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Factors to consider as part of shared decision making for RSV vaccination

Factors to consider as part of shared decision making for RSV vaccination
Questions that patients may have Points that may impact their decision
Am I at increased risk for infection? The following factors increase the risk of acquiring RSV:
  • Residing in a nursing home or other long-term care facility.
  • Having frequent exposure to young children.
Am I at increased risk for severe disease if infected? The following conditions increase the risk of developing severe disease (eg, pneumonia, asthma, COPD exacerbation):
  • Cardiopulmonary disease (eg, COPD, asthma, CHF, CAD).
  • Kidney disease.
  • Liver disease.
  • Diabetes mellitus.
  • Chronic or progressive neurologic or neuromuscular conditions.
  • Moderate to severe immunocompromise.
  • Hematologic disorders.
  • Frailty.
  • Advanced age.
What happens if someone has severe disease? Persons who develop severe disease may require hospitalization, supplemental oxygen, ICU care, or mechanical ventilation:
  • RSV leads to approximately 60,000 to 160,000 hospitalizations and 6000 to 10,000 deaths each year among adults 65 years and older.
  • The risk of hospitalization in persons over 65 with underlying conditions can be as high as 16%.
  • Among persons ≥60 years hospitalized with RSV between February 2022 and May 2023, approximately 80% required supplemental oxygen and 24% required ICU care. The risk of mechanical ventilation or death was 13.5%.
  • In persons with severe immunocompromise (eg, selected HCT and lung transplant recipients), mortality rates with RSV can approach 80%.
How can the vaccine help me? Vaccination can:
  • Reduce the risk of lower tract respiratory disease (eg, cough, wheezing, sputum production, shortness of breath) by 74.5 to 84.4%.
  • Reduce the need to seek medical care for RSV disease by 77.5 to 81.0%.
What are the risks of vaccination? Common side effects:
  • Mild to moderate injection site reactions.
  • Systemic side effects (eg, fever, fatigue, myalgia) which typically resolve within 4 days.

Possible rare side effects:

  • Guillain-Barré syndrome (GBS) has been associated with the RSV glycoprotein vaccines. In persons over 65, there are an estimated 9 excess cases of GBS per million doses of the bivalent vaccine and an estimated 7 excess cases of GBS per million doses of the adjuvanted vaccine.

Persons 60 years of age and over are eligible to receive one of the available RSV vaccines.

This table reviews factors that may inform a person's decision to be vaccinated. It is based on a shared decision making tool provided by the United States Centers for Disease Control and should be used in conjunction with UpToDate content on RSV.

CAD: coronary artery disease; CHF: congestive heart failure; COPD: chronic obstructive pulmonary disease; HCT: hematopoietic stem cell transplantation; ICU: intensive care unit.
References:
  1. 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; 72:793.
  2. Surie D, Yuengling KA, DeCuir J, et al. Disease severity of respiratory syncytial virus compared with COVID-19 and influenza among hospitalized adults aged ≥60 years - IVY Network, 20 U.S. States, February 2022-May 2023. MMWR Morb Mortal Wkly Rep 2023; 72:1083.
  3. Falsey AR, Hennessey PA, Formica MA, et al. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med 2005; 352:1749.
  4. Nam HH, Ison MG. Respiratory syncytial virus infection in adults. BMJ 2019; 366:l5021.
  5. Papi A, Ison MG, Langley JM, et al. Respiratory syncytial virus prefusion F protein vaccine in older adults. N Engl J Med 2023; 388:595.
  6. Walsh EE, Pérez Marc G, Zareba AM, et al. Efficacy and safety of a bivalent RSV prefusion F vaccine in older adults. N Engl J Med 2023; 388:1465.
  7. FDA requires Guillain-Barré syndrome (GBS) warning in the prescribing information for RSV Vaccines Abrysvo and Arexvy. US Food and Drug Administration. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/fda-requires-guillain-barre-syndrome-gbs-warning-prescribing-information-rsv-vaccines-abrysvo-and (Accessed on January 13, 2025).
  8. Britton A, Roper LE, Kotton CN, et al. Use of respiratory syncytial virus vaccines in adults aged ≥60 years: Updated recommendations of the Advisory Committee on Immunization Practices — United States, 2024. MMWR Morb Mortal Wkly Rep 2024; 73:696.
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