CDC Committee Advises Shared Decision Making for Older Adult RSV Vaccination

Using shared decision making, adults aged 60 years and older may receive a single dose of a respiratory syncytial virus (RSV) vaccine, according to guidance from the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices published in Morbidity and Mortality Weekly Report.

“For RSV vaccination, the decision to vaccinate a patient should be based on a discussion between the health care provider and the patient, which might be guided by the patient’s risk for disease and their characteristics, values, and preferences; the provider’s clinical discretion; and the characteristics of the vaccine,” the recommendations state.

Six cases of inflammatory neurologic events after RSV vaccination were reported in clinical trials, but it is unknown whether RSV vaccination increased the risk for such events or whether they occurred by chance. Until more data is available, the committee advised targeting RSV vaccination to those at highest risk for severe RSV disease.

Older adults most likely to benefit from vaccination include those with chronic lung diseases, chronic cardiovascular diseases, compromised immune systems, hematologic disorders, neurologic disorders, endocrine disorders, kidney and liver disorders, or other factors a provider determines may increase risk, as well as residents of nursing or other long-term care facilities, according to the report.

Because RSV seasonality has yet to return to prepandemic patterns, the 2023-2024 season remains difficult to predict. The guidance recommends providers offer RSV vaccination to adults 60 and older as soon as possible, with repeated offers to eligible patients who remain unvaccinated.

Coadministration with other vaccines at the same visit is acceptable, although it may increase reactogenicity, the recommendations state. However, RSV vaccination should be delayed for patients with moderate or severe acute illness, with or without fever, and is contraindicated in patients with a history of severe allergic reaction to any vaccine component.

“RSV vaccines have demonstrated moderate to high efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults; postmarketing surveillance will direct future guidance,” the committee wrote.

Reference

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(29):793-801. doi:10.15585/mmwr.mm7229a4