RSV Vaccination Recommendations

Age-Based Recommendations

The American Thoracic Society recommends RSV vaccination for all adults aged ≥60 years and for adults aged 50-59 years with risk factors for severe RSV disease, with priority given to those aged ≥75 years and those with multiple comorbidities if vaccine supply is limited 1, 2
Adults aged 60-74 years should receive RSV vaccination, as recommended by the American College of Physicians 1, 3
Adults aged 50-59 years with risk factors should receive RSVPreF3, the only vaccine approved for this age group, according to the Infectious Diseases Society of America 1

Risk Factors for Severe RSV Disease

Respiratory Conditions

Chronic obstructive pulmonary disease (COPD) is a risk factor for severe RSV disease, as stated by the American College of Chest Physicians 1, 4
Asthma is a risk factor for severe RSV disease, according to the National Asthma Education and Prevention Program 1, 4
Heart failure is a risk factor for severe RSV disease, as recommended by the American Heart Association 1, 4

Cardiovascular Conditions

Coronary artery disease is a risk factor for severe RSV disease, according to the American College of Cardiology 1, 4

Other Medical Conditions

Diabetes is a risk factor for severe RSV disease, as stated by the American Diabetes Association 1, 4
Chronic kidney disease is a risk factor for severe RSV disease, according to the National Kidney Foundation 1, 4

Administration Guidelines

A single lifetime dose of RSV vaccine is recommended, as stated by the Centers for Disease Control and Prevention 2
The vaccine should be administered between September and November, before or early in the RSV season, according to the American Academy of Family Physicians 1, 2
The vaccine can be co-administered with seasonal influenza vaccine at different injection sites, as recommended by the American Academy of Pediatrics 1, 2

Prioritization if Vaccine Supply is Limited

Adults aged ≥75 years should be prioritized for vaccination, as recommended by the National Institute on Aging 2, 4
Adults with multiple comorbidities should be prioritized for vaccination, according to the American Geriatrics Society 4

Clinical Considerations

Patient attestation is sufficient evidence of risk factors, and extensive medical documentation should not be required, as stated by the American Medical Association 2, 4
Previous RSV infection does not confer long-lasting immunity and does not contraindicate vaccination, according to the Infectious Diseases Society of America 4
The burden of RSV in older adults has been underrecognized, accounting for 10.6% of hospitalizations for pneumonia and 11.4% for COPD exacerbations, as reported by the Centers for Disease Control and Prevention 4

RSV Vaccine Administration Frequency

Recommendations for Different Age Groups

Adults aged 60 years and older should receive a single dose of RSV vaccine, with priority given to those aged ≥75 years if vaccine supply is limited, as recommended by the National Comprehensive Cancer Network 5
Adults with inflammatory bowel disease (IBD) aged 60 years and older should receive a single dose of RSV vaccine, with no preference for any specific RSV vaccine 6

Timing of Vaccination

The RSV vaccine can be administered at any time of year, but it is preferably given between September and November, before or early in the RSV season, according to Pulmonology guidelines 7
In the northern hemisphere, RSV season typically runs from November through April, though it may begin earlier or persist later in certain communities, as reported in Pulmonology 8

Special Considerations

The RSV vaccine can be co-administered with seasonal influenza vaccines at different injection sites, as stated in Pulmonology guidelines 7
For cancer patients, the effectiveness of RSV vaccines is unknown, and consultation with infectious disease specialists is recommended, according to the National Comprehensive Cancer Network 9

RSV Vaccination Recommendations for Adults

Primary Age-Based Recommendations

All adults aged ≥75 years should receive a single dose of RSV vaccine regardless of comorbidities, due to significantly elevated rates of hospitalization, severe disease, and mortality, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 10

High-Risk Medical Conditions (Ages 60-74)

Adults in this age range with chronic obstructive pulmonary disease (COPD), asthma, heart failure, coronary artery disease, diabetes mellitus, chronic kidney disease, or chronic liver disease should receive RSV vaccination, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 11, 12
Adults with chronic neurological or neuromuscular diseases, or those who are immunocompromised, should also receive RSV vaccination, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 10, 11

Special Population: Adults Aged 50-59 Years

For adults aged 50-59 years with risk factors for severe RSV disease, RSVPreF3 (Arexvy) is the only vaccine currently approved, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 11

Dosing and Administration

A single lifetime dose of RSV vaccine is currently recommended, and the vaccine should preferably be administered between September and November, before or early in the RSV season, to maximize protection, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 12, 13
RSV vaccine can be co-administered with seasonal influenza vaccine at different injection sites, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 12, 13

Prioritization if Vaccine Supply is Limited

If resources are constrained, adults aged ≥75 years should be prioritized for RSV vaccination, as recommended by the CDC's Advisory Committee on Immunization Practices (ACIP) 12

RSV Vaccine Administration and Efficacy

Adult Vaccination Schedule

The American Thoracic Society recommends that the RSV vaccine should preferably be administered between September and November, before or early in the RSV season, to maximize protection during peak transmission months 14
The vaccine can be co-administered with seasonal influenza vaccine at different injection sites, although some studies show numerically lower antibody titers for both RSV and influenza when co-administered 14
Co-administration with COVID-19 vaccines requires further study, with current data being lacking 14
The Centers for Disease Control and Prevention notes that co-administration of RSV vaccine with other vaccines may result in lower antibody titers, with clinical significance remaining unknown 14, 15

Duration of Protection

The RSVPreF3 (Arexvy) vaccine maintains efficacy for at least three seasons in adults aged ≥60 years, according to the Infectious Diseases Society of America 16
The RSVpreF (Abrysvo) vaccine maintains efficacy for at least two seasons in adults aged ≥60 years, as recommended by the American College of Physicians 16

Duration of Protection from RSV Vaccination

Duration by Vaccine Type and Population

The Centers for Disease Control and Prevention recommends that a single dose of RSV vaccine provides protection for at least two RSV seasons in adults aged ≥60 years, with current recommendations not requiring revaccination 17
The Advisory Committee on Immunization Practices will evaluate the need for additional RSV vaccine doses in the future and update recommendations as needed 17
Protection conferred through maternal vaccination likely wanes after 3 months, similar to what has been observed with influenza and COVID-19 vaccines given during pregnancy 18, 19
At least 14 days are required after maternal vaccination for adequate antibody development and transplacental transfer to protect the infant 18, 19
Additional data are needed to determine whether additional seasonal doses during subsequent pregnancies are indicated, and the Advisory Committee on Immunization Practices may update recommendations in the future 19

Clinical Algorithm for Duration Considerations

The Centers for Disease Control and Prevention recommends administering one dose of RSV vaccine preferably between August-October for adults aged ≥60 years 17
The Centers for Disease Control and Prevention recommends not revaccinating for at least two full RSV seasons for adults aged ≥60 years 17
The American College of Obstetricians and Gynecologists and the Centers for Disease Control and Prevention recommend vaccinating pregnant persons once between 32-36 weeks gestation during September-January 18, 19
The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend expecting infant protection primarily during the first 3 months of life 18, 19
The American Academy of Pediatrics recommends planning for nirsevimab if the infant will be <8 months during RSV season and maternal antibodies have waned 18
The Centers for Disease Control and Prevention recommends awaiting future guidance on revaccination in subsequent pregnancies 19
The American Academy of Pediatrics recommends that a single dose of nirsevimab provides protection through one RSV season 18
The American Academy of Pediatrics recommends that infants aged 8-19 months at increased risk entering their second RSV season require another dose of nirsevimab 18

Vaccine Effectiveness

Results from clinical trials indicate that palivizumab trough serum concentrations 30 days after the fifth dose remain well above protective concentrations for most infants 20
Five monthly doses of palivizumab provide substantially more than 20 weeks of protective serum antibody concentrations for most of the RSV season 20

RSV Vaccines for Adults

Characteristics of Approved RSV Vaccines

The American College of Physicians recommends the use of recombinant protein subunit vaccines, similar in design to the recombinant zoster vaccine, for adults aged ≥60 years, which contain purified RSV fusion protein antigens and are completely inactivated, meaning they contain no live viral particles 21
The Centers for Disease Control and Prevention suggests that these vaccines are non-live formulations, which are recombinant subunit vaccines that cannot replicate in the human body, making them safe for immunocompromised patients, such as cancer patients and other immunocompromised individuals 21, 22

Clinical Implications

The National Comprehensive Cancer Network recommends that the approved RSV vaccines can be safely administered to patients with cancer, those on immunosuppressive therapy, and elderly patients with multiple comorbidities 21
The Infectious Diseases Society of America states that no special precautions regarding live vaccine administration apply to RSV vaccination, as the approved vaccines are inactivated 23

Composition and Administration of Approved Adult RSV Vaccines

Vaccine Composition

Arexvy (RSVPreF3) – a recombinant protein subunit vaccine for adults that contains a stabilized prefusion RSV F antigen formulated with the AS01E adjuvant. 24
Abrysvo (RSVpreF) – a recombinant bivalent vaccine for adults that includes stabilized prefusion F proteins from both RSV‑A and RSV‑B strains. 25
European‑approved mRNA RSV vaccine – an mRNA‑based vaccine for adults that delivers a single‑strand mRNA encoding a prefusion‑stabilized RSV F glycoprotein. 24