What is the current recommendation for RSV (Respiratory Syncytial Virus) vaccine use?

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 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, regardless of health status or comorbidities, due to significantly elevated rates of RSV-associated hospitalization, severe disease, and mortality in this population. 1, 2
• This recommendation applies to all three FDA-approved RSV vaccines: Arexvy (GSK), Abrysvo (Pfizer), or mResvia (Moderna). 1

Adults Aged 60-74 Years

• Adults in this age group should receive RSV vaccination only if they have increased risk factors for severe RSV disease. 1
• High-risk medical conditions include:
  • Chronic respiratory diseases: COPD, asthma, bronchiectasis, interstitial lung disease, chronic respiratory failure 2, 3
  • Cardiovascular diseases: chronic heart failure, coronary artery disease, other chronic cardiovascular conditions 2, 3
  • Metabolic conditions: diabetes (particularly with complications), severe obesity (BMI ≥40 kg/m²) 2
  • Organ dysfunction: chronic kidney disease (especially end-stage renal disease), chronic liver disease 2
  • Neurological conditions: chronic neurological or neuromuscular diseases, dementia 2
  • Immunocompromised status: solid organ or hematopoietic stem cell transplant recipients, patients with malignancies, those on immunosuppressive medications, HIV-positive individuals 2
  • Living situation: residents of nursing homes or long-term care facilities 1, 2

Adults Aged 50-59 Years

• RSVPreF3 (Arexvy) is the only vaccine approved for adults aged 50-59 years with risk factors for severe RSV disease. 2, 3

Dosing and Administration

Single Lifetime Dose

• Only one dose of RSV vaccine is recommended for a lifetime—adults who have previously received any RSV vaccine should not receive another dose. 1, 2
• Current evidence demonstrates protection lasting through at least two consecutive RSV seasons. 2
• The need for additional doses will be evaluated as more data on duration of protection become available. 2

Optimal Timing

• Vaccination should preferably occur between September and November (late summer or early fall), just before RSV season begins, to maximize protection during peak transmission months. 1, 2, 3
• Eligible adults who have not been vaccinated may receive the vaccine at any time of year. 2

Co-Administration

• RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites. 2, 3
• Data on co-administration with other vaccines (pneumococcal, herpes zoster, COVID-19) are currently lacking. 3

Clinical Implementation Considerations

Determining Eligibility

• Patient attestation alone is sufficient evidence of risk factors—vaccination should not be denied due to lack of medical documentation. 2
• Qualified vaccinators (pharmacists, nurse practitioners, other providers based on state law) may determine patient eligibility based on clinical assessment even without medical documentation. 1
• Adults aged ≥75 years should not have vaccination delayed while waiting for documentation, as age alone is sufficient indication. 2

Priority When Supply Is Limited

• If vaccine supply is limited, prioritize in this order: 2, 3
  1. Adults aged ≥75 years
  2. Adults aged ≥50 years with multiple comorbidities
  3. Residents of long-term care facilities

Important Caveats

• Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination, as reinfections are common due to short-lived immune responses. 3
• The three approved vaccines (Arexvy, Abrysvo, mResvia) have comparable safety profiles for adults aged ≥60 years. 4
• ACIP does not express preference for any particular RSV vaccine. 4

Special Populations

Pregnancy

• Abrysvo is the only approved RSV vaccine for use during pregnancy (32-36 weeks gestation) to prevent RSV in infants through transplacental antibody transfer. 4, 5
• This is a separate indication from adult vaccination and provides protection to the newborn. 5

Infants and Children

• There is currently no RSV vaccine approved for neonates or infants. 6
• For infants, passive immunization with nirsevimab (a long-acting monoclonal antibody) is available for prevention of RSV lower respiratory tract disease. 3, 7, 8
• Palivizumab is indicated for prevention of serious RSV disease in high-risk pediatric patients (premature infants ≤35 weeks gestational age who are ≤6 months old, or children ≤24 months with bronchopulmonary dysplasia or hemodynamically significant congenital heart disease). 9