What are the indications for RSV (Respiratory Syncytial Virus) vaccine for high-risk patients?

RSV Vaccine Indications for High-Risk Patients

All adults aged ≥60 years should receive a single dose of RSV vaccine, with particularly strong indication for those ≥75 years and those with chronic medical conditions that increase risk of severe disease. 1

Age-Based Indications

Adults ≥75 Years

• Universal vaccination is recommended regardless of comorbidities, as this age group faces significantly higher risk of RSV-associated hospitalization and death 2
• This population accounts for a large proportion of all adult hospital admissions for RSV 1

Adults 60-74 Years

• Vaccination is indicated for those with any of the following risk factors 1, 2:
  • Chronic respiratory diseases (COPD, asthma, bronchiectasis, interstitial lung disease, chronic respiratory failure) 2
  • Chronic cardiovascular disease including heart failure 2
  • Chronic kidney disease, especially end-stage renal disease 2
  • Diabetes mellitus, particularly with complications 2
  • Chronic liver disease 2
  • Chronic neurological or neuromuscular diseases 2
  • Severe obesity (BMI ≥40 kg/m²) 2
  • Immunocompromised status 2
  • Residence in nursing homes or long-term care facilities 2
  • Frailty or dementia 2

Adults 50-59 Years

• Only RSVPreF3 (Arexvy) is approved for this age group 1, 2
• Vaccination is indicated specifically for those at increased risk for RSV disease with chronic conditions listed above 1

High-Risk Medical Conditions

Respiratory Diseases (Highest Priority)

• COPD patients aged ≥50 years should receive RSV vaccination, as they have the highest risk for hospitalization and severe outcomes, particularly those on systemic corticosteroids 3, 2
• Asthma, bronchiectasis, interstitial lung disease, and chronic respiratory failure all qualify as high-risk conditions 2

Immunocompromised Patients

• Solid organ transplant recipients 2
• Hematopoietic stem cell transplant recipients 2
• Patients with solid tumors or hematological malignancies 2
• Patients on immunosuppressive medications 2
• HIV-positive individuals 2

Cardiovascular and Metabolic Conditions

• Chronic heart failure and other chronic cardiovascular diseases 2
• Diabetes, particularly with complications 2
• Chronic kidney disease, with highest risk in end-stage renal disease 2

Available Vaccines and Administration

Two Vaccines Currently Available

• RSVPreF3 (Arexvy): Adjuvanted vaccine showing 82.6% efficacy against RSV-associated lower respiratory tract disease in first season and 94.1% efficacy against severe disease 1
• RSVpreF (Abrysvo): Non-adjuvanted bivalent vaccine showing 65.1-88.9% efficacy depending on symptom severity 1

Dosing Schedule

• Single lifetime dose only - no revaccination is currently recommended 2
• Administered as single intramuscular injection 1
• Optimal timing: September through November, before RSV season begins 3, 2
• Can be co-administered with influenza vaccine at different injection sites 2, 4

Special Populations

Pregnant Women

• RSVpreF (Abrysvo) is indicated for maternal immunization at 32-36 weeks of pregnancy to provide passive protection to infants through 6 months of age 1, 5

Infants and Children

• Nirsevimab (Beyfortus) is the monoclonal antibody indicated for neonates and infants entering their first RSV season 6
• Children up to 24 months who remain vulnerable through their second RSV season 6
• Palivizumab is indicated for high-risk pediatric patients including premature infants ≤35 weeks gestational age, those with bronchopulmonary dysplasia, or hemodynamically significant congenital heart disease 7

Priority Groups When Vaccine Supply is Limited

1. Adults aged ≥75 years 2, 4
2. Adults aged ≥60 years with multiple comorbidities 2, 4
3. Residents of long-term care facilities 2, 4

Important Clinical Considerations

Previous RSV Infection

• Prior RSV infection does NOT contraindicate vaccination, as natural infection does not confer long-lasting immunity and reinfection is common 4
• Protective antibodies wane rapidly after natural infection 4

Efficacy in High-Risk Populations

• Vaccine efficacy in patients with ≥1 pre-existing comorbidity: 94.6% in first season 1
• Protection is maintained for at least 2-3 seasons depending on vaccine type 4

Functional Impact

• RSV infection can cause significant functional decline in elderly patients, particularly those admitted from skilled nursing facilities who experience 66% decline in Activities of Daily Living scores 1
• This functional impact should be considered when assessing overall disease burden and vaccination benefits 1