RSV Vaccine Recommendations
All adults aged ≥75 years should receive a single lifetime dose of RSV vaccine, and adults aged 60-74 years should receive it if they have chronic medical conditions or risk factors for severe disease. 1, 2, 3
Age-Based Vaccination Criteria
Adults ≥75 Years
- Universal vaccination is recommended regardless of health status or comorbidities, due to significantly elevated rates of hospitalization, severe disease, and mortality in this age group 1, 2, 3
- This population should be prioritized if vaccine supply is limited 1, 2
Adults 60-74 Years
Adults in this age range should receive RSV vaccination if they have any of the following risk factors:
Respiratory conditions:
- Chronic obstructive pulmonary disease (COPD) 1, 2
- Asthma 1, 2
- Bronchiectasis 2
- Interstitial lung disease 2
- Chronic respiratory failure 2
Cardiovascular conditions:
Metabolic and organ dysfunction:
- Diabetes mellitus (particularly with complications) 1, 2
- Chronic kidney disease, especially end-stage renal disease 1, 2
- Chronic liver disease 1, 2
Neurological conditions:
Immunocompromised states:
- Solid organ transplant recipients 2
- Hematopoietic stem cell transplant recipients 2
- Solid tumors or hematological malignancies 2
- Patients on immunosuppressive medications 2
- HIV-positive individuals 2
Other risk factors:
- Severe obesity (BMI ≥40 kg/m²) 2
- Frailty 2
- Residence in nursing homes or long-term care facilities 1, 2
Adults 50-59 Years
- RSVPreF3 (Arexvy) is the only vaccine currently approved for adults aged 50-59 years with risk factors for severe RSV disease 1, 2
- The same risk factors listed above apply to this age group 1
Dosing and Administration
Single Lifetime Dose
- Only one dose of RSV vaccine is recommended for a lifetime 1, 2, 3
- Adults who have previously 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
Optimal Timing
- Vaccination should preferably occur between September and November, before or early in the RSV season, to maximize protection during peak transmission months 1, 2
- Eligible adults may be vaccinated at any time of year if they have not previously received RSV vaccination 1, 2
Co-administration
- RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites 1, 2, 3
- Some studies show numerically lower antibody titers for both RSV and influenza when co-administered, though clinical significance remains unknown 1
- Data on co-administration with COVID-19, pneumococcal, and herpes zoster vaccines are currently lacking 2
Clinical Implementation Considerations
Documentation Requirements
- Patient attestation alone is sufficient evidence of risk factors 1, 2, 3
- Extensive medical documentation should not be required and should not delay vaccination 1, 2, 3
- Adults aged ≥75 years should not be delayed vaccination while waiting for documentation, as age alone is sufficient indication 2
Important Clinical Context
- Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination, as reinfections are common due to short-lived immune responses 1, 2
- The burden of RSV in older adults has been underrecognized, accounting for 10.6% of hospitalizations for pneumonia and 11.4% for COPD exacerbations 1, 2
Common Pitfalls to Avoid
- Do not administer multiple doses - only a single lifetime dose is recommended 2, 3
- Do not delay vaccination for adults ≥75 years while waiting for medical documentation of risk factors, as age alone is sufficient 2, 3
- Do not withhold vaccination from adults aged 60-74 years who attest to having risk factors, even without formal medical records 2
- Do not require extensive documentation - patient attestation is sufficient 1, 2, 3