Ask the Experts: Respiratory syncytial virus (RSV): Vaccine Recommendations for Older Adults

Results (5)

ACIP recommends use of either RSVpreF (Abrysvo, Pfizer) or RSVPreF3 (Arexvy, GSK) as a single dose in adults age 60 years and older, using shared clinical decision-making (SCDM). In SCDM-type recommendations, the choice to vaccinate is an option guided by a patient’s individual risk for severe disease and the patient’s values and preferences. SCDM also takes into account the provider’s clinical discretion concerning the patient and the vaccine.

ACIP recommends the following factors be considered during the shared clinical decision-making process: whether the patient has one or more risk factors for severe RSV disease; a patient’s risk of exposure to RSV (e.g., are they around young children, or living in a long-term care facility?); a patient’s preferences for RSV vaccination, including an understanding of safety, side effects, and costs; and the clinical discretion of the health-care provider.

The risk of hospitalization with RSV disease rises with increasing age after age 60. Other factors that increase risk are overall frailty, residence in a long-term care facility or nursing home, and one or more chronic medical conditions. A separate question provides details on risk factors.

CDC has developed a simple job aid for providers to assist in these discussions: www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.

See the full 2023 ACIP recommendation for older adults here: www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm.

Last reviewed: January 22, 2024

The following conditions and factors place some older adults at the highest risk for severe RSV infection:

  • chronic medical conditions such as lung diseases (including chronic obstructive pulmonary disease and asthma)
  • cardiovascular diseases (such as congestive heart failure and coronary artery disease)
  • moderate or severe immune compromise (either due to an immunocompromising disease or treatment with an immunosuppressing treatment)
  • diabetes mellitus
  • neurologic or neuromuscular conditions
  • kidney disorders
  • liver disorders
  • hematologic disorders

Other factors associated with increased risk include:

  • overall frailty
  • advanced age
  • residence in a nursing home or other long-term care facility
  • other underlying factors that a health care provider determines might increase the risk for severe respiratory disease
Last reviewed: January 22, 2024

A shared clinical decision-making (SCDM) recommendation is different from routine vaccine recommendations based simply on a person’s age or risk for disease. With routine vaccine recommendations the default decision is to vaccinate all persons in a specified age group or risk group. With SCDM recommendations, vaccination is not the default decision based on age or risk group alone: desirability will vary from person to person.

In the case of RSV vaccine, SCDM recommendations are informed by:

  • whether the patient has any risk factors for severe RSV disease,
  • the safety profile of the RSV vaccine products and the patient’s risk tolerance,
  • a patient’s preferences for prevention of RSV, and
  • the clinical discretion of the health care provider

In the judgment of ACIP members, both vaccines were well tolerated, and the safety profiles were generally acceptable. Six cases of inflammatory neurologic events were reported (including Guillain Barré syndrome and others) after RSV vaccination during clinical trials of the two licensed vaccines, but evidence was insufficient to determine whether these were due to chance or possibly caused by vaccine. Investigations continue into these findings and safety monitoring is ongoing to clarify whether or not there is any increased risk of these conditions associated with RSV vaccination. The ACIP SCDM recommendation is intended to provide flexibility for providers and vaccine recipients to take into account an individual’s risks for severe RSV disease and patient preference. Some will choose to defer vaccination until more is known about the vaccine’s performance or until their personal risk for severe RSV is greater.

CDC has a one-page resource for healthcare providers to assist in these SCDM conversations with patients: www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.

Last reviewed: January 22, 2024

Document the discussion and reason for deferral in the medical record. Because the risk of severe disease increases with age, plan to revisit the decision periodically to vaccinate once the patient’s risk-benefit assessment shifts in favor of vaccination.

Last reviewed: January 22, 2024

No. Only a single dose of RSV vaccine is currently approved and recommended at this time. There is no evidence at this time to determine whether revaccination would be of value. As data become available, FDA and the ACIP will evaluate the benefit of revaccination.

Last reviewed: January 22, 2024

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