RSV Vaccination in Adults

Respiratory syncytial virus (RSV) is a common respiratory virus that nearly everyone gets by age two and can be caught multiple times throughout life. Adults who get RSV usually have mild symptoms like that of a common cold or have no symptoms at all. Historically, RSV has been associated with infants, but they are not the only group that can be affected by serious RSV illness. Older adults and adults with underlying medical conditions are also at increased risk.  

Understanding RSV in Adults 

For most adults, RSV symptoms include a runny nose, sore throat, cough, headache, fatigue and fever and resolve in one to two weeks. However, RSV can cause severe disease and hospitalization, with around 180,000 adults 50 or older being hospitalized in the United States each year. RSV can lead to exacerbation of existing chronic medical conditions like asthma and COPD, and some older adults may develop pneumonia. 

Understanding RSV Vaccination Options 

In 2023, the arrival of RSV vaccines for adults was a major advancement in public health. This development complements longstanding efforts to protect infants, providing a needed intervention across vulnerable populations. 

There are currently three RSV vaccine options available for adults: 

• Abrysvo (Pfizer) is a protein-based vaccine. Real-world effectiveness of Abrysvo during the 2023-24 season showed it was 79% effective in preventing RSV-associated emergency department visits and 73% effective in preventing RSV-associated hospitalizations in adults 60 or older.
• Arexvy (GSK) is a protein-based vaccine containing the same adjuvant used in the shingles vaccine. Real-world effectiveness of Arexvy during the 2023-24 season showed it was 77% effective in preventing RSV-associated emergency department visits and 83% effective in preventing RSV-associated hospitalizations in adults 60 or older.
• mResvia (Moderna) is a messenger RNA-based vaccine. Though mResvia is a newer product, its clinical trial data showed efficacy against symptomatic RSV was approximately 80% during the first four months following vaccination. Real world effectiveness is being monitored by CDC.

Adult Vaccination Recommendations 

Certain adults are at increased risk for severe RSV disease and complications and are recommended RSV vaccination. Those include: 

• All adults 75+
• Adults 50-74 with underlying medical conditions like chronic lung disease and risk factors like residence in a nursing home

Right now, revaccination is not recommended. The data is being monitored about how long immune protection from vaccination lasts. For example, a study recently published in JAMA looked at RSV vaccine effectiveness against hospitalization across two seasons. 

Coadministration with other adult vaccines (e.g., influenza and COVID-19) during the same visit is acceptable but may increase common side effects (pain at the injection site, fever, etc.). 

Addressing Common Patient Questions 

We discussed common patient questions with Robert H. Hopkins, Jr., MD, National Foundation for Infectious Diseases (NFID) Medical Director to help guide healthcare provider conversations. 

The Role of Healthcare Providers 

Last season, the American Lung Association surveyed older adults about RSV and found that 44% of had little to no familiarity with RSV. In addition, 64% of older adults who also had chronic lung disease had never discussed RSV with their doctor. This suggests that the main barrier preventing vaccination was a lack of a provider recommendation.  

We know from studies that a strong healthcare provider recommendation is often the determining factor in whether an individual receives a vaccine. Providers are reliable sources of information that patients rely on when they have questions or concerns about their healthcare. Every healthcare visit is an opportunity to assess patient health history and vaccination status as well as to recommend vaccines patients are eligible for. Healthcare providers should be prepared to address patient questions with empathy, refer individuals to a nearby vaccination site and discuss the benefits versus risks of vaccination and RSV.  

There are certain strategies that make provider recommendations stronger. Those include the presumptive approach (assuming the patient will vaccinate), motivational interviewing, tailoring messaging to the individual’s values and providing easy access to information and vaccination.  

“Vaccination saves lives – and it’s on all of us to take action,” said Dr. Hopkins of NFID. “As healthcare professionals, we play a crucial role in making strong vaccine recommendations to help protect our patients and our communities.” 

Healthcare providers are uniquely positioned to influence vaccine acceptance through strong, personalized recommendations and empathetic communication. By making vaccines a routine and expected part of care, addressing concerns, leveraging teams and reminder recall systems, providers can help increase vaccination rates and contribute to better public health outcomes.  

To learn more about RSV for healthcare providers, visit Lung.org/hcp-rsv. 

This educational activity is supported by an independent medical education grant from GSK. The content is developed by the American Lung Association.