ACIP Revises Recommendation for Adult RSV Vaccination

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) on Wednesday recommended that all US adults aged 75 years and older receive a one-time vaccination against respiratory syncytial virus (RSV) and that those aged 60 to 74 years who are at increased risk for severe disease also receive the vaccine.

The advisory committee, however, postponed a vote on recommending RSV vaccination for adults aged 50 to 59 years who are at increased risk, citing the need for additional data.¹

The ACIP considered recommendations for the former 2 age groups separately and voted unanimously, 11-0, to pass both.¹

The original recommendation made ahead of last year’s RSV season, the first for which any vaccine against the infection was available, was for immunization of adults aged 60 years and older based on a “shared clinical decision making” (SCDM) model that encouraged a conversation between patient and clinician on the risks and benefits of the vaccination.¹ 

Last year’s SCDM recommendation was made in the “setting of uncertainty about the estimated benefits and potential risks of RSV vaccination,” according to a slide presentation made during yesterday’s meeting.² The committee also presented results of physician surveys that found the clinicians think shared decision making “increases time and confusion,” and a significant proportion of respondents agreed that they were unsure of how to implement SCDM as the ACIP intended.² The group decided that simplification would be in the best interest of clinician and patients.

The transition to the universal recommendation could potentially increase access to RSV immunization for the estimated population of 23 million US adults aged 75 years and older.³ On the other hand, the risk-based guidance for the RSV vaccine in 60- to 74-year-olds may prove less permissive, with the potential to restrict access to individuals who don’t have a chronic condition that fits into the CDC qualification list.² To that end, the CDC “will publish Clinical Considerations that describe chronic medical conditions and other risk factors for severe RSV disease for use in this risk-based recommendation.”² (See below)

Immunizations were available last year for populations vulnerable to RSV infection, ie, infants and young children, and people 60-years-old and older. The amended recommendation is based on cost effectiveness studies and on analyses of real-world data demonstrating the level of protection against RSV-associated hospitalization during the first post-vaccination season among the population aged 60 and older, including adults 75 years and older.¹

Postponement of a recommendation for use of Arexvy (GSK) in the younger adult age group (50 to 59 years) for which GSK was just granted a label expansion, was a cautionary move and linked to a dearth of data that the ACIP said would support a population-based recommendation.² There are also lingering concerns about the magnitude of the risk for Guillan-Barre syndrome following RSV vaccination. The RSV Work Group “believes the GBS signal continues to warrant close attention and additionalfollow-up.”²

“The CDC has updated its RSV vaccination recommendation for older adults to prioritize those at highest risk for serious illness from RSV,” CDC director Mandy Cohen, MD, MPH, said in a news release. “People 75 or older, or between 60-74 with certain chronic health conditions or living in a nursing home should get one dose of the RSV vaccine to provide an extra layer of protection.”¹

These recommendations are only for adults who did not get an RSV vaccine last year, the CDC said. The RSV vaccine is not currently an annual vaccine. Eligible adults can get an RSV vaccine at any time, but the best time to for the shot is in late summer and early fall before RSV usually starts to spread in communities, according to the CDC’s statement.

Health care providers should recommend RSV vaccines to their eligible patients, as well as discuss what other vaccines they will need this fall to help prevent respiratory infections, the CDC recommended.

There are now 3 FDA-approved RSV vaccines approved for older adults. Abrysvo (Pfizer), and Arexvy (GSK) were approved last year. mRESVIA (Moderna), the first RSV vaccine produced using mRNA technology, was approved at the end of May.

References
1. CDC Updates RSV Vaccination Recommendation for Adults. News release. Centers for Disease Control and Prevention. June 26, 2024. Accessed June 27, 2024.https://www.cdc.gov/media/releases/2024/s-0626-vaccination-adults.html
2. Britton A, Melgar M, Roper L. Evidence to recommendations framework (EtR) RSV vaccination in adults aged 50-50 years, 60-74 years, and 75 years and older. Advisory Committee on Immunization Practices. Presentation June 26, 2024. Accessed June 27, 2024. https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2024-06-26-28/11-RSV-Adult-Melgar-Roper-Britton-508.pdf
3. United States Census Bureau. International Database: World Population Estimates and Projections: USA, 2024. https://www.census.gov/library/stories/2023/12/happy-new-year-2024.html