children; it poses major health risks to older adults 6
• Do not overlook RSV as a cause of exacerbation in patients with chronic conditions like COPD or heart failure 1, 6
• Avoid delaying vaccination until symptoms appear, as there are limited effective treatments once infected 6
• Do not assume vaccine effectiveness is equal across all high-risk groups; it may be lower in immunocompromised patients and those with cardiovascular disease 4