Adults aged 75 years and older are now recommended to receive a single dose of RSV vaccine, as are those aged 60 to 74 years who are at an increased risk of severe RSV disease, according to new guidance from a CDC advisory group.

The Advisory Committee on Immunization Practices (ACIP) recommendation is for a single lifetime dose only. Those who have already received RSV vaccination are not recommended to receive another dose.

The new recommendations, issued in mid-June and accepted by CDC Director Mandy K. Cohen, MD, MPH, override previous guidance that adults aged 60 years and older may receive RSV vaccination, using shared clinical decision-making.

The new policy is that adults aged 60 to 74 years who are not at an increased risk of severe RSV disease are not recommended to receive RSV vaccination.

The ACIP panel accepted the new RSV vaccine recommendations by a unanimous 11-0 vote. It did not recommend a booster based on data that additional doses did not appear to improve protection, although the ACIP noted that it is anticipated that adults might need additional doses of RSV vaccine in the future. The ideal revaccination timing is not yet known, the ACIP added.

The committee also reiterated that RSV vaccines can be given simultaneously with seasonal influenza, COVID-19, pneumococcal, tetanus and diphtheria/tetanus, diphtheria, and pertussis, and recombinant zoster (Shingrix) vaccines.

Conditions that predispose older adults to severe RSV include the following, according to the CDC:

• Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, congenital heart disease; excluding isolated hypertension)
• Chronic lung disease (e.g., chronic obstructive pulmonary disease [COPD], emphysema, asthma, interstitial lung disease, cystic fibrosis)
• Chronic kidney disease, advanced (e.g., stages 4-5, dependence on hemodialysis or other renal replacement therapy)
• Diabetes mellitus with end-organ damage (e.g., diabetic nephropathy, neuropathy, retinopathy, or cardiovascular disease)
• Severe obesity (BMI ≥40 kg/m2)
• Decreased immune function from disease or drugs (i.e., immunocompromising conditions)
• Neurologic or neuromuscular conditions (e.g., neuromuscular conditions causing impaired airway clearance or respiratory muscle weakness, excluding history of stroke without impaired airway clearance)
• Liver disorders (e.g., cirrhosis)
• Hematologic conditions (e.g., sickle cell disease, thalassemia)
• Frailty
• Residence in a nursing home or other long-term care facility
• Other chronic medical conditions or risk factors that a healthcare provider determines would increase the risk of severe disease due to respiratory infection.

While no formal recommendation was made, the panel suggested that RSV vaccination will have the most benefit if it is given in late summer or early fall, which means from August to October in most of the United States. Pharmacists should know that older adults may continue to receive RSV vaccination year-round, however.

With the recent approval of Moderna’s mRNA-1345 vaccine (mRESVIA) the last day of May, three RSV vaccines are currently available for use in older adults. The other two are GSK’s adjuvanted RSV prefusion F protein-based vaccine (Arexvy) and Pfizer’s unadjuvanted, bivalent RSV prefusion F protein vaccine (Abrysvo).

The FDA approved mRESVIA to protect adults aged 60 years and older from lower respiratory tract disease caused by RSV infection. The approval was granted under a breakthrough therapy designation and is the second approved mRNA product from Moderna.

“The FDA approval of our second product, mRESVIA, builds on the strength and versatility of our mRNA platform,” Stéphane Bancel, CEO of Moderna, said in a press release. “mRESVIA protects older adults from the severe outcomes of RSV infection, and it is the only RSV vaccine available in a pre-filled syringe designed to maximize ease of administration, saving vaccinators’ time and reducing the risk of administrative errors. This approval is also the first time an mRNA vaccine has been approved for a disease other than COVID-19. With mRESVIA, we continue to deliver for patients by addressing global public health threats related to infectious diseases.”

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