What is the recommended dosage and administration schedule for the Arexvy (respiratory syncytial virus vaccine) vaccine in adults?

Arexvy Dosage and Administration

Arexvy is administered as a single 0.5 mL intramuscular injection, and only one lifetime dose is currently recommended—adults who have already received any RSV vaccine should not receive another dose. 1, 2

Dosing Schedule

• Single lifetime dose: Administer one 0.5 mL intramuscular injection 1, 2
• No booster doses: Adults previously vaccinated with any RSV vaccine (Arexvy, Abrysvo, or mResvia) should not receive additional doses 1, 2
• Duration of protection: Current evidence demonstrates protection lasting through at least two consecutive RSV seasons 2

Optimal Timing for Administration

• Preferred timing: Administer between September and November (late summer to early fall), just before RSV season begins to maximize protection during peak transmission months 2, 3
• Flexible administration: Eligible adults who have not been previously vaccinated may receive the vaccine at any time of year 2

Who Should Receive Arexvy

Adults ≥75 Years

• Universal recommendation: All adults aged ≥75 years should receive RSV vaccination, regardless of comorbidities or health status 1, 2

Adults 60-74 Years with Risk Factors

• Chronic obstructive pulmonary disease (COPD), asthma, or other chronic respiratory conditions 2, 3
• Chronic heart failure, coronary artery disease, or congenital heart disease (excluding isolated hypertension) 3
• Chronic kidney disease, especially end-stage renal disease or hemodialysis dependence 2, 3
• Diabetes with complications (chronic kidney disease, neuropathy, retinopathy, or other end-organ damage) 3
• Chronic liver disease 2, 3
• Neurologic/neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness 2, 3
• Severe obesity (BMI ≥40 kg/m²) 2, 3
• Moderate or severe immunocompromise (solid organ transplant, hematopoietic stem cell transplant, malignancies, immunosuppressive medications, asplenia) 2, 4
• Nursing home or long-term care facility residents 1, 2

Adults 50-59 Years with Risk Factors

• Arexvy is the only RSV vaccine approved for adults aged 50-59 years with risk factors for severe RSV disease 2, 3
• Same risk factor criteria apply as for the 60-74 year age group 2, 3

Administration Technique

• Route: Intramuscular injection 1
• Volume: 0.5 mL per dose 1
• Co-administration: Can be given simultaneously with seasonal influenza vaccine at different injection sites 2, 3

Critical Implementation Points

• Patient attestation is sufficient: Vaccination should not be denied due to lack of formal medical documentation—patient self-report of risk factors is adequate evidence 2, 3
• Qualified vaccinators: Pharmacists, nurse practitioners, and other providers (based on state law) may determine eligibility based on clinical assessment 1
• Do not delay for documentation: Adults ≥75 years should not have vaccination delayed while waiting for documentation, as age alone is sufficient indication 2

Priority if Supply is Limited

If vaccine availability is constrained, prioritize in this order: 2, 4

1. Adults aged ≥75 years
2. Adults aged 60-74 years with multiple comorbidities
3. Residents of long-term care facilities
4. Adults aged 50-59 years with multiple comorbidities

Common Pitfalls to Avoid

• Do not revaccinate: The single-dose recommendation applies even if the patient received a different RSV vaccine brand previously 1, 2
• Do not withhold based on isolated hypertension: Hypertension alone without other cardiovascular disease does not qualify as a risk factor 3
• Do not require extensive documentation: Patient attestation alone is sufficient—do not create barriers by demanding medical records 2, 3
• Previous RSV infection does not contraindicate vaccination: Natural infection does not confer long-lasting immunity, and vaccination is still indicated 2