Is respiratory syncytial virus (RSV) vaccination recommended for adults aged 60 to 74 years?

RSV Vaccination for Adults Aged 60-74 Years

Adults aged 60-74 years should receive RSV vaccination only if they have specific risk factors for severe disease, not based on age alone. 1

Age-Based Recommendation Framework

The Advisory Committee on Immunization Practices (ACIP) updated RSV vaccination recommendations in June 2024, moving away from shared clinical decision-making to clear age- and risk-stratified guidance. 1

Universal Vaccination (Age ≥75 Years)

• All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of health status or comorbidities 1, 2
• This universal recommendation reflects significantly elevated rates of RSV-associated hospitalization, severe disease, and mortality in this age group 2

Risk-Based Vaccination (Ages 60-74 Years)

For adults aged 60-74 years, vaccination is recommended ONLY if they have at least one qualifying risk factor. 1, 3

Qualifying Risk Factors for Ages 60-74

Cardiovascular Conditions

• Chronic heart failure 1, 4
• Coronary artery disease 1, 4
• Congenital heart disease (excluding isolated hypertension alone) 1, 4

Respiratory Conditions

• Chronic obstructive pulmonary disease (COPD) 1, 4
• Asthma 1, 4
• Emphysema 1, 4
• Interstitial lung disease 1, 4
• Cystic fibrosis 1

Metabolic and Renal Conditions

• End-stage renal disease or dependence on hemodialysis 1, 4
• Diabetes mellitus with complications (chronic kidney disease, neuropathy, retinopathy, or other end-organ damage) 1, 4
• Diabetes requiring insulin or SGLT2 inhibitor treatment 1

Neurologic Conditions

• Conditions causing impaired airway clearance or respiratory muscle weakness 1, 4
• Poststroke dysphagia 1
• Amyotrophic lateral sclerosis 1
• Muscular dystrophy 1
• Note: History of stroke WITHOUT ongoing impaired airway clearance does NOT qualify 1, 4

Other Chronic Conditions

• Chronic liver disease (e.g., cirrhosis) 1, 4
• Chronic hematologic conditions (sickle cell disease, thalassemia) 1, 4
• Severe obesity (BMI ≥40 kg/m²) 1, 4

Immunocompromise and Living Situation

• Moderate or severe immunocompromise (see COVID-19 vaccination guidelines for full list) 1, 4
• Residence in a nursing home 1, 4
• Frailty (defined by Fried frailty phenotype: ≥3 of unintentional weight loss, exhaustion, weakness, slow walking, low activity) 1

Critical Implementation Points

Documentation Requirements

Patient attestation alone is sufficient evidence of a risk factor—vaccinators should NOT deny vaccination due to lack of medical documentation. 1, 4 This is a crucial point that removes barriers to vaccination for eligible patients. 4

Provider Flexibility

Healthcare providers maintain flexibility to offer RSV vaccine to patients assessed to be at increased risk even if they don't fall into an explicitly named category, particularly in remote/rural communities where medical transport is challenging. 1

Common Pitfall to Avoid

Isolated hypertension alone does NOT qualify a patient aged 60-74 years for RSV vaccination. 1, 4 The cardiovascular disease must include heart failure, coronary artery disease, or congenital heart disease.

Rationale for Risk-Based Approach in Ages 60-74

ACIP's decision to use risk-based rather than universal vaccination for ages 60-74 was driven by postlicensure safety surveillance showing a potential increased risk for Guillain-Barré syndrome (GBS) after protein subunit RSV vaccines (Arexvy and Abrysvo). 1, 3

The benefits of vaccination did not clearly outweigh potential harms in adults aged 60-74 years without risk factors. 1, 3 However, modeling showed that preventable RSV-associated hospitalizations, ICU admissions, and deaths exceeded estimated vaccine-attributable GBS cases in high-risk populations. 1

Vaccine Administration Details

Available Vaccines

Three FDA-approved RSV vaccines are acceptable for adults aged 60-74 years with risk factors: 1, 3

• Arexvy (GSK) - protein subunit vaccine
• Abrysvo (Pfizer) - protein subunit vaccine
• mResvia (Moderna) - mRNA-based vaccine 5

Dosing Schedule

Only a single lifetime dose is recommended—adults who have already received RSV vaccine should NOT receive another dose. 1, 2 A single dose provides protection for at least two consecutive RSV seasons. 1, 2

Optimal Timing

Vaccination should preferably occur in late summer or early fall (August-October in most of the continental United States), just before RSV season begins, though eligible adults may be vaccinated at any time of year. 1, 2

Coadministration

RSV vaccine can be coadministered with seasonal influenza vaccine at different injection sites. 1, 2