Understanding RSV and Why Vaccination Matters
Respiratory syncytial virus, commonly known as RSV, is a virus that infects the lungs and breathing passages. Nearly all children get RSV at least once before turning 2 years old, according to the Centers for Disease Control and Prevention (CDC). While most healthy children recover within one to two weeks, RSV can be serious for certain groups of people, including older adults, infants, and individuals with weakened immune systems.
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RSV spreads through respiratory droplets when an infected person coughs or sneezes. The virus can also spread by touching a contaminated surface and then touching your face. Symptoms typically appear four to six days after exposure and may include cough, runny nose, fever, sore throat, wheezing, and difficulty breathing. In severe cases, particularly among older adults and very young infants, RSV can lead to hospitalization.
The introduction of RSV vaccines represents a significant development in public health. For decades, no RSV vaccine was available, making prevention difficult. The first RSV vaccines for older adults became available in 2023, marking an important milestone. These vaccines work by teaching the immune system to recognize and fight RSV before infection occurs.
Understanding RSV's impact helps explain why health officials and medical professionals recommend vaccination for certain populations. According to CDC data, RSV hospitalizes approximately 60,000 children under five years old and 160,000 older adults annually in the United States. The economic burden is substantial, with RSV-related medical costs reaching billions of dollars each year in lost productivity and healthcare expenses.
Practical Takeaway: RSV is a common respiratory virus that can cause serious illness in vulnerable populations. Vaccination offers a way to reduce the risk of infection and severe disease. Learning about who benefits most from RSV vaccines helps individuals make informed decisions about their health and the health of their families.
RSV Vaccine Options Currently Available
As of 2024, two RSV vaccines have been approved by the Food and Drug Administration (FDA) for use in the United States. Both vaccines target older adults aged 60 and older. The vaccines are Arexvy (made by GSK) and Abrysvo (made by Pfizer). A third vaccine, RSVPreF3, is in development. These vaccines differ slightly in their design and how they prompt the immune response, but both aim to prevent RSV infection and reduce severity of illness.
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Arexvy is an adjuvanted vaccine, meaning it contains an ingredient that enhances the immune response. It is given as a single dose injection into the muscle. Clinical trials showed that Arexvy reduced the risk of RSV lower respiratory tract disease by approximately 82.6 percent in adults 60 years and older. The vaccine was shown to prevent severe RSV illness in this population.
Abrysvo is a recombinant protein-based vaccine, also given as a single intramuscular injection. In clinical trials, Abrysvo demonstrated an 86.5 percent reduction in RSV lower respiratory tract disease in adults 60 years and older. It also showed effectiveness in preventing severe disease and hospitalization. The vaccine uses a different technology than Arexvy but achieves similar protective outcomes.
RSV vaccines are also being studied for use in pregnant women and infants. The reasoning behind this approach is that antibodies from a vaccinated pregnant woman can pass to the fetus and newborn, potentially protecting the infant in early life when RSV can be particularly dangerous. Some data suggests that vaccinating pregnant women during the third trimester may provide protection to newborns up to six months of age. However, vaccines for pregnant women are still in development and not yet widely available in the United States.
For children and younger adults without specific risk factors, RSV vaccines are not currently approved. The FDA authorization focuses on older adults who face the highest risk of serious RSV complications. Healthcare providers may discuss RSV prevention strategies with patients in other age groups who have chronic illnesses or compromised immune systems.
Practical Takeaway: Two RSV vaccines are currently available for older adults in the United States, each given as a single dose. Understanding which vaccine options exist and how they work can help older adults discuss RSV vaccination with their healthcare provider to determine whether vaccination is appropriate for their individual health situation.
Vaccination Frequency and Dosing Schedules
RSV vaccination for older adults currently follows a straightforward schedule: a single dose of either Arexvy or Abrysvo. This one-time vaccination approach differs from some other vaccines, such as flu shots, which require annual administration. The single-dose recommendation is based on clinical trial data showing that one injection provides substantial and lasting protection against RSV infection and severe disease.
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The protection offered by RSV vaccines appears to be durable over time. In clinical trials, participants who received one dose of either vaccine maintained strong protection throughout the study period, which extended several years in some cases. However, healthcare providers continue to monitor long-term protection data to determine if booster doses might become necessary in the future. As of now, regular revaccination is not part of the standard recommendation for RSV vaccines in older adults.
Timing of RSV vaccination can be considered in relation to other vaccines. The CDC and other health authorities recommend that older adults can receive RSV vaccine at the same time as other vaccines, such as flu or pneumococcal vaccines, but in different injection sites. If vaccines are given simultaneously, they should be injected in different arms or different body locations. This practice does not reduce the effectiveness of any vaccine involved.
Some individuals may have received one RSV vaccine and want to know if they should receive the other vaccine instead. Current guidance indicates that people should not switch between the two available RSV vaccines or receive both vaccines. If someone has already received one dose of either Arexvy or Abrysvo, they have received adequate vaccination and do not need a second dose of the same vaccine or a dose of the alternative vaccine.
Healthcare providers may discuss individual circumstances that could affect vaccination timing. Factors such as acute illness, recent receipt of certain blood products, or current medical treatments might influence when a person should receive an RSV vaccine. However, most older adults can receive RSV vaccination at any time of year, unlike flu vaccination which is often recommended in fall and winter months.
Practical Takeaway: RSV vaccination for older adults involves a single dose, with protection appearing to last long-term based on current evidence. Understanding that one dose is typically sufficient helps set realistic expectations about RSV vaccination and allows people to plan with their healthcare provider.
Who Should Consider RSV Vaccination
RSV vaccination recommendations from the CDC focus primarily on adults aged 60 years and older. Within this age group, all older adults may consider RSV vaccination, though some face higher risk of severe disease and may benefit most from vaccination. The decision to vaccinate should be individualized based on personal health status, living situation, and preferences discussed with a healthcare provider.
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Older adults at higher risk for severe RSV disease include those with chronic lung diseases such as chronic obstructive pulmonary disease (COPD) or asthma, chronic heart disease, diabetes, and weakened immune systems. People living in long-term care facilities or congregate settings face elevated exposure risk. Additionally, older adults who have frequent contact with young children, such as grandparents in childcare arrangements, may consider their exposure risk when making vaccination decisions.
Healthcare workers and caregivers who work with older adults in facilities or home settings might also consider RSV vaccination, though recommendations for these populations are still evolving. By reducing their own RSV infection risk, caregivers can lower the chance of bringing the virus to vulnerable individuals they serve.
Younger adults with severe immunocompromise or specific chronic medical conditions might discuss RSV vaccination with their healthcare provider, even though the vaccine is not formally recommended for those under 60. People with conditions such as HIV, those receiving certain cancer treatments, or individuals who have undergone organ transplantation may face elevated RSV risk and could benefit from vaccination, though this would be a decision made with their healthcare team.
Children and infants cannot receive current RSV vaccines, though healthcare providers may recommend other preventive measures for high-risk children, such as hand hygiene and limiting exposure during RSV season. A medication called palivizumab, administered as a series of injections, may be recommended for certain high-risk infants, such as those born prematurely or with specific heart or lung conditions. Parents of high-risk children should discuss prevention strategies with their pediatrician.