RSV Vaccination Frequency in Elderly Patients
Elderly patients should receive only a single lifetime dose of RSV vaccine—no booster doses or annual revaccination is currently recommended. 1, 2
Current Dosing Recommendation
A single dose of RSV vaccine provides protection for at least two to three consecutive RSV seasons, and adults who have already received any RSV vaccine should not receive another dose. 1, 3 This applies to all three FDA-approved RSV vaccines (RSVPreF3/Arexvy, RSVpreF/Abrysvo, and mRNA-1345/mRESVIA). 2
Duration of Protection Evidence
The evidence supporting single-dose administration includes:
- RSVPreF3 (Arexvy) maintains efficacy for at least three seasons with cumulative efficacy of 62.9% against RSV-associated lower respiratory tract disease over three seasons 4
- RSVpreF (Abrysvo) demonstrates sustained protection for at least two seasons with cumulative efficacy of 58.8% with ≥2 symptoms and 81.5% with ≥3 symptoms over two seasons 4
- 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
Optimal Timing for the Single Dose
The vaccine should preferably be administered between September and November (late summer to early fall), just before RSV season begins, to maximize protection during peak transmission months. 1, 2, 3 However, eligible adults who have not previously received RSV vaccination may be vaccinated at any time of year. 1
Who Should Receive the Single Dose
Universal Recommendation
- All adults aged ≥75 years should receive the single dose regardless of comorbidities due to significantly elevated rates of hospitalization, severe disease, and mortality 1, 2, 3
Risk-Based Recommendation (Ages 60-74)
- Adults aged 60-74 years with chronic respiratory conditions (COPD, asthma), cardiovascular disease (heart failure, coronary artery disease), diabetes, chronic kidney disease, chronic liver disease, neurologic/neuromuscular conditions, severe obesity (BMI ≥40), or immunocompromise should receive the single dose 1, 2, 3
Younger High-Risk Adults (Ages 50-59)
- Adults aged 50-59 years with risk factors should receive RSVPreF3 (Arexvy), which is the only vaccine approved for this age group 1, 2, 3
Important Clinical Caveats
There is no annual or periodic revaccination schedule for RSV vaccine in adults—this is fundamentally different from influenza vaccination. 1 The single-dose recommendation is based on demonstrated sustained efficacy over multiple seasons, unlike influenza where annual vaccination is required due to antigenic drift. 4
Patient attestation alone is sufficient evidence of risk factors for adults aged 60-74 years; vaccination should not be delayed while waiting for medical documentation. 1, 3 For adults aged ≥75 years, age alone is sufficient indication without requiring documentation of risk factors. 2
Co-administration Considerations
The single RSV vaccine dose can be co-administered with seasonal influenza vaccine at different injection sites on the same visit, though this may result in numerically lower antibody titers for both vaccines with unknown clinical significance. 2, 3