Is the respiratory syncytial virus (RSV) vaccine a live vaccine?

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Last updated: February 10, 2026 • View editorial policy

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RSV Vaccines Are NOT Live Vaccines

All currently approved RSV vaccines for adults are recombinant protein subunit vaccines that contain no live viral particles and cannot replicate in the human body. 1

Vaccine Technology and Composition

The approved RSV vaccines use recombinant technology to produce stabilized prefusion F (fusion) proteins, making them completely inactivated formulations:

  • RSVPreF3 (Arexvy): Contains recombinant RSV pre-fusion F protein adjuvanted with AS01E 2
  • RSVpreF (Abrysvo): Contains recombinant bivalent RSV-A and RSV-B pre-fusion F protein 2
  • mRNA vaccine (approved in Europe): Contains single-stranded mRNA encoding the RSV glycoprotein F stabilized in prefusion conformation 2

These vaccines are similar in design to the recombinant zoster vaccine and contain purified RSV fusion protein antigens with no live viral components. 1

Clinical Implications of Non-Live Formulation

Because RSV vaccines are non-live, they have important safety advantages:

  • Safe for immunocompromised patients: Can be administered to cancer patients, those on immunosuppressive therapy, solid organ transplant recipients, and other immunocompromised individuals 1, 3
  • No special precautions required: Unlike live vaccines, no restrictions apply regarding timing with immunosuppressive medications 1
  • No risk of vaccine-strain infection: The vaccines cannot cause RSV infection since they contain no replicating virus 1

Administration Details

Both approved vaccines are given as:

  • Single 0.5 mL intramuscular injection 2
  • One lifetime dose currently recommended 1, 3
  • Preferably between September and November 1, 3, 4
  • Can be co-administered with influenza vaccine at different injection sites 1, 3, 4

Historical Context

While live-attenuated RSV vaccine candidates have been evaluated in clinical trials historically (cold-passaged, temperature-sensitive vaccines), none of these live vaccine candidates have been approved for market use. 5 The formalin-inactivated RSV vaccine developed in the 1960s caused vaccine-enhanced disease, which guided subsequent vaccine development away from certain approaches. 6, 5

References

1
Guideline

RSV Vaccination Recommendations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

3
Guideline

RSV Vaccine Indications and Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

4
Guideline

RSV Vaccine Recommendations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Research

Respiratory syncytial virus vaccines.

Clinical microbiology reviews, 1998

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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