ACP Updates: RSV Vaccine Recommendations for Seniors & At-Risk Adults

The American College of Physicians (ACP) has issued updated recommendations regarding respiratory syncytial virus (RSV) vaccination for adults. The guidance, released this week, advises that all adults aged 75 or older should receive a protein subunit RSV vaccine. For those aged 60–74, vaccination with a protein subunit RSV vaccine may be considered, particularly if they are at increased risk for severe RSV illness. This updated advice reflects a growing understanding of RSV’s impact on older adults and the availability of new preventative measures.

Understanding RSV and Why Older Adults Are Vulnerable

Respiratory syncytial virus is a common respiratory virus that usually causes mild, cold-like symptoms. Although, for older adults and those with underlying health conditions, RSV can lead to severe illness, including pneumonia and hospitalization. The virus spreads through close contact with infected individuals, much like the common cold or flu. As we age, our immune systems naturally weaken, a process known as immunosenescence, making us more susceptible to severe infections like RSV. This decline in immune function means that older adults may not mount as strong an immune response to the virus, increasing their risk of complications.

Several conditions can further elevate the risk of severe RSV illness. These include chronic cardiovascular disease (such as heart failure or coronary artery disease), chronic lung diseases like chronic obstructive pulmonary disease (COPD) or asthma, conclude-stage renal disease requiring dialysis, and diabetes mellitus complicated by kidney disease or nerve damage. Neurological or neuromuscular conditions that impair airway clearance or respiratory muscle weakness also increase vulnerability. The CDC provides a detailed list of conditions that increase risk.

Protein Subunit Vaccines: How They Perform

The ACP’s recommendation specifically focuses on protein subunit RSV vaccines. These vaccines work differently than some other types of vaccines. Instead of introducing a weakened or inactive whole virus, protein subunit vaccines contain specific proteins from the RSV virus. These proteins trigger an immune response, teaching the body to recognize and fight off the virus if exposed. Currently, three FDA-licensed RSV vaccines are available for adults 50 and older: GSK’s Arexvy, Moderna’s mResvia, and Pfizer’s Abrysvo. The CDC notes there is no preference for which vaccine adults should receive.

What the ACP Guidance Means for Patients and Physicians

The ACP’s updated practice points are intended to guide physicians in counseling their patients about RSV vaccination. The recommendation for all adults 75 and older reflects the higher risk of severe illness in this age group. The consideration for those aged 60–74 with increased risk acknowledges that vulnerability isn’t solely determined by age. Physicians are encouraged to assess individual patient risk factors and discuss the benefits and risks of vaccination. It’s important to note that the ACP’s guidance is based on a review of available evidence and is subject to change as new data emerge.

Timing and Ongoing Vaccination Needs

The optimal timing for RSV vaccination is generally considered to be in late summer and early fall, before RSV typically begins to circulate widely in the community. This allows the immune system to build protection before the peak of RSV season. Currently, the RSV vaccine is not an annual vaccine. Individuals who have received one dose are considered fully vaccinated and do not need a booster at this time. The American College of Allergy, Asthma & Immunology highlights this point, also noting the availability of a maternal RSV vaccine for pregnant individuals.

RSV Vaccination and Existing Health Conditions

For individuals with asthma or allergies, respiratory infections like RSV can be particularly problematic, potentially triggering asthma attacks and exacerbating breathing difficulties. Vaccination can help protect these individuals by reducing their risk of contracting RSV and experiencing severe illness. It’s crucial for people with asthma or allergies to discuss vaccination with their healthcare provider to determine the best course of action. The presence of these conditions is specifically cited as increasing risk for severe RSV illness, supporting the consideration of vaccination in the 60-74 age group.

The Broader Context of RSV Prevention

RSV vaccination is just one component of a broader public health strategy to prevent and control the spread of the virus. Other preventative measures include practicing good hygiene, such as frequent handwashing, covering coughs and sneezes, and avoiding close contact with sick individuals. Public health surveillance systems are also crucial for monitoring RSV activity and identifying outbreaks. The CDC and other health agencies track RSV cases and hospitalizations to assess the impact of the virus and inform public health recommendations.

What Comes Next: Surveillance and Guidance Updates

The rollout of RSV vaccines is a relatively recent development, and ongoing surveillance is essential to monitor their effectiveness and safety in real-world settings. Health agencies will continue to track RSV cases, hospitalizations, and vaccine coverage rates to assess the impact of vaccination programs. As more data develop into available, guidance from organizations like the ACP and the CDC may be updated to reflect the latest evidence. Further research is also needed to evaluate the long-term durability of vaccine protection and to determine whether booster doses will be necessary in the future. The American Academy of Family Physicians is actively promoting increased RSV vaccination in adults 60 and older, emphasizing the importance of proactive prevention.