What are the high-risk conditions specified by ACIP as indications for RSV vaccination among adults age 60 through 74 years?

Because of the strong association between the risk of severe RSV disease and age, ACIP recommends RSV vaccination of all adults age 75 years or older. ACIP has specified several conditions as reasons for RSV vaccination before age 75 years (age 60 through 74 years) due to their association with a high risk of hospitalization with severe RSV disease compared to otherwise healthy adults of the same age. These conditions are similar to, but not the same as, high-risk conditions specified for pneumococcal or influenza vaccination. An individual’s risk is increased further if they have more than one of the conditions.

• Non-immunocompromising chronic health conditions:
  • Chronic cardiovascular disease (such as heart failure, coronary artery disease, or congenital heart disease [excluding isolated hypertension])
  • Chronic lung disease (such as chronic obstructive lung disease [COPD], emphysema, asthma, interstitial lung disease, or cystic fibrosis)
  • End-stage kidney disease or dependence on hemodialysis or other renal replacement therapy
  • Diabetes mellitus complicated by chronic kidney disease, neuropathy, retinopathy, or other end-organ damage, or requiring treatment with insulin or sodium-glucose cotransporter-2 (SGLT2) inhibitor
  • Severe obesity (measured as a body mass index of 40 kilograms per meter squared or greater)
  • Chronic liver disease (such as cirrhosis)
  • Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness (such as poststroke dysphagia [swallowing dysfunction], amyotrophic lateral sclerosis [ALS], or muscular dystrophy [excluding history of stroke without impaired airway clearance])
  • Chronic blood disorders (such as sickle cell disease, thalassemia)
• Moderate or severe immune compromise (due to a medical condition or due to immunosuppressive medications or treatment)
• Overall frailty (based on an assessment of frailty)
• Residence in a nursing home or other long-term care facility
• Other chronic medical conditions or risk factors not specified in this list that a healthcare provider determines might increase the risk of severe disease due to RSV respiratory infection

People age 60 through 74 years who do not have a medical condition or risk factor that increases their risk of severe RSV disease are not recommended to receive RSV vaccine: they should wait to be vaccinated until a high-risk condition develops or until they turn 75, whichever comes first.