Is the Respiratory Syncytial Virus (RSV) vaccine indicated in a 55-year-old male with Diabetes Mellitus (DM)?

RSV Vaccination in a 55-Year-Old Male with Diabetes

Yes, the RSV vaccine is indicated for this 55-year-old male with diabetes, specifically RSVPreF3 (Arexvy), which is the only RSV vaccine currently approved for adults aged 50-59 years with risk factors for severe RSV disease. 1, 2

Rationale for Vaccination

Age and Risk Factor Criteria

• Diabetes mellitus is explicitly listed as a risk factor for severe RSV disease in adults aged 50-59 years, making this patient eligible for vaccination 1
• Multiple international medical societies, including the Portuguese Society of Endocrinology, Diabetes and Metabolism, specifically recommend RSV vaccination for people aged ≥50 years with diabetes 1
• Diabetes increases the risk of RSV-associated hospitalization and severe outcomes, placing this patient in a high-risk category 1, 2, 3

Vaccine Selection

• RSVPreF3 (Arexvy) is the only vaccine approved for adults aged 50-59 years at increased risk of RSV disease 1, 2
• The other available vaccines (RSVpreF/Abrysvo and mRNA-1345/mRESVIA) are only approved for adults aged ≥60 years 1, 4
• RSVPreF3 demonstrated immunological non-inferiority in adults aged 50-59 years compared with those aged ≥60 years, with a consistent safety profile 1

Administration Guidelines

Dosing

• A single lifetime dose is recommended - no revaccination is needed 2, 5, 3
• Patient attestation of diabetes is sufficient evidence; extensive medical documentation should not be required 2, 5

Timing

• The vaccine should preferably be administered between September and November, before or early in the RSV season 1, 2
• However, it can be given at any time of year if needed 1, 2

Co-administration

• The RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 1, 2
• Data on co-administration with other vaccines (pneumococcal, herpes zoster, COVID-19) are currently lacking 1

Clinical Context and Disease Burden

Why Diabetes Matters

• Adults with chronic medical conditions like diabetes have significantly elevated rates of RSV-associated hospitalization, severe disease, and mortality 2, 3
• RSV accounts for 10.6% of hospitalizations for pneumonia in adults and causes substantial morbidity 3, 6
• The disease burden in adults with comorbidities has been historically underrecognized compared to influenza 3, 6

Expected Outcomes

• RSV vaccines have demonstrated efficacy in reducing RSV-associated lower respiratory tract disease in clinical trials 4, 7
• Protection lasts at least two consecutive RSV seasons 3
• The vaccines are safe and effective, with common adverse effects limited to injection-site pain, myalgia, fatigue, and headaches 4

Common Pitfalls to Avoid

• Do not wait until age 60 - this patient qualifies now based on age 50-59 years plus diabetes as a risk factor 1, 2
• Do not require extensive medical documentation - patient attestation of diabetes is sufficient 2, 5
• Do not administer multiple doses - only a single lifetime dose is recommended 2, 5, 3
• Do not use RSVpreF (Abrysvo) or mRNA-1345 (mRESVIA) in this age group - only RSVPreF3 is approved for ages 50-59 years 1, 2