Outpatient Management and Prevention of RSV in Adults ≥ 65 Years
Acute Outpatient Care
- For stable outpatients ≥ 65 years with confirmed or suspected RSV infection, management is limited to supportive care (hydration, antipyretics, supplemental oxygen if needed); no antiviral therapy has demonstrated efficacy for established disease. 1
- In patients with a bothersome dry cough, symptomatic relief may be provided with dextromethorphan or codeine. 2
- Expectorants, mucolytics, antihistamines, and bronchodilators should be avoided because they have not shown benefit in acute lower‑respiratory‑tract infections. 2
Vaccination Recommendations
- Universal recommendation: All adults ≥ 75 years should receive a single dose of an RSV vaccine. [4][5][6][7][8][9]
- Targeted recommendation for adults 65‑74 years with chronic conditions:
- Chronic respiratory disease (e.g., COPD, asthma, bronchiectasis, interstitial lung disease). [4][5]8
- Chronic heart failure or coronary artery disease. [4][5]8
- Chronic kidney disease. [4][8]
- Diabetes mellitus. [4][8]
- Immunocompromise (malignancy, immunosuppressive therapy, transplantation). [4][8]
- Residence in long‑term care facilities. [4][8]
Available Vaccines and Efficacy
| Vaccine (Manufacturer) | Reported Efficacy* | Duration of Observed Protection |
|---|---|---|
| RSVPreF3 (Arexvy, GSK) | 82.6 % against RSV‑associated lower‑respiratory‑tract disease in season 1; cumulative 62.9 % over ≥ 3 seasons | ≥ 3 seasons |
| RSVpreF (Abrysvo, Pfizer) | 88.9 % against severe disease (≥ 3 symptoms) in season 1; maintained efficacy over ≥ 2 seasons | ≥ 2 seasons |
Timing and Co‑administration
- Vaccination should ideally be administered between September and November to coincide with the RSV season. 1
- RSV vaccine may be given concurrently with the influenza vaccine at separate injection sites; a modest reduction in antibody titers has been observed, but the clinical relevance is uncertain. 1