CIDRAP RSV Vaccination Recommendations
I was unable to locate specific RSV vaccination recommendations from CIDRAP (Center for Infectious Disease Research and Policy) in the provided evidence. The evidence contains guidelines from multiple other authoritative organizations including the CDC, Portuguese medical societies, and various international health agencies, but no CIDRAP-specific guidance is present.
Current Evidence-Based RSV Vaccination Recommendations
Since CIDRAP recommendations are not available in the evidence provided, I will present the most recent and authoritative guidance from available sources:
Primary Age-Based Recommendations
All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities 1, 2. This represents the strongest recommendation based on the highest risk profile in this age group, with significantly elevated rates of hospitalization, severe disease, and mortality 3, 4.
For adults aged 60-74 years, RSV vaccination is recommended only if they have specific risk factors for severe disease 1, 2. This risk-based approach was updated by the CDC's Advisory Committee on Immunization Practices (ACIP) in June 2024, moving away from the previous shared clinical decision-making model 2.
High-Risk Medical Conditions (Ages 60-74)
Adults in this age range should receive RSV vaccination if they have any of the following conditions:
Respiratory conditions:
- Chronic obstructive pulmonary disease (COPD) 3, 1
- Asthma 3, 1
- Bronchiectasis 5
- Interstitial lung disease 5
- Chronic respiratory failure 5
Cardiovascular conditions:
Metabolic and renal conditions:
- Diabetes mellitus, particularly with complications 3, 1
- Chronic kidney disease, especially end-stage renal disease 3, 5
Other conditions:
- Chronic liver disease 3, 5
- Severe obesity (BMI ≥40 kg/m²) 5, 2
- Chronic neurological or neuromuscular diseases 3, 5
- Immunocompromise (solid organ transplant, hematologic malignancy, immunosuppressive medications) 3, 5
Living situation factors:
Special Population: Adults Aged 50-59 Years
For adults aged 50-59 years with risk factors for severe RSV disease, RSVPreF3 (Arexvy) is the only vaccine currently approved 3, 1, 5. This represents a narrower indication than for older adults.
Dosing and Administration
A single lifetime dose is currently recommended 1, 5, 2. Adults who have previously received any RSV vaccine should not receive another dose at this time 5.
The vaccine should preferably be administered between September and November, before or early in the RSV season, to maximize protection 3, 1. However, eligible adults who have not been vaccinated can receive the vaccine at any time of year 5.
RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 3, 1, 2. This is an important practical consideration for fall vaccination campaigns.
Duration of Protection
Current evidence demonstrates protection lasting through at least two RSV seasons with a single dose 5. Real-world effectiveness data shows:
- Overall vaccine effectiveness against RSV-associated hospitalization: 58% across two seasons 6
- Same-season vaccination: 69% effectiveness 6
- Prior-season vaccination: 48% effectiveness (P = 0.06 compared to same-season) 6
Important Clinical Caveats
Patient attestation is sufficient evidence of risk factors—extensive medical documentation should not be required 1, 2. This practical approach facilitates vaccination access.
Immunocompromised patients show lower vaccine effectiveness (30% vs. 67% in immunocompetent adults, P = 0.02) 6. Similarly, patients with cardiovascular disease demonstrate reduced effectiveness (56% vs. 80% without cardiovascular disease, P = 0.03) 6. Despite lower effectiveness, vaccination is still recommended for these high-risk groups given their elevated risk of severe outcomes.
Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination 1, 5.
Prioritization if Vaccine Supply is Limited
If resources are constrained, prioritize:
- Adults aged ≥75 years 3, 1
- Adults with multiple comorbidities 1
- Residents of long-term care facilities 5
Safety Considerations
Postlicensure surveillance has identified a potential increased risk for Guillain-Barré syndrome (GBS) after protein subunit RSV vaccination, which informed the ACIP's risk-based recommendation for adults aged 60-74 years 2. Common adverse effects include injection-site pain, myalgia, fatigue, and headaches 7.
Clinical Context
RSV accounts for 10.6% of hospitalizations for pneumonia and 11.4% for COPD exacerbations in older adults 1, 5. Among hospitalized adults aged ≥60 years, severe outcomes occur in 18.5%, with 17.0% requiring ICU admission, 4.8% requiring mechanical ventilation, and 4.7% mortality 4. The burden has been historically underrecognized compared to influenza, though RSV-hospitalized patients tend to be older with more comorbidities 8.