ACP Updates RSV Vaccine Guidance for Older Adults | Healio

ACP Updates Guidance on RSV Vaccination for Seniors

The American College of Physicians (ACP) has released updated practice points regarding respiratory syncytial virus (RSV) vaccination in older adults. The guidance, published on March 10, 2026, focuses on recommendations for individuals who are not immunocompromised or pregnant, offering a nuanced approach to vaccination strategies. This comes after the first RSV vaccines were approved in 2023, marking the first time ACP has developed specific recommendations for this emerging preventative measure.

According to ACP, adults aged 75 years or older should receive a protein subunit RSV vaccine. For those aged 60 to 74, vaccination may be considered, particularly for individuals at higher risk of severe illness. These recommendations reflect a careful evaluation of available evidence and a consideration of potential risks and benefits.

Understanding RSV and Its Impact

RSV is a common respiratory virus that typically causes mild, cold-like symptoms. Although, it can be severe, even life-threatening, in older adults and young children. Approximately 170,000 American adults aged 50 years and older are hospitalized due to RSV annually, with around 14,000 fatalities each year. Research indicates that vaccination can significantly reduce the risk of hospitalization and severe illness.

How ACP Developed These Recommendations

The ACP’s Population Health and Medical Science Committee based its practice points on a review of eight studies examining the efficacy and risks of RSV vaccination in non-pregnant, non-immunocompromised adults. This rigorous review, detailed in Annals of Internal Medicine, considered both the benefits of vaccination in preventing severe RSV outcomes and the potential for adverse events.

ACP’s Guidance Compared to the CDC

While both ACP and the Centers for Disease Control and Prevention (CDC) recommend RSV vaccination for adults aged 75 and older, there are some differences. The CDC currently recommends RSV vaccination for adults aged 50 to 74 at higher risk for severe disease, in addition to all adults 75 years and older. This broader recommendation reflects a different interpretation of the available data regarding risk and benefit across different age groups.

Benefits and Risks of RSV Vaccination

The ACP review found that RSV vaccination demonstrably reduced the risk of RSV-related hospitalizations and severe illness in adults aged 60 and older. The greatest benefits were observed in those 75 and older. However, the review also identified a potential risk of Guillain-Barré syndrome associated with the protein subunit vaccine, estimated at approximately one in 100,000 person-years among adults aged 60 to 74 who are not at increased risk for severe disease. This risk needs to be carefully weighed against the potential benefits of vaccination in this population.

Clinical Considerations for Healthcare Providers

ACP highlights several key considerations for clinicians discussing RSV vaccination with their patients:

• Guillain-Barré Syndrome Risk: The potential, albeit small, risk of Guillain-Barré syndrome following protein subunit vaccination should be discussed, particularly with those aged 60-74 who are not at high risk for severe RSV.
• Limited Data in Younger Adults: Research is currently insufficient to make definitive recommendations for adults aged 18 to 59 who are not immunocompromised or pregnant but may be at increased risk. Clinical judgment should guide vaccination decisions in these cases.
• Comprehensive Discussion: Clinicians should discuss the risks and benefits of vaccination, including potential adverse events like fever or injection site soreness, and consider the patient’s likelihood of exposure to others at high risk, their personal values, and the cost of the vaccine.

Timing of Vaccination

According to Amir Qaseem, MD, PhD, MHA, MGIN, MRCP, FACP, ACP chief science officer, the RSV vaccine can be administered throughout the year, but the optimal timing is early fall for both the Northern and Southern Hemispheres. This timing aims to maximize protection during peak RSV season.

Future Research Needs

The ACP emphasizes the need for further research to better understand the long-term clinical benefits and harms of RSV vaccination, particularly in different adult populations. Future trials should employ standardized definitions of severe RSV to ensure consistent and comparable results. Ongoing studies are crucial to refining vaccination strategies and optimizing patient care.

For further information, Amir Qaseem, MD, PhD, MHA, MGIN, MRCP, FACP, can be reached at [email protected].