What are the guidelines for RSV (Respiratory Syncytial Virus) vaccination in the Philippines, according to Clinical Practice Guidelines (CPG)?

RSV Vaccine Guidelines for the Philippines

I was unable to locate specific Clinical Practice Guidelines from Philippine medical societies regarding RSV vaccination. However, I can provide evidence-based recommendations from international guidelines that can inform clinical practice in the Philippines until local guidelines are established.

Primary Vaccination Recommendations

All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities, due to significantly elevated rates of hospitalization, severe disease, and mortality. 1, 2

Age-Based Recommendations

• Adults aged 60-74 years should receive RSV vaccination if they have risk factors for severe RSV disease, as the benefits clearly outweigh potential harms in this population 1, 2

• Adults aged 50-59 years with risk factors should receive RSVPreF3 (Arexvy), which is the only vaccine currently approved for this age group 1, 2

• All adults aged ≥60 years without specific risk factors may also be considered for vaccination, though priority should be given to those with comorbidities 3

Risk Factors for Severe RSV Disease

Respiratory Conditions

• Chronic obstructive pulmonary disease (COPD) 3, 1
• Asthma 3, 1

Cardiovascular Conditions

• Heart failure 3, 1
• Coronary artery disease 3, 1

Metabolic and Renal Conditions

• Diabetes mellitus 3, 1
• Chronic kidney disease 3, 1

Other High-Risk Conditions

• Chronic liver disease 3, 2
• Immunocompromise 3, 2
• Frailty 3, 2
• Dementia 3
• Residence in a nursing home or chronic care facility 3, 4
• Severe obesity (BMI ≥40 kg/m²) 2
• Neurologic/neuromuscular conditions affecting airway clearance 2

Available RSV Vaccines

Three RSV vaccines are currently approved for older adults 2, 5:

• Arexvy (RSVPreF3) - Recombinant RSV pre-fusion F protein adjuvanted with AS01E, approved for adults ≥50 years 2, 5
• Abrysvo (RSVpreF) - Recombinant bivalent RSV-A and RSV-B pre-fusion F protein, approved for adults ≥60 years 2, 5
• mRESVIA (mRNA-1345) - mRNA vaccine, approved for adults ≥60 years 2, 5

All three vaccines demonstrate over 80% efficacy in preventing symptomatic RSV infections and associated lower respiratory tract disease in older adults 5, 6

Administration Guidelines

A single lifetime dose of RSV vaccine is currently recommended - no booster doses are indicated at this time 1, 2

Optimal Timing

• The vaccine should preferably be administered between September and November, before or early in the RSV season, to maximize protection 3, 1, 2
• In tropical climates like the Philippines, RSV seasonality may differ from temperate regions, so local epidemiological data should guide timing if available 3

Co-Administration

• RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 3, 1, 2

Prioritization Strategy if Vaccine Supply is Limited

If resources are constrained in the Philippines, the following prioritization is recommended:

1. Adults aged ≥75 years (highest priority) 3, 1
2. Adults aged ≥50 years with multiple risk factors 3
3. Residents of nursing homes and chronic care facilities aged ≥60 years 4

Important Clinical Considerations

Documentation Requirements

• Patient attestation is sufficient evidence of risk factors - extensive medical documentation should not be required to avoid barriers to vaccination 1, 2

Previous RSV Infection

• Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination, as the immune response to natural infection is short-lived 1

Safety Concerns

• Postlicensure surveillance suggests a potential increased risk for Guillain-Barré syndrome (GBS) after protein subunit RSV vaccination (Arexvy and Abrysvo), which informed updated recommendations 2
• Patients should be informed about benefits and risks, including the potential GBS risk with protein subunit vaccines 2
• The vaccines were well-tolerated in clinical studies with an acceptable safety profile among older adults 4, 5

Special Populations

Inflammatory Bowel Disease (IBD)

• All adult patients with IBD aged ≥60 years should receive RSV vaccine, as they have 30% higher risk of hospitalization due to RSV compared with non-IBD controls 3
• There is no preference for any specific RSV vaccine in this population 3

Immunocompromised Patients

• Adults with moderate or severe immune compromise should receive RSV vaccination 2
• Further evaluation in immunocompromised patients is ongoing, as they were underrepresented in pivotal clinical trials 5

Common Pitfalls to Avoid

• Do not delay vaccination waiting for "perfect" timing - the vaccine can be administered at any time of year, though September-November is preferred 3, 1
• Do not require extensive medical record review to document risk factors - patient self-report is sufficient 1, 2
• Do not withhold vaccination from adults 60-74 years without documented risk factors if clinical judgment suggests increased risk for severe disease 2
• Do not assume natural RSV infection provides lasting protection - vaccination is still indicated 1