RSV Vaccine Indications
All adults ≥75 years should receive a single dose of RSV vaccine, and adults 60-74 years with chronic conditions (heart disease, lung disease, diabetes, immunocompromise) should also be vaccinated; pregnant individuals should receive RSV vaccination to protect their infants. 1
Universal Vaccination Recommendations
Adults ≥75 Years
- Recommend RSV vaccination for all adults ≥75 years without exception 1
- This represents a universal recommendation based on the substantial burden of severe RSV disease in this age group
- Single intramuscular dose of either available vaccine (RSVPreF3 or RSVpreF)
Pregnant Individuals
- Recommend RSV vaccination during pregnancy for passive infant protection 1
- Vaccination provides protection against lower respiratory tract disease in infants from birth through 6 months of age
- Optimal timing: 32-36 weeks' gestation (no significant association with preterm birth at this timing) 2
- Efficacy >80% in first 3 months of infant life 3
Risk-Based Vaccination (Ages 60-74 Years)
Vaccinate adults 60-74 years who have ANY of the following conditions 1, 4:
Chronic Respiratory Disease
- Chronic obstructive pulmonary disease (COPD)
- Asthma
- Bronchiectasis
- Interstitial lung disease
- Chronic respiratory failure
Cardiovascular Disease
- Chronic heart failure
- Other chronic cardiovascular conditions
- Note: Vaccine effectiveness may be lower in cardiovascular disease (56% vs 80% without) 5
Metabolic/Endocrine Conditions
- Diabetes mellitus (particularly with complications)
- Severe obesity (BMI ≥30)
Renal Disease
- Chronic kidney disease
- End-stage renal disease
Immunocompromising Conditions
- Solid organ transplantation
- Hematopoietic cell transplantation
- Solid cancers or hematologic malignancies
- HIV infection
- Use of immunosuppressive medications
- Important caveat: Vaccine effectiveness is significantly lower in immunocompromised adults (30% vs 67% in immunocompetent) 5
Neurological Conditions
- Chronic neurological disease
- Neuromuscular conditions
Other High-Risk Situations
- Residents of nursing homes or long-term care facilities
- Chronic liver disease
- Chronic hematologic conditions
Patient Self-Attestation
- Patients can self-attest to the presence of risk factors 1
- No formal documentation required for risk-based vaccination
Adults 50-59 Years
- One vaccine (RSVPreF3) is approved for adults 50-59 years at increased risk 4
- Consider vaccination in this age group with the same chronic conditions listed above
- This represents an individual decision in consultation with healthcare provider 6
Key Clinical Considerations
Vaccine Effectiveness
- First season efficacy: 65-83% against RSV-associated lower respiratory tract disease 4
- Severe disease prevention: 94% efficacy for severe RSV-associated disease 4
- Duration of protection: Effectiveness decreases over time
Safety Profile
- Well-tolerated with acceptable safety profile 4
- Myocarditis risk with COVID vaccines (not RSV): 1.3-3.1 per 100,000 doses in male adolescents 2
- Guillain-Barré syndrome: 18.2 excess cases per million doses in older adults with RSVPreF 2
- Severe side effects are rare
Dosing
- Single intramuscular injection 4
- No booster currently recommended, though protection wanes
- Can be co-administered with other vaccines (influenza, pneumococcal, COVID-19)
Common Pitfalls to Avoid
- Don't delay vaccination in eligible adults ≥75 years - this is a universal recommendation, not risk-based
- Don't overlook immunocompromised patients - they need vaccination but counsel about reduced effectiveness (30% vs 67%) 5
- Don't forget nursing home residents - they qualify regardless of age if ≥60 years 4
- Don't require formal documentation of chronic conditions - patient self-attestation is acceptable 1
- Monitor for waning immunity - effectiveness decreases from 82.5% at 0-1 month to 59.4% at 18 months 7