Adults aged 75 or older should receive a protein subunit Respiratory Syncytial Virus (RSV) vaccine

 

The American College of Physicians (ACP) issued updated vaccine practice points for physicians that advise adults aged 75 or older should receive a protein subunit Respiratory Syncytial Virus (RSV) vaccine and those aged 60-74 at increased risk for severe RSV may consider receiving the protein subunit RSV vaccine. “Respiratory Syncytial Virus Vaccines in Adults Who Are Not Pregnant or Immunocompromised: Rapid Practice Points from the American College of Physicians” is published in Annals of Internal Medicine.  

 

Annually in the US, an estimated 170,000 adults aged 50 or older will be hospitalized and 14,000 deaths will occur due to RSV. Most adults infected by RSV have mild upper respiratory tract infections, but it can also cause life threatening lower respiratory tract infections. Among adults, severe RSV infection is more likely in those aged 75 or older, living in a long-term care facility or with a comorbid condition such as chronic kidney, liver, or lung disease, cardiovascular disease, hematologic conditions (such as sickle cell disease), diabetes, obesity, or a combination of these conditions. Unlike other respiratory virus vaccines that are administered annually, such as influenza, an RSV vaccine is administered only once, and the need for repeat vaccination is being studied.

 

The ACP Population Health and Medical Science Committee (PHMSC) developed the RSV practice points based on a rapid review by the ACP Center for Evidence Reviews. They addressed the efficacy, comparative effectiveness, and harms of RSV vaccines in adults aged 18 or older who were not pregnant or immunocompromised. 

 

The PHMSC considered evidence on benefits (all-cause mortality, reduced RSV-related hospitalization or severe illness) and harms (such as Guillain-Barré syndrome) and concluded that the benefits of the protein subunit vaccines outweigh the harms in adults aged 75 years or older. The benefits, such as prevention of hospitalization, are lower in adults aged 60-74 years compared to those 75 years or older but with the same harms.