Which RSV (Respiratory Syncytial Virus) vaccine to prescribe?

RSV Vaccine Recommendations

For adults aged ≥60 years and those aged 50-59 years with risk factors, RSV vaccination is recommended, while for infants, either maternal RSVpreF vaccination during pregnancy or nirsevimab is recommended, but both are not typically needed. 1

Adult RSV Vaccination

Who Should Receive RSV Vaccination

• Adults aged ≥60 years should receive RSV vaccination 1
• Adults aged 50-59 years with risk factors should also receive RSV vaccination, with RSVPreF3 being the only approved vaccine for this age group 1
• Risk factors that warrant vaccination in adults aged 50-59 years include:
  • Chronic respiratory conditions (COPD, asthma, bronchiectasis, interstitial lung disease) 1
  • Cardiovascular disease (heart failure, coronary artery disease) 1
  • Diabetes 1
  • Chronic kidney or liver disease 1
  • Immunocompromised status 1
  • Frailty, dementia, or residence in nursing homes 1

Timing of Vaccination

• RSV vaccination for adults should preferably be administered between September and November, though it can be given at any time 1
• The vaccine can be co-administered with seasonal influenza vaccines at different injection sites 1

Vaccine Effectiveness

• In adults aged ≥60 years, RSVPreF3 has demonstrated maintained efficacy for at least three seasons 1
• RSVpreF has shown maintained efficacy for at least two seasons in this population 1
• The effectiveness of RSV vaccines in patients with cancer is currently unknown 1

Pediatric RSV Protection

Options for Infants

• For infants, two main options exist for RSV protection 1:
  1. Maternal RSVpreF vaccination during pregnancy
  2. Nirsevimab (monoclonal antibody) administration to the infant

Maternal RSVpreF Vaccination

• Recommended as a one-time dose during 32-36 completed weeks' gestation 1
• Should be administered seasonally (September through January in most of the continental US) 1
• Protects infants from birth through 6 months of age 1

Nirsevimab for Infants

• Recommended for infants aged <8 months who are born during or entering their first RSV season 1
• Specifically indicated for infants whose mothers did not receive RSVpreF vaccine, whose mother's vaccination status is unknown, or who were born <14 days after maternal vaccination 1
• Also recommended for all infants born at <34 weeks' gestation regardless of maternal vaccination status 1
• Approved for infants <24 months of age to prevent RSV infection 1

Special Considerations

When Both Products May Be Needed

• Nirsevimab may be considered in addition to maternal vaccination in rare circumstances when incremental benefit is warranted 1:
  • Infants born to mothers who might not have mounted adequate immune response to vaccination (e.g., immunocompromised mothers) 1
  • Infants who might have experienced loss of maternal antibodies (e.g., those who underwent cardiopulmonary bypass) 1
  • Infants with substantially increased risk for severe RSV disease 1

Older Palivizumab Recommendations

• Historically, palivizumab was used for RSV prophylaxis in high-risk infants 2, 3
• It reduced RSV-associated hospitalizations by 45-55% in clinical trials 2, 4
• Current guidelines have shifted toward newer options (nirsevimab and maternal vaccination) 1

Practical Guidance

• When administering multiple vaccines concurrently, use different injection sites 1
• For adults receiving RSV and influenza vaccines together, no clinically significant interference has been established, though some studies show numerically lower antibody titers 1
• Data on co-administration with vaccines other than influenza (e.g., COVID-19, pneumococcal, herpes zoster) are currently lacking 1
• For cancer patients, the effectiveness of RSV vaccines is unknown, and consultation with infectious disease specialists may be warranted 1