Respiratory Syncytial Virus (RSV) Vaccine

There are 3 RSV vaccines:

• Nonadjuvanted RSV vaccine

• Adjuvanted RSV vaccine

• Nonadjuvanted mRNA-based RSV vaccine

The nonadjuvanted RSV vaccine and the adjuvanted RSV vaccine are inactivated recombinant respiratory syncytial virus glycoprotein antigen components.

The nonadjuvanted mRNA-based RSV vaccine is a nucleoside-modified mRNA encoding the RSV F glycoprotein (preF protein).

The RSV vaccines are indicated for the prevention of infection caused by respiratory syncytial virus. Guidance on RSV vaccination evolves over time, and various expert organizations issue differing recommendations. See Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP) for specific recommendations and further information.

The nonadjuvanted RSV vaccine is indicated for pregnant patients at 32 through the end of 36 weeks gestation from September through January in most of the continental United States (1). Additional doses within the same or in subsequent pregnancies are not recommended. Infants born to pregnant patients who received RSV vaccine during a previous pregnancy should receive RSV monoclonal antibody instead. In locations with RSV seasonality that differs from most of the continental United States (eg, Alaska, locations with tropical climate), it is recommended that clinicians follow guidance from public health authorities (eg, the Centers for Disease Control and Prevention [CDC], state and local health departments) or regional medical centers on timing of administration based on local RSV seasonality. The vaccine should be administered regardless of previous RSV infection.

Any of the 3 RSV vaccines are recommended for all adults ≥ 75 years as well as for some adults ≥ 50 years based on shared clinical decision making. Specifically, adults ≥ 50 years who are most likely to benefit from the vaccine are those who are considered to be at increased risk of severe RSV disease, including those with chronic medical conditions such as the following:

• Lung diseases

• Cardiovascular diseases

• Neurologic or neuromuscular conditions

• Kidney disorders

• Liver disorders

• Hematologic disorders

• Diabetes mellitus

• Moderate or severe immunocompromise (either attributable to a medical condition or to receipt of immunosuppressants or treatment)

People who are frail or who reside in nursing homes or other long-term care facilities are also at high risk of severe RSV infection.

The main contraindication for RSV vaccines is:

• A severe allergic reaction (eg, anaphylaxis) to a vaccine component

The main precaution with RSV vaccines is:

• Moderate or severe acute illness with or without fever

For RSV vaccines available for use in the United States, all dose and administration information for all age groups and people with special conditions is available from the CDC, AAP, and AAFP (1–3).

RSV vaccine doses should be administered by the intramuscular route.

The RSV vaccine is administered as a single 0.5 mL-dose IM.

Adverse effects include injection site pain, fatigue, myalgia, headache, and arthralgia.

For more information about adverse effects of these vaccines, refer to the prescribing information.

The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.

1. Advisory Committee on Immunization Practices (ACIP): ACIP Recommendations: Respiratory Syncytial Virus (RSV) Vaccine Immunizations

2. Centers for Disease Control and Prevention (CDC): RSV (Respiratory Syncytial Virus)

3. CDC: Healthcare Providers: RSV Vaccination for Adults 60 Years of Age and Over

4. CDC: Clinical Guidance for RSV Immunizations and Vaccines

5. CDC: Healthcare Providers: RSV Immunization for Infants and Young Children

6. European Centre for Disease Prevention and Control (ECDC): RSV: Recommended vaccinations