Educate Patients About Changing Adult RSV Vaccine Recommendations

Respiratory syncytial virus (RSV) is a respiratory virus thatR usually causes mild symptoms, but it can cause serious illness in infants and older adults.1 Until recently no vaccines were available for RSV, and the lack of preventive measures was a significant problem. The CDC estimates that each year RSV leads to approximately 2.¹ million outpatient visits and between 100 and 300 deaths among children younger than 5 years, and between 60,000 and 160,000 hospitalizations and 6000 to 10,000 deaths among adults 65 years and older.²

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In May 2023, the FDA approved the first RSV vaccine, Arexvy (GSK), for patients 60 years and older.³ Shortly thereafter, the agency approved another RSV vaccine, Abrysvo (Pfizer), with the same indication. Most recently, in May 2024, mRESVIA (Moderna) received approval as a third option for vaccination in those 50 years and older, although there is no current recommendation for vaccination for anyone under 60 years old, unless they fall under the seasonal pregnancy indication.

Initially, the CDC Advisory Committee on Immunization Practices (ACIP) decided on a shared clinical decision-making (SCDM) recommendation in lieu of a routine recommendation for these vaccines for everyone 60 years and older. Pharmacists and other clinicians were faced with the challenge of interpreting SCDM and how to use it in their practices and recommendations. SCDM is intended to remove the default decision to vaccinate. The CDC explains, “The decision about whether or not to vaccinate may be informed by the best available evidence of who may benefit from vaccination; the individual’s characteristics, values, and preferences; the health care provider’s clinical discretion; and the characteristics of the vaccine being considered.”⁴ The challenge for pharmacists is that there is no prescribed set of considerations or discussion points in the decision-making process. This lack of structure can make the recommendation process more difficult and, at times, confusing for both pharmacist and patient.

In June 2024, ACIP updated its RSV vaccine recommendation for adults to include a routine (universal) recommendation for patients 75 years and older. Those aged 60 to 74 years are still advised to receive an RSV vaccine, but only if they are at increased risk of severe RSV disease according to high-risk factors defined by the CDC.⁵ Although these recommendations are clearer, especially for patients older than 75 years, some gray area remains for those aged 60 to 74. This ambiguity makes pharmacists hesitant to make a strong recommendation. For example, patients with cardiovascular diseases are included in the recommendation, but those with isolated hypertension are excluded.⁵ Similarly, patients with diabetes are included, but only those with endorgan damage (diabetic nephropathy, neuropathy, retinopathy, etc).⁵ These types of specific recommendations make it difficult to confidently identify patients at the community pharmacy level because a full medical history, laboratory values, and other information are often not readily available to pharmacists.

Many community pharmacists are asking how they are supposed to effectively identify, engage with, and talk to patients about the RSV vaccines. In a little more than a year, the FDA has approved 3 new RSV vaccines for use, and the recommendations have already been changed from the original ACIP voting language. At Rite Aid, pharmacists have been directed to focus on adults who are 75 years and older who are universally recommended to be vaccinated, while the clinical services team works to provide tools to efficiently and effectively identify patients aged 60 to 74 years who are likely candidates for vaccination.

One group of likely candidates at Rite Aid are patients aged 60 to 74 with chronic lung conditions. Both asthma and chronic obstructive pulmonary disease (COPD) are included as high-risk factors for RSV, making patients with those conditions eligible for vaccination. Patients with asthma or COPD are generally easy to identify in a community pharmacy setting if they are filling or picking up maintenance inhalers. Pharmacists can confidently recommend the RSV vaccine to these patients, knowing that their risk factor is clearly stated in the ACIP recommendation for those 60 to 74 years old.

Although this is just one example of how pharmacists can concentrate their efforts this fall and winter, the concept can be applied to other parts of the recommendation. RSV, influenza, and COVID-19 are all expected to increase in activity throughout the fall and winter months. For community pharmacists, the time to protect patients is now, and becoming comfortable with the available RSV vaccines and recently updated RSV vaccine recommendations will be paramount to success.

References

1. About RSV. CDC. June 5, 2024. Accessed July 20, 2024. https://www.cdc.gov/rsv/about/index.html

2. Surveillance of RSV. CDC. June 5, 2024. Accessed July 19, 2024. https://www.cdc.gov/rsv/php/surveillance/index.html

3. FDA approves first respiratory syncytial virus (RSV) vaccine. FDA. News release. May 3, 2023. Updated May 4, 2023. Accessed July 17, 2024. https://www.fda.gov/news-events/press-announcements/fda-approvesfirst-respiratory-syncytial-virus-rsv-vaccine

4. ACIP shared clinical decision-making recommendations. CDC. Updated September 29, 2023. Accessed July 20, 2024. https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html

5. Healthcare providers: RSV vaccination for adults 60 years of age and over. CDC. Updated July 3, 2024. Accessed July 22, 2024. https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html