In June 2024, ACIP updated its recommendations for RSV vaccination. ACIP routinely recommends a single dose of any of the three licensed RSV vaccines for all adults age 75 years and older. ACIP also recommended a single dose of any RSV vaccine for adults age 60 through 74 years who are increased risk for serious RSV infection due to specific high risk conditions, frailty, or high-risk living arrangements (e.g., residents of long-term care facilities). Refer to the question and answer about high-risk conditions for which CDC recommends vaccination among adults age 60 through 74 years for the detailed list.
See current ACIP recommendation for older adults here: www.cdc.gov/acip-recs/hcp/vaccine-specific/rsv.html
Last reviewed:
August 25, 2024
The following conditions and factors place some older adults at the highest risk for severe RSV infection:
- chronic medical conditions such as lung diseases (including chronic obstructive pulmonary disease and asthma)
- cardiovascular diseases (such as congestive heart failure and coronary artery disease)
- moderate or severe immune compromise (either due to an immunocompromising disease or treatment with an immunosuppressing treatment)
- diabetes mellitus
- neurologic or neuromuscular conditions
- kidney disorders
- liver disorders
- hematologic disorders
Other factors associated with increased risk include:
- overall frailty
- advanced age
- residence in a nursing home or other long-term care facility
- other underlying factors that a health care provider determines might increase the risk for severe respiratory disease
Last reviewed:
January 22, 2024
CDC specifies for RSV vaccination the same moderate to severe immunocompromising conditions that require additional doses of COVID-19 vaccines. Below is the CDC description from its website (www.cdc.gov/vaccines/covid-19/clinical-considerations/interim-considerations-us.html#immunocompromised).
Moderate and severe immunocompromising conditions and treatments include but are not limited to:
- Active treatment for solid tumor and hematologic malignancies
- Hematologic malignancies associated with poor responses to COVID-19 vaccines regardless of current treatment status (e.g., chronic lymphocytic leukemia, non-Hodgkin lymphoma, multiple myeloma, acute leukemia)
- Receipt of solid-organ transplant or an islet transplant and taking immunosuppressive therapy
- Receipt of chimeric antigen receptor (CAR)-T-cell therapy or hematopoietic cell transplant (HCT) (within 2 years of transplantation or taking immunosuppressive therapy)
- Moderate or severe primary immunodeficiency (such as common variable immunodeficiency disease, severe combined immunodeficiency, DiGeorge syndrome, or Wiskott-Aldrich syndrome)
- Advanced HIV infection (people with HIV and CD4 cell counts less than 200 per cubic milliliter, history of an AIDS-defining illness without immune reconstitution, or clinical manifestations of symptomatic HIV) or untreated HIV infection
- Active treatment with high-dose corticosteroids (i.e., 20 mg or more of prednisone or equivalent per day when administered for 2 or more weeks), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor necrosis factor (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory (e.g., B-cell-depleting agents)
Factors to consider in assessing the general level of immune competence in a patient include disease severity, duration, clinical stability, complications, comorbidities, and any potentially immune-suppressing treatment.
For additional information about the degree of immune suppression associated with different medical conditions and treatments, refer to the CDC General Best Practice Guidelines for Immunizations section on altered immunocompetence (www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html).
Last reviewed:
August 25, 2024
No. RSV vaccination is not recommended for people his age with hypertension and no other risk conditions. People age 60 through 74 years who do not have a medical condition or risk factor that increases their risk of severe RSV disease are not recommended to receive RSV vaccination at this time.
Last reviewed:
August 25, 2024
A shared clinical decision-making (SCDM) recommendation is different from routine vaccine recommendations based simply on a person’s age or risk for disease. With routine vaccine recommendations the default decision is to vaccinate all persons in a specified age group or risk group. With SCDM recommendations, vaccination is not the default decision based on age or risk group alone: desirability will vary from person to person.
In the case of RSV vaccine, SCDM recommendations are informed by:
- whether the patient has any risk factors for severe RSV disease,
- the safety profile of the RSV vaccine products and the patient’s risk tolerance,
- a patient’s preferences for prevention of RSV, and
- the clinical discretion of the health care provider
In the judgment of ACIP members, both vaccines were well tolerated, and the safety profiles were generally acceptable. Six cases of inflammatory neurologic events were reported (including Guillain Barré syndrome and others) after RSV vaccination during clinical trials of the two licensed vaccines, but evidence was insufficient to determine whether these were due to chance or possibly caused by vaccine. Investigations continue into these findings and safety monitoring is ongoing to clarify whether or not there is any increased risk of these conditions associated with RSV vaccination. The ACIP SCDM recommendation is intended to provide flexibility for providers and vaccine recipients to take into account an individual’s risks for severe RSV disease and patient preference. Some will choose to defer vaccination until more is known about the vaccine’s performance or until their personal risk for severe RSV is greater.
CDC has a one-page resource for healthcare providers to assist in these SCDM conversations with patients: www.cdc.gov/vaccines/vpd/rsv/downloads/provider-job-aid-for-older-adults-508.pdf.
Last reviewed:
January 22, 2024
Document the discussion and reason for deferral in the medical record. Because the risk of severe disease increases with age, plan to revisit the decision periodically to vaccinate once the patient’s risk-benefit assessment shifts in favor of vaccination.
Last reviewed:
January 22, 2024
No. Only a single dose of RSV vaccine is currently approved and recommended at this time. There is no evidence at this time to determine whether revaccination would be of value. As data become available, FDA and the ACIP will evaluate the benefit of revaccination.
Last reviewed:
January 22, 2024
