RSV Vaccination Age Recommendations
RSV vaccination is recommended for all adults aged ≥75 years and for adults aged 60-74 years who are at increased risk for severe RSV disease. 1, 2
Age-Based Recommendations
- All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of health status 1, 2
- Adults aged 60-74 years with risk factors for severe RSV disease should receive a single dose of RSV vaccine 1
- In some countries like Ireland, RSV vaccination is recommended for all adults aged ≥65 years 1, 2
- For adults aged 50-59 years with risk factors, RSVPreF3 (Arexvy) is the only approved vaccine 1
Risk Factors for Adults Aged 60-74 Years
Adults aged 60-74 years with any of the following conditions should receive RSV vaccination:
- Chronic respiratory conditions (COPD, asthma, bronchiectasis, interstitial lung disease) 1, 3
- Chronic cardiovascular disease (heart failure, coronary artery disease) 1, 3
- Chronic kidney disease, especially end-stage renal disease 1, 3
- Diabetes, particularly with complications 1, 3
- Chronic liver disease 1, 3
- Chronic neurological or neuromuscular conditions 1, 3
- Severe obesity (BMI ≥40 kg/m²) 1, 3
- Moderate or severe immunocompromise 1, 3
- Residence in a nursing home or long-term care facility 1
- Frailty or dementia 1, 3
Pediatric RSV Protection
It's important to note that the adult RSV vaccines are distinct from pediatric RSV protection:
- Palivizumab (Synagis) is indicated for prevention of serious lower respiratory tract disease caused by RSV in specific pediatric patients, including premature infants ≤35 weeks gestational age who are ≤6 months old at the beginning of RSV season 4
- Nirsevimab (Beyfortus) is recommended for all infants <8 months of age and for children 8-19 months who are at increased risk for severe RSV disease 5
- For pregnant women, Abrysvo (RSVpreF) is approved for use between 32-36 weeks of gestation to protect newborns through passive immunity 6, 7
Administration Guidelines
- Only a single lifetime dose of RSV vaccine is recommended for adults 1, 2
- Adults who have previously received any RSV vaccine should not receive another dose 1
- RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 1, 2
- Vaccination is preferably administered between September and November, before or early in the RSV season 1, 2
Clinical Considerations
- Patient attestation is sufficient evidence of the presence of a risk factor; extensive medical documentation should not be required 1, 2
- If vaccine supply is limited, priority should be given to those of more advanced age, those with multiple comorbidities, and residents of long-term care facilities 1, 3
- Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination 3
Available Vaccines for Adults
- Three RSV vaccines are currently approved for adults aged ≥60 years: Arexvy (GSK), Abrysvo (Pfizer), and mResvia (Moderna) 8, 9
- ACIP does not express preference for any particular RSV vaccine 8
- Arexvy is the only vaccine approved for adults aged 50-59 years with risk factors 1
Pitfalls to Avoid
- Do not administer multiple doses of RSV vaccine - only a single lifetime dose is 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 confuse adult RSV vaccination recommendations with those for infants or pregnant women, which have different products and schedules 4, 6