Is the Respiratory Syncytial Virus (RSV) vaccine recommended for a 62-year-old female?

RSV Vaccination Recommendations for a 62-Year-Old Female

For a 62-year-old female, RSV vaccination is recommended only if she has specific risk factors for severe RSV disease, as the benefits of vaccination do not clearly outweigh potential risks in adults aged 60-74 years without risk factors. 1

Current Recommendations

• All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities 1, 2
• Adults aged 60-74 years (including a 62-year-old female) should receive RSV vaccination only if they have risk factors for severe RSV disease 1
• The Advisory Committee on Immunization Practices (ACIP) updated these recommendations in June 2024, changing from the previous shared clinical decision-making approach 1

Risk Factors That Would Qualify a 62-Year-Old Female for RSV Vaccination

A 62-year-old female should receive RSV vaccination if she has any of these conditions:

• Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, congenital heart disease) 1, 2
• Chronic lung or respiratory disease (e.g., COPD, emphysema, asthma, interstitial lung disease) 1, 3
• End-stage renal disease or dependence on dialysis 1, 2
• Diabetes mellitus with complications (chronic kidney disease, neuropathy, retinopathy) or requiring insulin or SGLT2 inhibitors 1, 4
• Neurologic/neuromuscular conditions affecting airway clearance 1, 2
• Chronic liver disease (e.g., cirrhosis) 1, 2
• Chronic hematologic conditions (e.g., sickle cell disease, thalassemia) 1, 2
• Severe obesity (BMI ≥40 kg/m²) 1, 2
• Moderate or severe immune compromise 1, 2
• Residence in a nursing home 1, 2
• Frailty or other conditions that a healthcare provider determines increase risk for severe viral respiratory infection 1

Rationale for Current Recommendations

• Postlicensure safety surveillance suggests a potential increased risk for Guillain-Barré syndrome (GBS) after protein subunit RSV vaccination 1
• Based on available evidence, ACIP concluded that benefits of RSV vaccination do not clearly outweigh potential harms in adults aged 60-74 years without risk factors 1
• RSV causes substantial morbidity and mortality in older adults, with severe outcomes occurring in 18.5% of hospitalized patients aged ≥60 years 5
• RSV accounts for 4-11% of adults hospitalized with respiratory tract infections, with 6-15% admitted to intensive care 6

Vaccine Administration Guidelines

• Only a single lifetime dose of RSV vaccine is recommended 1, 2
• Vaccination is preferably administered between September and November, before or early in the RSV season 1, 4
• RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 3, 2
• Patient attestation is sufficient evidence of risk factors; extensive medical documentation is not required 1, 2

Available RSV Vaccines

• Three RSV vaccines are currently approved: Arexvy (RSVPreF3), Abrysvo (RSVpreF), and mRESVIA (mRNA-1345) 4, 7
• For adults aged 50-59 years with risk factors, only RSVPreF3 (Arexvy) is approved 3, 2

Important Considerations

• The risk-based recommendation for adults aged 60-74 years might result in lower vaccination coverage among at-risk individuals compared to an age-based recommendation 1
• Healthcare providers have flexibility to offer RSV vaccine to patients they assess to be at increased risk for severe disease even if they don't fall into an explicitly named risk category 1
• Patients should be informed about benefits and risks of RSV vaccination, including the potential risk for GBS with protein subunit vaccines 1