Aug. 7, 2024 – The CDC has published updated recommendations for older adults, detailing who should get vaccinated against respiratory syncytial virus (RSV).
The new advice scales back the recommendation of who should get the shot, stating that “the benefits of RSV vaccination did not clearly outweigh the potential harms in adults aged 60-74 years without risk factors for severe RSV disease.”
The move comes after concerns were raised earlier this year that RSV vaccination may be linked to a heightened risk of a rare nervous system condition called Guillain-Barré syndrome (GBS). The CDC advisory committee that updated the recommendations has called for more research on the topic, including a full safety analysis incorporating data from this past first full RSV season.
RSV vaccination is now recommended for all people ages 75 and older. People ages 60 to 74 who are at increased risk for severe disease due to RSV should also get vaccinated.
Those criteria are a change from last year, when all people ages 60 and older were eligible. The revision, which came as a conclusion earlier this year from an advisory committee, was officially published Wednesday in a widely read weekly CDC report.
In most people, particularly younger ones, RSV usually causes mild symptoms like runny nose, cold, cough, and headache. But up to 160,000 older adults are hospitalized annually due to RSV, and as many as 10,000 die due to complications. The likelihood of needing medical treatment for RSV infection increases with age and is highest among people ages 70 and older, according to a recent summary published in the journal Drugs and Aging.
“These updated recommendations are intended to maximize RSV vaccination coverage among persons most likely to benefit, by clarifying who is at highest risk and by reducing implementation barriers,” the CDC report stated, particularly noting that one challenge had been last year’s advice that RSV vaccines should be given after people had a shared decision-making conversation with their medical provider. The report stated that “shared clinical decision-making has drawbacks. Providers find it confusing and time-consuming to implement.”
Vaccination rates this past season had only been modestly higher among people with chronic medical conditions, compared to adults without those conditions.
For people ages 60 to 74 years old, people may be considered at risk for severe RSV if they have one of 11 risk factors, including heart disease, living in a nursing home, frailty, or severe obesity. People ages 60 to 74 seeking an RSV vaccine may simply attest to the fact that they have one of these risk factors and should not need to provide documentation, the new guidance stated. If someone doesn’t explicitly meet one of the 11 risk factors, a provider may still determine that the person is at high risk.
The report also instructed that people should be advised of the potential but small risk for developing Guillain-Barré syndrome after vaccination.
Clinical trial results have suggested vaccination could reduce the risk of severe RSV complications by up to 94%. Some early estimates of first-season effectiveness for preventing hospitalization ranged from 75% to 82% among people ages 60 and older, according to this latest CDC report.
As of early May, an estimated 24% of adults 60 and older reported getting vaccinated for RSV, with an additional 11% stating they definitely planned to get vaccinated. That uptake has widely been considered low by public health officials. There are now RSV vaccines made by three manufacturers: GSK’s Arexvy, Pfizer’s Abrysvo, and Moderna’s mResvia.
Adults previously vaccinated against RSV don’t need a second shot this season, the guidelines stated, because one shot provides protection for two seasons, the report advised. The need for additional doses in the future will be considered at future advisory committee meetings.
“Eligible adults who have not previously received RSV vaccination may be vaccinated at any time of year, but vaccination will have the most benefit if administered in late summer or early fall, just before the RSV season,” the report advised. “In most of the continental United States, this corresponds to vaccination during August-October.”
