ASHP Midyear: Pharmacists Can Advocate for Expanded RSV Vaccination Recommendations

The updated 2024 RSV vaccination guidelines have provided clearer recommendations, stating that adults 75 and older should receive the vaccine, while those aged 60 to 74 should be vaccinated if they have additional risk factors, said Chelsea Keedy, PharmD, BCACP, clinical assistant professor at the University of Georgia. This is a change from the previous 2023 guidelines, which presented the RSV vaccine as an option based on shared decision-making between patients and providers. Pharmacists play a vital role in this space, advocating for vaccination, ensuring patients understand the vaccine information and potential adverse effects, and identifying eligible individuals to receive the shot. With the introduction of a third RSV vaccine, an mRNA option that comes ready-to-use, pharmacists can further streamline the vaccination process and reduce burdens.

Pharmacy Times: Have there been any significant updates to RSV guidelines for older adults?

Chelsea Keedy: So the most significant update in the guidelines was that the 2023 guidelines that initially presented the [respiratory syncytial virus (RSV)] vaccination as an option for prevention against RSV recommended that those 60 and above receive the vaccine based on shared clinical decision making between themselves and their providers, so their physician and or their pharmacist, and that can be kind of confusing for patients and providers alike, right? So what does shared decision making really mean? What it means is that you make sure that you are giving the patient all the applicable information in a way that they understand, and you're having a conversation about the vaccine to decide whether or not it's appropriate for that individual. So that was kind of challenging. I think that we are also in a time post-COVID where we're getting new vaccines every year. For this older population, there are a lot of vaccines that are recommended from a year-to-year basis, and sometimes folks are hesitant, right? So I think we find ourselves in this situation where we're choosing which vaccines may be more important than another, and sometimes then those vaccines that have that shared decision making label fall to the wayside. So the 2024 guidelines are more clear in their recommendations, and it takes some of that guesswork out of it. So the new guidelines state that those 75 and older, no matter what, should be vaccinated against, RSV, and those aged 60 to 74 should be vaccinated if they have some of those additional risk factors.

Pharmacy Times: What is the role of the pharmacists in RSV management for older adults, especially those at high risk?

Chelsea Keedy: In the outpatient setting, with regards to management, I think it really has to do with pharmacists advocating for patients to get the vaccine and making sure that patients understand the information about the vaccine when they should get it, and what those potential [adverse] effects are. Those [adverse] effects are relatively low and typically involve some injection site pain that is self limiting and goes away relatively quick. So I think just promoting vaccination, because this is a newer vaccine, it is not a vaccine that you need to get every year, as far as the guidelines go right now, it's a one time vaccination. But we still have room, room to go in terms of how many individuals need to get vaccinated. So I think the role of the pharmacist is really identifying those patients that meet the guideline criteria for vaccination and making sure that they get vaccinated, and making sure that the patients understand the information about the vaccine and that they feel comfortable getting the vaccination, asking their community pharmacists about the vaccination, asking their primary care health provider about the vaccination. So I think our role is really in education and population health management and advocacy to make sure that we are vaccinating the greatest number of people possible in line with the new, updated guideline recommendations.

Pharmacy Times: Is there anything else you would like to add?

Chelsea Keedy: So another update in 2024 is that we have a third RSV vaccine with FDA approval. So the newest vaccine on the market is an mRNA vaccine, and one of the things that's unique about that vaccine is that it does not need to be reconstituted, so it comes in a ready to use syringe, so that can certainly ease the burden for pharmacists a little bit, reduce the risk of needle sticks and things like that. So that's another change, along with the guideline recommendation changes in 2024 is that we now have 3 vaccines on the market that are FDA approved and available for our older patients to get vaccinated against the RSV infection.