This summer, the Advisory Committee on Immunization Practices (ACIP) voted to update recommendations as follows: A single dose of any FDA-approved RSV vaccine (Arexvy [GSK]; Abrysvo [Pfizer]; or mResvia [Moderna]) is now recommended for all adults aged 75 years and older and for adults aged 60 to 74 years who are at increased risk for severe RSV disease. The guidelines published recently in the Morbidity & Mortality Weekly Report (MMWR) advised that adults who have previously received RSV vaccine should not receive another dose.
“This report summarizes the evidence considered for these updated recommendations, including post-licensure data on vaccine effectiveness and safety, and provides clinical guidance for the use of RSV vaccines in adults aged ≥60 years,” the CDC authors and colleagues wrote. “These updated recommendations are intended to maximize RSV vaccination coverage among persons most likely to benefit, by clarifying who is at highest risk and by reducing implementation barriers associated with the previous shared clinical decision-making recommendation. Continued post licensure monitoring will guide future recommendations.”
The MMWR article pointed out that qualified vaccinators, including pharmacists, nurse practitioners, and other providers (based on state and jurisdictional law), are allowed to determine patient eligibility for RSV vaccination based on clinical assessment even without medical documentation of a named risk condition.
“Patient attestation is sufficient evidence of the presence of a risk factor; vaccinators should not deny RSV vaccination to a person because of lack of documentation,” the authors wrote. “These factors should be considered to optimize patient access, including in administrative procedures, such as reimbursement policies for RSV vaccination.”
Here are the conditions that put adults aged 60 to 74 years at increased risk of RSV, according to the guidance:
• Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, or congenital heart disease [excluding isolated hypertension])
• Chronic lung or respiratory disease (e.g., chronic obstructive pulmonary disease, emphysema, asthma, interstitial lung disease, or cystic fibrosis)
• End-stage renal 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 inhibitor
• Neurologic or neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness (e.g., poststroke dysphagia, amyotrophic lateral sclerosis, or muscular dystrophy [excluding history of stroke without impaired airway clearance])
• Chronic liver disease (e.g., cirrhosis)
• Chronic hematologic conditions (e.g., sickle cell disease or thalassemia)
• Severe obesity (BMI ≥40 kg/m2)
• Moderate or severe immune compromise
• Residence in a nursing home
• Other chronic medical conditions or risk factors that a healthcare provider determines would increase the risk for severe disease due to viral respiratory infection (e.g., frailty, situations in which health care providers have concern for presence of undiagnosed chronic medical conditions or residence in a remote or rural community where transportation of patients with severe RSV disease for escalation of medical care is challenging).
As of this past spring, 20% to 25% of U.S. adults aged 60 years or older were estimated to have received RSV vaccine under the previous guidelines.
Recommendations could change again in the future. In June, the ACIP decided that insufficient evidence was available to inform a vote on RSV vaccination policy in adults aged 50 to 59 years who are at increased risk for RSV disease. The group said it needed more information on updated RSV vaccine safety analyses among adults aged 60 years and older, including results from the full 2023–2024 RSV season in the FDA analysis incorporating chart confirmation of Guillain-Barré syndrome diagnoses; additional data on duration of protection from RSV vaccination and immune response after revaccination; and immunogenicity data in adults with immunocompromise. The ACIP said it will review evidence and vote on RSV vaccination policy in this age group when additional data are available.
The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.
