Emphasizing the Potential Long-Term Effects of RSV in Older Adults

Although respiratory syncytial virus (RSV) can cause mild coldlike symptoms, some older adults may develop more severe lung infections, pneumonia, and long-lasting conditions.¹ When counseling patients about the importance of immunization, emphasizing the following impacts and associated risk factors could help encourage vaccination.

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RSV Risk Factors

Data have shown that RSV results in an estimated 60,000 to 160,000 hospitalizations and 6000 to 10,000 deaths annually among adults aged 65 years and older.² Adults who are 60 years and older are at an increased risk of severe RSV disease, according to the CDC. Chronic medical conditions such as chronic obstructive pulmonary disease (COPD), cardiovascular disease, and age-associated frailty can further elevate patients’ risk.¹

In one study, with results published in the CDC’s Morbidity and Mortality Weekly Report, researchers examined which patient populations were most at risk for RSV-related hospitalization and which underlying conditions were most commonly associated with RSV in these patients. Among 3218 adults 60 years and older with an identified RSV-associated hospitalization between July 2022 and June 2023, 1738 (54%) were aged 75 years and older, whereas 434 (13.5%) and 1208 (37.5%) were aged 60 to 64 years and 80 years and older, respectively.² Notably, among a random sample of 1634 adults aged 60 years and older who were hospitalized between October 2022 and April 2023 and whose medical charts were reviewed, 290 (17.2%) were residents of long-term care facilities, including 175 (26.9%) of those aged 80 years and older.²

Almost all the sampled patients (1584; 95.5%) had at least 1 underlying medical condition. The most common was obesity (37.8%), followed by COPD (33.7%), congestive heart failure (33.2%), and diabetes mellitus (32.6%). Furthermore, 18.6% had an immunocompromising condition. Several underlying conditions were significantly more prevalent in patients with severe RSV outcomes than in those without severe outcomes, including COPD (40% vs 32%), chronic lung diseases excluding COPD and asthma (9.1% vs 4.4%), and congestive heart failure (41.2% vs 31.4%).²

According to the study authors, their findings could help clinicians and patients make educated decisions regarding RSV vaccination. They also emphasized the need for equitable access to vaccines for underrepresented populations who were hospitalized for RSV at younger ages than were White adults, according to their research.²

Long-Term Impacts of RSV

In addition to identifying underlying conditions that can place older adults at greater risk of severe outcomes with RSV, researchers have also found that RSV can have significant long-term impacts on patients. Although most individuals who contract RSV will have an acute illness, individuals with preexisting medical conditions could experience long-term exacerbations or even permanent challenges.³

For instance, patients who develop pneumonia as a result of RSV can experience lingering coughing that lasts for weeks or months. Furthermore, bronchiolitis, or inflammation in the airways, can be found in adults, although it is more common in children.³ Researchers are also looking at whether RSV can predispose patients to asthma, and although the data are still uncertain, researchers do know that RSV can have a significant impact on individuals who already have asthma. Patients can experience worsening asthma symptoms or asthma attacks as a result of RSV.³ Similarly, individuals with a previous RSV infection and COPD may notice wheezing, coughing, and more difficulties breathing even after they have recovered from their RSV.³

New research has found that a significant number of older adults hospitalized with RSV experience acute cardiac events that are associated with severe clinical outcomes. According to findings, researchers analyzed surveillance data from the RSV Hospitalization Surveillance Network, including adults aged 50 years and older in 12 states over 5 RSV seasons (2014-2015 through 2017-2018 and 2022-2023). The analysis included 6248 hospitalized adults with RSV with a median age of 72.7 years, 59.6% of whom were women and 56.4% of whom had underlying cardiovascular disease.⁴

The weighted estimated prevalence of experiencing a cardiac event was 22.4%. Furthermore, the weighted estimated prevalence was 15.8% for acute heart failure, 7.5% for acute ischemic heart disease, 1.3% for hypertensive crisis, 1.1% for ventricular tachycardia, and 0.6% for cardiogenic shock.⁴

Furthermore, adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event than those who had no underlying cardiovascular disease (33% vs 8.5%). Among all hospitalized adults with RSV, 18.6% required intensive care unit admission and 4.9% died during their hospitalization. Compared with those without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of intensive care unit admission (25.8% vs 16.5%) and in-hospital death (8.1% vs 4%).⁴

Immunizations

The FDA has approved 2 vaccines—Arexvy (GSK) and Abrysvo (Pfizer Inc)—for adults aged 60 years and older, using shared clinical decision-making.⁵ Understanding the underlying conditions that can put patients at greater risk of severe RSV can help properly educate them about the benefits of vaccination, and pharmacists can take a leading role in these conversations.

Arexvy contains a recombinant RSV F protein antigen based on the RSV-A subtype, stabilized in the prefusion conformation (preF) and AS01E adjuvant. Meanwhile, Abrysvo consists of a recombinant RSV F protein antigen based on both the RSV-A and RSV-B subtypes, stabilized in preF.⁶

Pharmacists should educate patients that, in adults aged 60 years and older with healthy immune systems, a single dose of Arexvy was 83% effective in preventing lung infections such as pneumonia due to RSV during the first RSV season after vaccination. During the second season after vaccination, the vaccine was still 56% effective.⁵

Similarly, a single dose of Abrysvo was 89% effective in preventing lung infections in adults aged 60 years and older with healthy immune systems during their first RSV season after vaccination. Research is still ongoing regarding the level of protection provided in the second season after vaccination, although researchers say it continues to provide some level of protection.⁵

Adverse effects such as injection site pain, redness, swelling, fever, fatigue, headache, nausea, diarrhea, and muscle or joint pain are possible after vaccination and are usually mild. A small number of clinical trial participants have developed serious neurologic conditions, including Guillain-Barré syndrome (GBS). Early safety surveillance data suggest a potential increased risk of GBS after RSV vaccination in older adults, but these data are preliminary and cannot be confirmed at this point.⁵

The Pharmacist’s Role

By educating themselves on the developing research on RSV and available vaccines, pharmacists can better inform patients about the risks associated with RSV and whether immunization is right for them. Pharmacists should listen carefully to patients’ concerns, ensuring that they feel heard and that their questions can be answered prior to making a decision.

References

1. RSV in older adults and adults with chronic medical conditions. CDC. Reviewed April 12, 2024. Accessed May 3, 2024. https://www.cdc.gov/rsv/high-risk/older-adults.html

2. Havers FP, Whitaker M, Melgar M, et al. Characteristics and outcomes among adults aged ≥60 years hospitalized with laboratory-confirmed respiratory syncytial virus — RSV-NET, 12 states, July 2022-June 2023. MMWR Morb Mortal Wkly Rep. 2023;72(40):1075-1082. doi:10.15585/mmwr.mm7240a1

3. What are the long-term effects of RSV? Cleveland Clinic. May 14, 2023. Accessed May 3, 2024. https://health.clevelandclinic.org/long-termeffects-of-rsv-in-adults

4. Woodruff RC, Melgar M, Pham H, et al. Acute cardiac events in hospitalized older adults with respiratory syncytial virus infection. JAMA Intern Med. Published online April 15, 2024. doi:10.1001/jamainternmed.2024.0212

5. RSV vaccination for older adults 60 years of age and over. CDC. Reviewed March 1, 2024. Accessed April 3, 2024. https://www.cdc.gov/vaccines/vpd/rsv/public/older-adults.html

6. Healthcare providers: RSV vaccination for adults 60 years of age and over. CDC. Reviewed March 1, 2024. Accessed May 3, 2024. https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html