RSV Vaccination Dosing for Adults
Adults should receive only a single lifetime dose of RSV vaccine—no additional doses are recommended or needed. 1
Single-Dose Recommendation
One dose provides protection for at least two consecutive RSV seasons, eliminating the need for annual revaccination like influenza vaccines. 1, 2
Adults who have already received any RSV vaccine should not receive another dose, regardless of which vaccine product they received (Arexvy, Abrysvo, or mRESVIA). 1, 3
This single-dose recommendation applies uniformly to all three FDA-approved RSV vaccines and to all eligible age groups (adults ≥75 years and adults 60-74 years with risk factors). 2
Who Should Receive This Single Dose
All adults aged ≥75 years should receive one dose, regardless of health status or comorbidities. 1, 2, 3
Adults aged 60-74 years with increased risk factors should receive one dose, including those with chronic lung disease, heart failure, diabetes, chronic kidney disease, immunocompromise, nursing home residence, or severe obesity. 1, 2, 3
Adults aged 50-59 years with risk factors may receive RSVPreF3 (Arexvy) only, as it is the only vaccine approved for this age group. 2, 4
Optimal Timing for the Single Dose
Vaccination should preferably occur in late summer or early fall (August-October), just before RSV season begins, to maximize protection. 1, 2
However, eligible adults who have not been vaccinated may receive the vaccine at any time of year. 1, 2
RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites. 2, 3
Duration of Protection and Future Revaccination
Current evidence demonstrates protection lasting through at least two RSV seasons from a single dose. 2
The Advisory Committee on Immunization Practices (ACIP) will evaluate the need for additional doses in the future as more data on duration of protection and immune response after revaccination become available. 1, 2
Recent real-world data from 2023-2025 showed vaccine effectiveness of 58% against RSV-associated hospitalization across two seasons, with same-season vaccination showing 69% effectiveness versus 48% for prior-season vaccination (though this difference was not statistically significant, P=0.06). 5
Critical Implementation Points
Do not administer multiple doses—this is the most important pitfall to avoid, as only a single lifetime dose is recommended. 2, 3
Patient attestation alone is sufficient evidence of risk factors for adults aged 60-74 years; extensive medical documentation should not be required. 2, 3
Adults aged ≥75 years should not be delayed vaccination while waiting for documentation of risk factors, as age alone is sufficient indication. 2