What vaccines prevent lower respiratory tract infection (LRTI)?

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Last updated: February 12, 2026 • View editorial policy

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Vaccines to Prevent Lower Respiratory Tract Infections

The two primary vaccines recommended to prevent LRTI are the annual influenza vaccine and the pneumococcal vaccine, with the newer RSV vaccines now also playing a critical role in specific populations. 1, 2

Influenza Vaccination

Annual influenza vaccination should be given to all adults at increased risk for complications, with the strongest evidence supporting this intervention among vaccine strategies for LRTI prevention. 1

Target Populations for Influenza Vaccine

  • Adults aged ≥65 years should receive yearly vaccination 1
  • Individuals with chronic cardiac diseases, chronic pulmonary diseases (including COPD and asthma), diabetes mellitus, chronic renal diseases, or haemoglobinopathies require annual vaccination 1
  • Institutionalized individuals and pregnant women in their second or third trimester during influenza season should be vaccinated 1
  • Healthcare personnel should receive yearly vaccination, especially those working with elderly or high-risk populations 1

Administration Details

  • Inactivated vaccine is recommended over live attenuated vaccine in adults 1
  • Repeated vaccinations are safe and do not decrease immune response 1
  • Efficacy ranges from 70-90% in healthy adults under 65 years 3

Pneumococcal Vaccination

The 23-valent polysaccharide pneumococcal vaccine is recommended for all adults at risk from pneumococcal disease, though the evidence is not as robust as for influenza vaccination. 1

Risk Factors Requiring Pneumococcal Vaccination

  • Age >65 years is the primary indication 1
  • Institutionalization, dementia, or seizure disorders warrant vaccination 1
  • Congestive heart failure, cerebrovascular disease, or COPD are clear indications 1
  • History of previous pneumonia, chronic liver disease, or diabetes mellitus require vaccination 1
  • Functional or anatomic asplenia and chronic cerebrospinal fluid leakage are high-risk conditions 1

Revaccination Strategy

  • A single revaccination can be considered in elderly patients 5-10 years after primary vaccination 1

RSV Vaccination (Newer Recommendation)

All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities, representing the most recent advancement in LRTI prevention. 2, 4

Age-Based RSV Vaccination Guidelines

  • Adults aged 60-74 years with risk factors (COPD, asthma, heart failure, coronary artery disease, diabetes, chronic kidney disease, immunocompromise) should receive RSV vaccination 2, 4
  • Adults aged 50-59 years with risk factors should receive RSVPreF3 (Arexvy), the only vaccine approved for this age group 2, 4

RSV Vaccine Administration

  • A single lifetime dose is currently recommended, administered preferably between September and November 2, 4
  • The vaccine can be co-administered with influenza vaccine at different injection sites 2, 4
  • RSVPreF3 demonstrates 82.6% efficacy against RSV-associated LRTI in the first season and 94.1% efficacy against severe disease 5
  • Protection is maintained for at least 2-3 seasons depending on vaccine type 2

Available RSV Vaccines

  • RSVPreF3 (Arexvy) is an adjuvanted recombinant vaccine approved for adults ≥50 years 4, 5
  • RSVpreF (Abrysvo) is a non-adjuvanted bivalent vaccine approved for adults ≥60 years 4, 5
  • mRESVIA (mRNA-1345) is an mRNA-based vaccine approved for adults ≥60 years and those 18-59 years at increased risk 6

Implementation Strategies

Active interventions are necessary to achieve adequate vaccination coverage, as passive approaches consistently fail to reach target populations. 1

  • Standing orders and systematic reminders significantly increase vaccination rates 7
  • Patient attestation of risk factors is sufficient; extensive documentation should not create barriers 2, 4
  • When vaccine supply is limited, prioritize adults ≥75 years and those with multiple comorbidities 2, 4

Important Clinical Caveats

  • Antibiotic treatment of upper respiratory tract infections does not prevent LRTI and should not be used for this purpose 1
  • Inhaled steroids, long-acting β2-agonists, oral mucolytics, and physiotherapy are not recommended as preventive approaches for LRTI 1
  • Previous RSV infection does not confer long-lasting immunity and does not contraindicate RSV vaccination 2, 4
  • Influenza and pneumococcal vaccines remain underutilized, particularly among minority populations who bear disproportionate disease burden 7

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

RSV Vaccination Recommendations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

3
Research

Immunization against viral respiratory disease: a review.

The Pediatric infectious disease journal, 2004

4
Guideline

RSV Vaccine Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

5
Guideline

RSV Vaccine Indications and Guidelines

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

7
Research

Lower respiratory tract infections: prevention using vaccines.

Infectious disease clinics of North America, 2004

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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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