Vaccine Fatigue? Time To Add RSV

The new adult respiratory syncytial virus (RSV) vaccine may exacerbate vaccine fatigue. Many older adults can feel overwhelmed by the discussion of additional immunizations. Another has been added to the already long list of recommended shots, including the flu, shingles, pneumonia, tetanus/diphtheria vaccines, and multiple COVID boosters.

Until now, RSV was associated with serious risk to infants. For most people, a simple cold resulted. However, the Centers for Disease Control (CDC) now recommends the RSV vaccine for adults over 60. Why the addition?

What is RSV?

RSV usually causes mild, cold-like symptoms; most people recover in 1-2 weeks. Even though nearly all children get RSV before they are two years old, it can cause severe illness in infants and is the leading cause of hospitalization for them.

RSV can also develop into severe symptoms requiring hospitalization for older adults. Unfortunately, by contracting the virus, there is no long-lasting immunity.  

RSV is very contagious. It is spread from person to person through close contact, causing exposure to secretions from coughing or sneezing. The virus can live on objects for extended periods, spreading much more from contaminated surfaces such as a doorknob or toy. 

Symptoms of RSV are a runny nose, decreased appetite, coughing, sore throat, sneezing, shortness of breath, fever, and wheezing. Infants and adults are usually hospitalized if they have developed lower airway respiratory disease, resulting in bronchiolitis, pneumonia, or exacerbation of other chronic diseases. 

The Risks of RSV

The CDC reports that there are 60,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths annually among adults aged 65 or older due to the RSV virus. This fact and other developments persuaded the CDC to prioritize a vaccine for the RSV virus. 

One implication included seasonal changes in RSV after COVID-19, making it unpredictable. Another CDC analysis revealed RSV can cause more severe disease than expected, and there is a growing population of the 60+ age group with chronic medical conditions. 

According to “Scientific American,” public health officials have only begun to recognize the threat to older adults in the past decade. 

Testing for RSV

The CDC recommends rRT-PCR assay (blood test) to diagnose RSV in older adults. The recommendation is based on adults having less virus in their nose; therefore, the antigen tests (nose swabs) are less sensitive. 

The Urgency of the RSV Vaccine

A CDC “Morbidity and Mortality Weekly Report” conducted in April 2023 described the seasonal change in behavior of the RSV virus after COVID-19. In the three years before the pandemic, RSV began in October, peaked in December, and ended in March or April, lasting approximately 27 weeks. In 2021-2022, the epidemic started in May and peaked in July, lasting 33 weeks. “The peak percentage of RSV-positive PCR results were comparable to pre-pandemic levels.” In 2022-2023, the onset was in June and peaked in November with a 19% higher peak than pre-pandemic levels. That RSV season was 32 weeks long. 

According to an article posted on healthessentials from the Cleveland Clinic, recent RSV seasons have caused a “nearly ten-fold” increase in the number of elderly infected by the virus.

Another CDC article, “Morbidity and Mortality Weekly Report,” details an analysis conducted from February 1, 2022, through May 31, 2023. It predisposed the CDC Advisory Committee on Immunization Practices in June 2023 to recommend the RSV vaccination for adults aged 60 or above. This report found that compared to COVID-19 and influenza, hospitalizations for RSV were less frequent but associated with more severe diseases requiring higher levels of medical intervention. In addition, an article entitled “Rates of Medically Attended RSV among U.S. Adults: A Systematic Review and Meta-analysis” from Open Forum Infectious Disease concluded that “the true burden of RSV has been underestimated and is significant among older adults and individuals with chronic medical conditions.” 

The population of elderly with chronic medical conditions is growing. This group and the relaxing COVID-19 precautions caused greater exposure to the virus. 

Dr. Decoy, a pulmonary medicine physician at Cleveland Clinic, quoted in healthessentials, “We’ve seen more RSV in older adults this past winter (2022) than we’ve seen in the last seven years.” 

The CDC’s Current Update

On October 30, 2023, the CDC posted an update on the upcoming fall and winter season, stating that it expects a respiratory viral season similar to last year. The update recommends vaccinations as the best strategy to prevent illness individually and across the population to avoid the number of hospitalizations and hospital strain.

The official CDC recommendation states that “RSV vaccination in older adults should be targeted to those at highest risk for severe RSV disease and therefore most likely to benefit from vaccination.” People who are considered the highest risk are those over age 60 who have a compromised immune system (leukemia, HIV) or due to cancer or organ transplant treatment, a chronic medical condition such as heart or lung disease, or live in a nursing home. 

Shared Decision-Making

In addition, the CDC recommends that practitioners should use “shared decision-making” when offering the RSV vaccine to their patients. Shared decision-making is a more individualized discussion that includes the patient’s risk for developing RSV and the patient’s characteristics, values, and preferences. The discussion should include the provider’s clinical discretion and the features of the vaccine. 

The FDA has approved two vaccines for people aged 60 and older: 

1. RSVPreF3 (Arexvy) Manufacturers Package Insert
2. RSVpreF (Abrysvo) Manufacturers Package Insert

Vaccine highlights include:

• Both protect against lower respiratory tract disease caused by the RSV virus.
• Both intramuscular injections are single-dose. 
• Coadministration with other adult vaccines is acceptable according to the CDC, but there is limited information regarding coadministration.

The Bottom Line

People aged 60 and above interested in the RSV vaccine should speak with their care provider to determine the best course for them.