What high-risk conditions qualify an adult 50-74 for Respiratory Syncytial Virus (RSV) vaccination?

High-Risk Conditions Qualifying Adults 50-74 for RSV Vaccination

Adults aged 50-74 years qualify for RSV vaccination if they have chronic medical conditions, moderate/severe immunocompromise, nursing home residence, severe obesity, or other conditions that increase risk for severe respiratory viral disease, with patient attestation being sufficient evidence without requiring medical documentation. 1

Age-Specific Qualification Framework

Ages 60-74 Years

The 2024 ACIP guidelines establish clear risk-based criteria for this age group 1:

Cardiovascular Conditions:

• Chronic heart failure 1
• Coronary artery disease 1
• Congenital heart disease (excluding isolated hypertension) 1

Pulmonary Conditions:

• Chronic obstructive pulmonary disease (COPD) 1
• Asthma 1
• Emphysema 1
• Interstitial lung disease 1
• Cystic fibrosis 1

Renal Disease:

• End-stage renal disease 1
• Dependence on hemodialysis or other renal replacement therapy 1

Diabetes Mellitus (Complicated):

• Diabetes with chronic kidney disease, neuropathy, retinopathy, or other end-organ damage 1
• Diabetes requiring insulin treatment 1
• Diabetes requiring sodium-glucose cotransporter-2 (SGLT2) inhibitor 1

Neurologic/Neuromuscular Conditions:

• Conditions causing impaired airway clearance 1
• Conditions causing respiratory muscle weakness 1
• Poststroke dysphagia 1
• Amyotrophic lateral sclerosis 1
• Muscular dystrophy 1
• Note: History of stroke WITHOUT impaired airway clearance does NOT qualify 1

Other Chronic Conditions:

• Chronic liver disease (e.g., cirrhosis) 1
• Chronic hematologic conditions (e.g., sickle cell disease, thalassemia) 1
• Severe obesity (BMI ≥40 kg/m²) 1

Immunocompromise:

• Moderate or severe immune compromise 1
• This includes solid organ transplant recipients, hematopoietic stem cell transplant recipients, patients with malignancies, and those on immunosuppressive medications 2

Living Situation:

• Residence in a nursing home 1

Provider-Determined Risk:

• Frailty (defined by Fried criteria: ≥3 of unintentional 10-lb weight loss, exhaustion, weakness, slow walking, low activity) 1
• Concern for undiagnosed chronic conditions 1
• Residence in remote/rural communities where transport for escalation of care is challenging 1

Ages 50-59 Years

Only RSVPreF3 (Arexvy) is FDA-approved for adults aged 50-59 years with risk factors 2. The same risk conditions listed above apply to this age group when using this specific vaccine 2.

Critical Implementation Points

Documentation Requirements:

• Patient attestation alone is sufficient evidence of a risk factor 1
• Vaccinators should NOT deny vaccination due to lack of medical documentation 1
• Qualified vaccinators (pharmacists, nurse practitioners, other providers per state law) may determine eligibility based on clinical assessment 1

Common Pitfall to Avoid: The most important caveat is that isolated hypertension does NOT qualify as a cardiovascular risk factor 1. Similarly, a history of stroke without ongoing impaired airway clearance does NOT qualify 1.

Clinical Flexibility: ACIP explicitly states that research on RSV risk factors is ongoing, so providers should maintain flexibility in offering RSV vaccine to patients assessed to be at increased risk even if they don't fall into an explicitly named category 1. This is particularly relevant for adults in remote communities or those with multiple borderline conditions 1.

Vaccine Options: All three FDA-approved RSV vaccines (Arexvy [GSK], Abrysvo [Pfizer], mResvia [Moderna]) are acceptable for adults aged 60-74 years with risk factors 1. For ages 50-59, only Arexvy is approved 2.