There are 3 RSV vaccines: Pfizer RSV vaccine (RSVpreF protein subunit), GSK adjuvanted RSV vaccine (RSVPreF3 subunit), and Moderna mRNA RSV vaccine.
Indications
- The CDC recommends that all adults 75 years and older should receive a single dose of RSV vaccine. In addition, adults 60-74 years old who are at increased risk for severe RSV disease should receive a single dose of RSV vaccine.
Contraindications and Precautions
- History of a severe allergic reaction (e.g., anaphylaxis) to any component of RSV vaccine
- RSV vaccination should be delayed for persons experiencing moderate or severe acute illness with or without fever
Vaccine Dosing and Administration
- Single dose (0.5 mL) intramuscularly
Side Effects
- Pain, redness, and swelling at the injection site
- Fatigue; myalgia; headache; arthralgia; fever; nausea; diarrhea
Benefits
- In adults 60 years and above, all RSV vaccines significantly reduce the risk of RSV lower respiratory tract disease.
Harms
- Serious neurological inflammatory events, including Guillain-Barre Syndrome (GBS), were reported in the vaccine arms of the Pfizer RSVpreF and GSK RSVPreF3 clinical trials. The FDA’s post-licensure analysis of these two vaccines did not provide conclusive evidence of an increased risk for GBS, but it could not rule out the possibility of an elevated risk.
Talking Points with Patients
- RSV causes upper and lower respiratory disease similar to influenza in older adults.
- Older adults account for most adult RSV disease burden, with an estimated 60,000–160,000 hospitalizations and 6,000-10,000 deaths in adults aged ≥65 years annually.
- There are 3 RSV vaccines: Pfizer RSV vaccine (RSVpreF protein subunit) GSK adjuvanted RSV vaccine (RSVPreF3 protein subunit), and Moderna mRNA RSV vaccine.
- The CDC recommends that adults 75 years and older receive a single dose of the RSV vaccine. In addition, adults 60-74 years old who are at increased risk for severe RSV disease, should receive a single dose of RSV vaccine.
- Benefits: in adults 60 years and above, all RSV vaccines significantly reduce the risk of RSV lower respiratory tract disease
- Harms: The risk of Guillain-Barre Syndrome (GBS) is 7 cases per million doses of GSK RSV vaccine and 9 cases per million doses of Pfizer RSV vaccine
- Persons who have already received RSV vaccination are NOT recommended to receive another dose.
- Medicare Part D is currently covering the cost of RSV vaccination with zero out-of-pocket expense to the patient but some private insurers do not cover the vaccine.