Commentary
Article
What You Should Know About RSV and How to Prevent It
It is important for pharmacists to understand what RSV is, who is most affected by it, and what options are out there to prevent serious disease.
Respiratory syncytial virus (RSV) is a respiratory virus that infects the nose, throat, and lungs, which makes it difficult to differentiate it from the common cold or other respiratory viruses, such as the flu or COVID-19.1 RSV usually does not affect healthy individuals, but rather older adults aged 65 years and older, adults aged 50 years and older with chronic health conditions, and young children.
In older adults and young children, RSV can become severe and result in hospitalizations and possibly death. In the US, RSV is the most common cause of bronchiolitis (inflammation of the small airways within the lungs) in children younger than 1 year old and causes approximately 58,000 hospitalizations among children under 5 annually.2
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Who Should Get the RSV Vaccine?
Older Adults
In June 2023, the Advisory Committee on Immunization Practices (ACIP) and CDC recommended that adults aged 60 years and older receive a single dosage of either RSVPreF3 (Arexvy; GlaxoSmithKline) or RSVpreF (Abrysvo; Pfizer), vaccination to protect against severe RSV, using shared clinical decision-making.3,4 However, in June 2024 the ACIP and CDC modified their recommendations for RSV vaccines to state that all adults aged 75 years and older and adults aged 60 to 74 years old who are at an increased risk for severe RSV should receive a single dose of any of the RSV vaccinations.3,5 Neither ACIP or CDC has a preferential recommendation for any specific vaccine. Eligible adults should receive an appropriate RSV vaccine available to them.
Pregnant Women
The CDC, ACIP, and the American College of Obstetricians and Gynecologists recommend that pregnant women should receive a single dose of the RSV vaccine RSVpreF during 32 to 36 weeks of pregnancy from September to January.6,7 RSVpreF is the only RSV vaccine that is FDA approved to be administered to pregnant women. Currently, the CDC does not recommend additional doses of RSV vaccine during subsequent pregnancies if a pregnant mother has already received a maternal RSV vaccine during any previous pregnancy.7
Infants
Nirsevimab (Beyfortus; AstraZeneca and Sanofi) is recommended by the CDC and American Academy of Pediatrics for administration to neonates and infants born during or who are entering their first RSV season.8 However, nirsevimab should only be given to neonates and infants whose mother did not receive RSVpreF while pregnant, if the vaccination status of the mother is unsure, or if the mother received RSVpreF less than 14 days prior to giving birth. Additionally, nirsevimab may be given to children up to 24 months of age who remain vulnerable to contracting severe RSV-lower respiratory tract disease (LRTD) into and through their second RSV season.8 Nirsevimab, unlike all other RSV vaccines, is not a vaccine that helps an infant's body produce antibodies against RSV, but rather a monoclonal antibody that is injected into the infant’s body to help fight off the RSV infection if they are to be infected by it.9
Clinical Trials and Real World Vaccination Rates
Protein Subunit Vaccines in the 60 and Older Population
RSVPreF3 and RSVpreF were shown in clinical trials to reduce the risk of symptomatic RSV-LRTD by 80% to 90% during the first season following receiving either of these RSV vaccinations.4 The CDC indicated that in the 2023-2024 season, RSVPreF3 was effective in preventing RSV-associated hospitalizations (including critical illness) or emergency department encounters by approximately 77% to 83%.5 Similarly, RSVpreF was effective by approximately 73% to 79%.5
Moderna’s Vaccine
mRNA-1345 (mRESVIA; ModernaTX, Inc) was shown to be effective in protecting adults aged 60 years and older against RSV-LRTD, regardless of comorbidities, by 81% in patients with 3 or more signs or symptoms of RSV during their first season following vaccination.10 Additionally, mRNA-1345 was 79% effective in patients with 2 or more signs or symptoms. No studies have been conducted to show mRNA-1345’s effectiveness in secondary and additional seasons due to its recent FDA approval.
RSVpreF in Pregnancy
RSVpreF, administered to pregnant women during weeks 32 to 36 gestation, demonstrated effectiveness in a phase 3 clinical trial by reducing the risk of a mother’s child being hospitalized for RSV and risk of having a health care visit for RSV within 3 and 6 months after birth.7 Additionally, the maternal RSV vaccine was shown to reduce the risk of severe infant outcomes caused by RSV, such as low oxygen in the blood, the need for mechanical ventilation, or admission to an intensive care unit (ICU) within 3 and 6 months after birth. There was limited real-world effectiveness shown during the 2023-2024 season due to the timing of RSV season and the overall low uptake of maternal RSV vaccine.
Nirsevimab in Neonates and Infants
Nirsevimab was shown during a phase 3 clinical trial to reduce RSV-triggered lower respiratory tract infections that were serious enough to require medical care in infants by 76.4%. Additionally, nirsevimab was shown to cut RSV hospitalizations by 76.8% within healthy full-term and near-full-term infants.9
The CDC continues to monitor the RSV vaccine rates and effectiveness across all vaccine eligible populations. As of October 26th, 2024, an estimated 30.7% of adults aged 75 years old and older and adults 60 to 74 years old with high risk conditions had received an RSV vaccination nationwide.11
Other Ways to Protect From RSV
Getting vaccinated is one way to protect yourself and others from RSV. Additional ways to help prevent the spread of RSV are12:
- Wash your hands often by scrubbing with soap and warm water for at least 20 seconds.
- Keep your hands away from your face, nose, and mouth as much as possible.
- Use a tissue or the inside of your elbow to cover any coughs and sneezes. Make sure to throw away used tissues in the trash and wash your hands after you cough or sneeze.
- Clean high-touch surfaces often (eg, doorknobs, counters, and children’s toys).
- Limit your time spent in crowded spaces.
- Stay home if you or your child is sick.
Conclusion
RSV can cause a respiratory infection for adults aged 75 years and older, adults aged 65 to 74 years old with high risk health conditions, and infants younger than 8 months old. Knowing the different vaccination options available, the populations at risk, and the populations each vaccination is indicated for is vital information for pharmacists across the nation to be well informed about. Additionally, pharmacists should know the best time to encourage patients to receive these vaccinations and common adverse effects of each vaccination to inform patients about. Together, health care providers and patients can work together to prevent the spread of disease by increasing vaccinations towards RSV.
