RSV Vaccination Recommendations

Current Recommendations

The Centers for Disease Control and Prevention recommends that all adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities 3, 4
Adults aged 60-74 years should receive RSV vaccination only if they have risk factors for severe RSV disease, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1, 2, 5
The ACIP updated these recommendations in June 2024, changing from the previous shared clinical decision-making approach 5, 6

A 62-year-old female should receive RSV vaccination if she has chronic cardiovascular disease, such as heart failure, coronary artery disease, or congenital heart disease, as recommended by the Centers for Disease Control and Prevention 1, 4
The presence of chronic lung or respiratory disease, such as COPD, emphysema, asthma, or interstitial lung disease, is also a qualifying risk factor for RSV vaccination 2, 7
Other qualifying risk factors include end-stage renal disease or dependence on dialysis 3, 4, diabetes mellitus with complications 2, 8, neurologic/neuromuscular conditions affecting airway clearance 3, 4, chronic liver disease 2, 4, chronic hematologic conditions 3, 4, severe obesity (BMI ≥40 kg/m²) 2, 4, moderate or severe immune compromise 3, 4, residence in a nursing home 2, 4, and frailty or other conditions that increase risk for severe viral respiratory infection 3, 9

Postlicensure safety surveillance suggests a potential increased risk for Guillain-Barré syndrome (GBS) after protein subunit RSV vaccination, which informed the ACIP's recommendation 5, 10
The ACIP concluded that benefits of RSV vaccination do not clearly outweigh potential harms in adults aged 60-74 years without risk factors, based on available evidence 1, 5

Only a single lifetime dose of RSV vaccine is recommended, as stated by the Centers for Disease Control and Prevention 3, 4
Vaccination is preferably administered between September and November, before or early in the RSV season, to maximize protection 9, 8
RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites, according to the Centers for Disease Control and Prevention 7, 4
Patient attestation is sufficient evidence of risk factors; extensive medical documentation is not required, as recommended by the Advisory Committee on Immunization Practices (ACIP) 2, 4

Three RSV vaccines are currently approved: Arexvy (RSVPreF3), Abrysvo (RSVpreF), and mRESVIA (mRNA-1345), as reported by the Centers for Disease Control and Prevention 8
For adults aged 50-59 years with risk factors, only RSVPreF3 (Arexvy) is approved, according to the Food and Drug Administration 7, 4

The risk-based recommendation for adults aged 60-74 years might result in lower vaccination coverage among at-risk individuals compared to an age-based recommendation, as noted by the Advisory Committee on Immunization Practices (ACIP) 5, 10
Healthcare providers have flexibility to offer RSV vaccine to patients they assess to be at increased risk for severe disease even if they don't fall into an explicitly named risk category, as recommended by the Centers for Disease Control and Prevention 1, 9
Patients should be informed about benefits and risks of RSV vaccination, including the potential risk for GBS with protein subunit vaccines, as advised by the Advisory Committee on Immunization Practices (ACIP) 2, 10