Help Patients Age 60 and Over Decide About the RSV Vaccine

We’re getting questions about the first vaccines to prevent respiratory syncytial virus (RSV) in older adults...Abrysvo and Arexvy.

We know RSV is a common virus that generally causes mild cold-like symptoms...and typically circulates from October through March.

But RSV may cause serious lower respiratory tract infections in infants and older adults...and it’s possible to get RSV multiple times.

In fact, RSV causes up to 160,000 hospitalizations and 10,000 deaths annually in patients over age 65. This rate is similar to many flu seasons.

Now Abrysvo or Arexvy are approved for adults age 60 and older. Either option is a single 0.5 mL IM dose.

Recommend either RSV vaccine...along with other immunizations patients may need (flu, COVID-19, pneumococcal, etc) at the same visit.

Use shared decision-making to help patients decide.

Educate that evidence in patients 60 and older suggests getting a single dose of either RSV vaccine makes it about 85% less likely to need a healthcare visit due to an RSV lower respiratory infection.

But it’s too soon to say how well either vaccine prevents RSV hospitalization or death...or whether vaccination is needed annually.

Look for patients at higher risk of severe RSV who may benefit most...such as those with diabetes or chronic heart or lung conditions. Immunocompromised patients weren’t studied...but are likely to benefit.

Reinforce that these vaccines aren’t live...and can’t cause RSV.

Reassure that most patients tolerate these vaccines well. Side effects due to the immune response (fever, body aches, etc) may be slightly more common with Arexvy...since it is adjuvanted.

Arexvy costs $280/dose...Abrysvo is $295/dose. But expect Medicare Part D to cover no co-pay. And many payers will cover RSV vaccines for age 60 to 64...since CDC recommends them.

Stay tuned for our guidance about maternal use of Abrysvo...and nirsevimab-alip (Beyfortus), a new monoclonal antibody to prevent RSV in infants and some toddlers.

Key References

  • Melgar M, Britton A, Roper LE, et al. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Jul 21;72(29):793-801.
  • CDC. Respiratory Syncytial Virus Infection (RSV). Older Adults. July 14, 2023. (Accessed August 3, 2023).
Prescriber's Insights. September 2023, No. 390902

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