RSV Vaccination: Building Trust in Communities

Pharmacists are the cornerstone of health care, connecting prescribing physicians and their local communities. In particular, patients in underserved communities do not have easy access to health care or regular physician visits, so as the most accessible health care professionals, pharmacists need the necessary skills to prevent, identify, and treat various illnesses.

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With the incidence of respiratory syncytial virus (RSV) on the rise, pharmacists are often faced with questions regarding the virus and its recently approved vaccines. Pharmacists must educate and counsel patients about RSV to help keep local communities safe and healthy. Counseling patients involves being transparent about the virus and the vaccine to build trust with the community and decrease vaccine hesitancy.¹

About the Virus

RSV is a respiratory virus that primarily infects young children and older adults.² Frequently, younger children are exposed to the virus when at school or day care, then transmit it to caregivers or grandparents.² The virus is very contagious because it travels via respiratory droplets and can remain on surfaces for many hours.³ Individuals infected with the virus are contagious for 3 to 8 days and can transmit the virus to others before showing any symptoms.³

As a precaution, pharmacists must regularly disinfect surfaces around the pharmacy department and patient areas using 70% isopropyl alcohol to prevent spread of all viruses.⁴ Many pharmacies provide hand sanitizer stations and post signs around the pharmacy to remind patients about the importance of hand hygiene. Because not all infected patients show symptoms, regular disinfection and hand hygiene go a long way to limit transmission.³ These are inexpensive ways to prevent illness, particularly for underserved populations who may not be able to access or afford more intensive prevention methods.

For patients who are showing symptoms, pharmacists must identify RSV to prevent contamination to other patients and staff members. Patients who do not have access to other health care professionals or medical information may mistake an RSV infection for another respiratory virus and transmit it to others. COVID-19, influenza, the common cold, and RSV all have similar symptoms, making it increasingly difficult for patients to identify.⁵ Symptoms of these infections include runny nose, fever, cough, and shortness of breath.⁵ Mild RSV symptoms peak 3 to 5 days after the infection begins.⁶

Because of time constraints, counseling all patients in a community pharmacy is difficult, so many pharmacists place pamphlets in prescription bags or signage on doors to reach more patients. Infographics that are easy to understand are helpful for counseling all patients, including those with low health literacy, language barriers, or other obstacles that prevent comprehension. The Table shows an example of a typical infographic for patients.⁵

For mild infections, OTC products are most effective for symptom management because prescription treatment is not indicated. Asking the patient a few simple questions can narrow down which OTC options might be best. These questions could include, but are not limited to, the patient’s age, symptoms, and other medications (including prescriptions, OTC options, and supplements).

This type of counseling may not be possible if language barriers exist. If a pharmacy is located in an area with many different cultural backgrounds and languages, leadership can encourage staff to learn common health care phrases in the languages most often spoken by patients. For example, if Spanish-speaking patients mention duele (“hurt”) and cabeza (“head”) in the same sentence, they might be trying to indicate that they have a headache. However, because this method is imperfect, pharmacy staff also need education about using online translators to aid patients who speak other languages. Most smartphones come equipped with a translator application that has type- or voice-to-text options.

Many OTC treatment options are inexpensive and improve patient comfort. Pharmacists can educate patients on the importance of remaining hydrated when they are sick. Drinking fluids loosens phlegm and mucus to keep airway passages open for better breathing. OTC nasal saline also helps with congestion and can be used in younger children.⁷ If a patient is experiencing headache or fever, recommending OTC anti-inflammatory medications such as acetaminophen, ibuprofen, and aspirin is appropriate. If a patient is experiencing shortness of breath, they should be referred to the emergency department, as breathing issues are a sign of more severe infection.⁵

RSV Vaccination

Two vaccines were approved for RSV in 2023. Both vaccines, Arexvy (GSK) and Abrysvo (Pfizer Inc), are indicated for active immunization for prevention of lower respiratory tract disease (LRTD) caused by RSV in patients 60 years or older. Recommending Arexvy or Abrysvo to all patients who meet this criterion and do not have an allergy to the vaccine is prudent. Vaccination for older adults is important to prevent serious illness. Between 60,000 and 160,000 older adults are hospitalized and 6000 to 10,000 die from RSV every year.² On average, each RSV-related hospital visit can cost $8049 to $12,125.⁸ Costs this high are an economic burden for both the patient and the health care system.

In underserved communities, pharmacies are often the most convenient locations for patients to receive vaccines. When appointments are convenient, accessible, and have short wait times, patients are more willing to be vaccinated. Sometimes co-administration of vaccinations is appropriate and saves the patient time by not requiring another trip to the pharmacy. Access to transportation may hinder a patient from returning to the pharmacy for a second vaccine. Due to similar peak seasons with COVID-19, RSV, and influenza, patients may be eligible for multiple vaccinations.^9,10 Studies on the effects of RSV and influenza vaccine co-administration found a lower antibody titer, but conclusions about the clinical significance of this result are unknown.⁷ Pharmacists can discuss receipt of multiple vaccinations in 1 sitting with the patient and emphasize the benefits.

Vaccine Hesitancy

Vaccine hesitancy has many influences. One often underdiscussed influence is cultural differences regarding vaccines and health care approaches more broadly. During the COVID-19 pandemic, acceptance for the COVID-19 vaccine in White and Asian populations was around 37% and 44% respectively.¹¹ In comparison, vaccine acceptance was 30% and 19% for Hispanic and Black populations, respectively.¹¹ Pharmacists are responsible for building trust in these communities. Encourage open conversations led by the patients so they can ask questions and learn more about the vaccine.

Understanding the RSV vaccines’ safety and efficacy will help when counseling a patient who is vaccine hesitant. During phase 3 clinical trials for Abrysvo, a single dose was 84.4% effective at preventing RSV-associated LRTD across 2 seasons.⁷ Clinical trials for Arexvy demonstrated a 74.5% effectiveness at preventing RSV-related LRTD from a single dose.⁷

For the safety of Abrysvo, 1% of the intervention group had a grade 3 or higher reaction vs 0.7% of the placebo group.⁷ Arexvy vs placebo had 4.4% and 4.3% frequency of serious adverse events, respectively.⁷ To ease vaccine hesitancy, it is essential to answer any questions patients have about vaccines prior to administration.

Some patients may be hesitant because of the cost of these vaccines. Affordability is a barrier to care for many patients.¹ Without insurance, prices for the RSV vaccine are as much as $350 for patients using online coupon vouchers.^12,13 In low-income communities, vaccines are unobtainable at this price. However, Medicare and Medicaid patients receive full coverage for RSV vaccines.^14,15 Under Medicare part D and Medicaid, all vaccines recommended by the Advisory Committee on Immunization Practices have no co-payment or deductible.^14,15 Patients with these qualifications need to be made aware that they can receive the RSV vaccine at no cost.

Conclusions

For patients in underserved populations, the community pharmacy may be the only way to receive trustworthy information about RSV. Transportation, language, culture, and hesitancy are barriers for many patients who are eligible for preventive care. Pharmacists must combine their knowledge of the vaccine and their understanding of the community they work in to promote preventive health care and the RSV vaccine.

References

1. Lazar M, Davenport L. Barriers to health care access for low income families: a review of literature. J Community Health Nurs. 2018;35(1):28-37. doi:10.1080/07370016.2018.1404832

2. RSV (respiratory syncytial virus). US Department of Health and Human Services. Reviewed November 14, 2024. Accessed March 25, 2024. https://www.hhs.gov/immunization/diseases/rsv/index.html

3. RSV transmission. CDC. Reviewed April 26, 2023. Accessed March 25, 2024. https://www.cdc.gov/rsv/about/transmission.html

4. Cleaning for RSV. American Cleaning Institute. Accessed March 25, 2024. https://www.cleaninginstitute.org/understandingproducts/promoting-wellness/cleaning-rsv

5. How to tell the difference between flu, RSV, COVID-19, and the common cold. National Foundation for Infectious Diseases. Accessed March 26, 2024. https://www.nfid.org/resource/how-to-tell-the-difference-between-flu-rsv-covid-19-and-thecommon-cold/

6. RSV (respiratory syncytial virus). Yale Medicine. Accessed March 26, 2024. https://ym.care/k73

7. Use of respiratory syncytial virus vaccines in older adults: recommendations of the Advisory Committee on Immunization Practices — United States, 2023. CDC. July 21, 2023. Accessed March 26, 2024. https://www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm

8. Grace M, Colosia A, Wolowacz S, Panozzo C, Ghaswalla P. Economic burden of respiratory syncytial virus infection in adults: a systematic literature review. J Med Econ. 2023;26(1):742-759. doi:10.1080/13696998.2023.2213125

9. RSV surveillance & research. CDC. Reviewed July 17, 2023. Accessed March 26, 2024. https://www.cdc.gov/rsv/research/index.html

10. Flu season. CDC. Reviewed September 20, 2022. Accessed

March 25th, 2024. https://www.cdc.gov/flu/about/season/index.html

11. Jones J, Trombley TE, Trombley MP. Impact of cultural tightness on vaccination rate. Risk Manag Insur Rev. 2022;25(3):367-389. doi:10.1111/rmir.12223

12. Abrysvo. GoodRX. Accessed March 27, 2024. https://www.goodrx.com/abrysvo

13. Abrysvo coupons & prices. SingleCare. Accessed March 27, 2024. https://www.singlecare.com/prescription/abrysvo

14. How to pay for vaccines. CDC. Reviewed September 28, 2023. Accessed March 25, 2024. https://www.cdc.gov/vaccines/adults/pay-for-vaccines.html

15. Respiratory syncytial virus (RSV) shot. Medicare.gov. Accessed March 25, 2024. https://www.medicare.gov/coverage/respiratory-syncytial-virus-rsv-shot