RSV Vaccine Age Recommendations
All adults aged ≥75 years should receive a single dose of RSV vaccine, and adults aged 60-74 years should receive it if they have any chronic medical conditions or risk factors for severe disease. 1
Age-Based Vaccination Guidelines
Adults ≥75 Years
- Universal vaccination is recommended for all adults aged 75 years and older, regardless of health status or comorbidities. 1, 2
- This age group has significantly elevated rates of RSV-associated hospitalization, severe disease, and mortality, making vaccination critical even without additional risk factors. 2
Adults Aged 60-74 Years
- Vaccination is recommended for those with any of the following risk factors: 1, 2
- Chronic respiratory conditions: COPD, asthma, bronchiectasis, interstitial lung disease, or chronic respiratory failure 1, 2
- Cardiovascular disease: chronic heart failure, coronary artery disease, or other chronic cardiovascular conditions 1, 2
- Metabolic conditions: diabetes mellitus (particularly with complications) 1, 2
- Chronic kidney disease, especially end-stage renal disease 1, 2
- Chronic liver disease (e.g., cirrhosis) 1, 2
- Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness 1, 2
- Severe obesity (BMI ≥40 kg/m²) 1, 2
- Moderate or severe immunocompromise (including solid organ transplant recipients, hematopoietic stem cell transplant recipients, patients with malignancies, or those on immunosuppressive medications) 1, 2
- Residence in a nursing home or long-term care facility 1, 2
- Frailty or dementia 2, 3
Adults Aged 50-59 Years
- RSVPreF3 (Arexvy) is the only vaccine currently approved for adults aged 50-59 years with risk factors for severe RSV disease. 2, 4
- The same risk factors listed above apply to this age group. 2
Dosing and Administration
Single Lifetime Dose
- Only one dose of RSV vaccine is recommended for a lifetime—adults who have already received any RSV vaccine should not receive another dose. 1, 2, 3
- A single dose provides protection for at least two consecutive RSV seasons. 1, 2
- The need for additional doses will be evaluated by ACIP in the future as more data become available. 1
Optimal Timing
- Vaccination should preferably occur in late summer or early fall (August-October in most of the continental United States), just before RSV season begins. 1, 2
- However, eligible adults who have not been vaccinated may receive the vaccine at any time of year. 1, 2
- In most regions, RSV season runs from November through April. 1
Co-administration
- RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites during the same visit. 2, 3, 4
Important Clinical Considerations
Documentation Requirements
- Patient attestation alone is sufficient evidence of risk factors—do not deny vaccination due to lack of medical documentation. 1, 2, 3
- This is a critical point to avoid unnecessary barriers to vaccination. 2
Vaccine Supply Limitations
- If vaccine supply is limited, prioritize in this order: 2, 4
- Adults aged ≥75 years
- Adults aged 60-74 years with multiple comorbidities
- Residents of long-term care facilities
Common Pitfalls to Avoid
- Do not administer multiple doses—only a single lifetime dose is currently recommended. 2, 3
- Do not delay vaccination for adults ≥75 years while waiting for documentation of risk factors—age alone is sufficient indication. 3
- Do not withhold vaccination from adults aged 60-74 years who attest to having risk factors, even without formal medical records. 1, 2
Special Populations
- Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination. 2, 4
- Patients with inflammatory bowel disease aged ≥60 years should receive RSV vaccine due to their 30% higher risk of RSV-related hospitalization. 3
- Children undergoing cardiopulmonary bypass who are receiving palivizumab should receive an additional dose immediately after the procedure. 5