From the Guidelines
Adults aged 65 and older are recommended to receive a single dose of an RSV vaccine to protect against respiratory syncytial virus infection, particularly if they have underlying health conditions such as chronic heart or lung disease, weakened immune systems, or diabetes. The Advisory Committee on Immunization Practices (ACIP) recommends a single dose of any FDA-approved RSV vaccine for all adults aged ≥75 years and for adults aged 60–74 years who are at increased risk for severe RSV disease 1. The vaccines are typically administered as a one-time injection, ideally before the RSV season begins (usually fall through spring in most regions) 1. No booster doses are currently recommended 1. The vaccines work by stimulating the immune system to produce antibodies against the RSV F protein, which the virus uses to enter cells. Side effects are generally mild and may include injection site pain, fatigue, muscle pain, headache, and joint pain lasting 1-3 days 1. These vaccines significantly reduce the risk of RSV-related lower respiratory tract disease and have shown effectiveness rates of approximately 70-80% in clinical trials 1. Some key factors that increase the risk of severe RSV disease in adults aged 60–74 years include:
- Chronic cardiovascular disease
- Chronic lung or respiratory disease
- End-stage renal disease or dependence on hemodialysis or other renal replacement therapy
- Diabetes mellitus complicated by chronic kidney disease, neuropathy, retinopathy, or other end-organ damage
- Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness
- Chronic liver disease
- Chronic hematologic conditions
- Severe obesity
- Moderate or severe immune compromise
- Residence in a nursing home 1. Individuals should consult their healthcare provider about specific timing and which vaccine is most appropriate for their health situation.
From the Research
RSV Vaccine Recommendations for Adults Over 65 Years Old
- The Advisory Committee on Immunization Practices (ACIP) recommends that adults aged 60 years and older may receive a single dose of an RSV vaccine, using shared clinical decision-making 2.
- In Germany, RSV vaccination is currently recommended for all individuals aged 75 years and older, as well as people aged 60-74 years of age with severe underlying conditions 3.
- Two RSV vaccines, Arexvy and Abrysvo, have been approved for preventing RSV-associated lower respiratory tract disease in adults aged 60 years or older in the United States 4.
- These vaccines have demonstrated moderate to high efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults 2, 5, 4.
- The efficacy of prefusion anti-RSV vaccines in preventing LRTI/LRTD and ARI/ARD cases has been reported, with a vaccine efficacy of 73% for prefusion vaccines alone 5.
- The most common adverse effects of these vaccines include injection site reactions, such as site pain, redness, and swelling 4.
Vaccine Administration and Safety
- Administration of the RSV vaccines requires a single intramuscular injection of 0.5 mL, reconstituted prior to administration 4.
- The vaccines have been shown to be safe and effective in preventing RSV-associated lower respiratory tract disease in adults aged 60 years and older 2, 5, 4.
- Postmarketing surveillance will direct future guidance on the use of RSV vaccines in adults aged 60 years and older 2.
Target Population and Disease Burden
- RSV is a common cause of respiratory tract infections, posing a risk of severe disease, particularly for older individuals with pre-existing conditions 3, 6.
- Community-based studies estimate the yearly incidence of RSV infection at around 3-7% in adults aged 60 years and older in high-income countries 6.
- RSV accounts for a similar disease burden as influenza in adults, but those hospitalized with severe RSV disease are typically older and have more comorbidities 6.