CDC Offers Guidance on RSV Vaccines for Adults

Marcia Frellick

July 24, 2023

Two newly approved respiratory syncytial virus (RSV) vaccines for adults age 60 years and older may be able to prevent illness in those at risk for severe RSV disease.

Most adult RSV illness occurs among the older age group and results in an estimated 60,000–160,000 hospitalizations and 6000–10,000 deaths a year among people at least 65 years old.

Older adults deciding whether to get the vaccines should weigh risks and their own preferences and make the decision in consultation with their clinician, say authors of a Centers for Disease Control and Prevention report published Friday.

Michael Melgar, MD, with the Coronavirus and Other Respiratory Viruses Division at the CDC, was lead author on the report, published in the Morbidity and Mortality Weekly Report.

Two New Vaccines

In May, the US Food and Drug Administration (FDA) approved the first of two vaccines for preventing RSV lower respiratory tract disease for adults at least 60 years old.

On June 21, the Advisory Committee on Immunization Practices (ACIP) recommended that people in that age group receive a single dose of RSV vaccine using shared decision-making.

The recommendation for shared decision-making makes the ACIP decision different from routine and risk-based vaccine recommendations. Rather than targeting all in a particular age group or risk group, the decision calls for consideration of a patient's risk for disease and their characteristics, preferences, and values; the healthcare professional's clinical discretion; and performance of the vaccine.

Melgar and colleagues report that vaccination with one dose of the GSK or Pfizer RSV vaccines has proved moderately to highly effective in preventing symptomatic RSV-associated lower respiratory tract disease over two consecutive RSV seasons among people age 60 and older.

The trials that led to approval weren't powered to gauge efficacy against RSV-associated hospitalization and death. However, the authors write, the prevention of lower respiratory tract disease, including medically attended illness, suggests that the shots might prevent considerable morbidity from RSV disease among those age 60 and older.

Both vaccines were generally well-tolerated with a good safety profile. However, six cases of inflammatory neurologic events (including Guillain-Barré Syndrome, acute disseminated encephalomyelitis and others) were reported in clinical trials after RSV vaccination.

"Whether these events occurred due to chance, or whether RSV vaccination increases the risk for inflammatory neurologic events, is currently unknown," the authors write.

Postmarketing surveillance may help clarify the existence of any potential risk, but until those results are clearer, the CDC researchers say, RSV vaccinations should be targeted to older adults at highest risk for severe RSV and those most likely to benefit from the shots.

At Higher Risk

Some adults with certain medical conditions have a higher risk for RSV-associated hospitalization, according to the report.

Those conditions include chronic obstructive pulmonary disease, asthma, congestive heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus and chronic kidney disease.

People who are frail and of advanced age are also at higher risk for RSV hospitalization. That risk increases with age and the highest risk is for people at least 75 years old.

Researchers add that RSV can also cause severe disease in those with compromised immunity, including people who have received hematopoietic stem cell transplants and patients taking immunosuppressive drugs, including those used with solid organ transplants, cancer treatment, or for other conditions.

As for when physicians should offer the vaccinations, shots are optimally given before the start of the RSV season.

However, the COVID-19 pandemic interrupted the seasonality and the timing has not yet returned to pre-pandemic patterns.

For the 2023-24 season, this report states, clinicians should offer RSV vaccination to adults at least 60 years old using shared clinical decision-making as early as vaccine supply is available and continue to offer vaccination to eligible adults who remain unvaccinated.

RSV vaccines can be administered with other adult vaccines during the same visit, the authors confirm.

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