Federal health experts adopt new guidelines for adult RSV vaccines. Who should get them?

July 10, 2024
Adults ages 75 and older should get a single dose of an adult RSV vaccine. People ages 60 to 74 who have health complications should also get vaccinated. Photo: Getty Images.
Adults ages 75 and older should get a single dose of an adult RSV vaccine. People ages 60 to 74 who have health complications should also get vaccinated. Photo: Getty Images.

Federal health experts have issued new guidelines for adult RSV vaccines, and some people may be confused since this year’s advice is a little different than last year’s.

So, who should get an RSV vaccine? How are the newest guidelines different from last year’s RSV vaccine recommendations, and how often do older adults need to get an RSV vaccine?

To better understand RSV vaccines for adults, we consulted with Dr. Michelle Barron, UCHealth’s senior medical director of infection prevention and control.

Barron said it’s excellent that there are now RSV vaccines for at-risk older adults. The vaccines were first approved in 2023, and if you’ve already gotten a single dose of an RSV vaccine, you don’t need to worry about getting another dose now.

“You should be good. At this point in time, a single shot is considered a lifetime dose, so you should not get another one,” Barron said. “The new guidelines only apply to people who didn’t get an RSV vaccine last year and are wondering if they would benefit from getting one this year.”

Health experts are encouraging people who could get sickest from RSV to get the new vaccines. People ages 75 and older and those ages 60 and older who have serious health conditions are most at risk if they get RSV and should consider getting the vaccine, Barron said.

“It’s wonderful anytime we can prevent a disease from becoming severe, and preventing hospitalizations is definitely worthwhile, said Barron, who is also a professor at the University of Colorado School of Medicine on the Anschutz Medical Campus.

For both medical providers and patients, the fine print about RSV vaccines can be confusing. So we went over the most frequently asked questions with Barron.

First, what is RSV?

RSV stands for Respiratory Syncytial Virus. Parents of young children may think of RSV by its more common name: croup. Along with older adults, RSV or croup can be very dangerous for newborns and young children. And parents who’ve nursed sick children through a case of croup can attest to the alarming barking seal sound that children make when they’re coughing or gasping for air.

Does RSV cause serious illness for everyone?

No. RSV can be very dangerous for babies, young children and some older adults. But many other people likely have had RSV and didn’t realize it.

That’s because RSV in older children and healthy adults can manifest with basic cold symptoms or those of bronchitis.

“For most people, this is not a big deal,” Barron said. “But in patients who are immunosuppressed because they’ve had a transplant or are undergoing chemotherapy or have really bad underlying lung disease, RSV can get them into a trouble and put them in the hospital. So it’s something we have to pay attention to.”

Is there an RSV vaccine for babies and children?

No. There is not an RSV vaccine for infants and children. Especially vulnerable newborns — like those born prematurely — can receive a new injected medication called nirsevimab. It’s a type of monoclonal antibody that babies can receive if they’re born during RSV season. Learn more about monoclonal antibodies for RSV.

What about those who are pregnant? Should they get an RSV vaccine?

Yes. For pregnant women who are due to deliver babies during the winter months — when RSV most commonly peaks — medical experts recommend one dose of an RSV vaccine at 32 to 36 weeks of pregnancy.

So what are the new guidelines for adult RSV vaccines?

Medical advisers to the U.S. Centers for Disease Control and Prevention (CDC) who are part of the CDC’s Advisory Committee on Immunization Practices voted on June 26 to revise guidance related to adult RSV vaccines. Leaders at the CDC then adopted these new guidelines.

Here are the newest recommendations for RSV vaccines for adults:

  • Everyone ages 75 and older is at greater risk of getting severely ill with RSV and should get a single dose of an RSV vaccine.
  • People ages 60 to 74 should get an RSV vaccine if they have health complications including the following:
    • Heart disease
    • Lung disease including asthma, emphysema and COPD or chronic obstructive pulmonary disease
    • Diabetes with end-stage organ damage
    • Severe obesity (a body mass index or BMI greater than 40)
    • Chronic kidney disease
    • Liver disorders
    • Illnesses like sickle cell disease

In addition, experts encourage people who are immunocompromised, such as transplant recipients, to get the RSV vaccine. And people living in nursing homes and long-term care facilities should also get a single dose of the RSV vaccine since the virus can spread quickly and cause serious illness to people living in elder care facilities.

“Older people who get RSV infections tend to end up in the hospital and can have complications once they’re hospitalized,” Barron said. “The new guidelines make sense in that they’re trying to target the people who are at highest risk.”

People who have questions about whether they should get an RSV vaccine should talk with their doctors.

Dr. Michelle Barron provides information on new RSV vaccines for older adults. Photo by Sonya Doctorian.
Dr. Michelle Barron said RSV is especially dangerous for young babies and older adults. There’s not an RSV vaccine for kids yet, but older adults should consider getting one dose of the new RSV vaccines. Photo by Sonya Doctorian.

How did the guidelines for RSV vaccines change in 2024 compared to 2023?

Last year’s guidelines for RSV vaccines encouraged “shared decision making” for people ages 60 and older. Those guidelines spurred confusion both for medical providers and patients who weren’t certain who should get an RSV vaccine.

In addition, RSV vaccines are relatively expensive. For people without insurance, they can cost about $400 per dose, and a very small percentage of people can experience a serious side effect called Guillain-Barré syndrome.

When medical experts reviewed RSV vaccines this year, they decided to focus on the people who needed them most: those ages 75 and older and those who are dealing with serious underlying health conditions.

Dr. Oliver Brooks is the chief medical officer for Watts HealthCare Corporation in Los Angeles and is a member of the CDC advisory committee for vaccines.

During a recent meeting of the advisers, Brooks said it makes sense to change guidance when new information emerges.

“We shouldn’t vaccinate people who don’t need the vaccine,” Brooks said of the new RSV guidance. “Sometimes we change our minds based on data.”

Barron concurred.

“RSV is not going to have a big impact on everybody. So, from an economic perspective and as it relates to the potential for side effects, not offering this vaccine to the universe at large is probably the best answer for now,” Barron said.

She emphasized that it’s normal for viruses to evolve. So, it’s wise for health experts and policy makers to keep evaluating and reevaluating proper recommendations for RSV and other vaccines.

“We may need to change the recommendations again based on what we learn five years from now,” Barron said. “We’ll continue to evaluate as we go along.”

What’s the ideal time for an adult to get an RSV vaccine?

The best time to get an RSV vaccine is in the late summer or early fall before RSV starts to spread widely during the winter respiratory virus season.

If I’m supposed to get an RSV vaccine, should I get a dose every year like I do for flu and COVID-19 vaccines?

No. For now, medical experts advise people who qualify for RSV vaccines to get a single dose.

Barron said medical experts will continue to monitor the long-term effectiveness of the new RSV vaccines. If the effect of the vaccine wanes over time — as is typical for other vaccines, like those for flu and COVID-19 — it’s possible that federal health authorities will recommend booster doses of RSV sometime in the future.

Were there shortages of RSV vaccines last year?

“No. There were no shortages of the (adult) RSV vaccine,” Barron said.

There were some shortages of the monoclonal antibodies that help prevent RSV in infants and young children, and some people may have mixed up those treatments with the adult RSV vaccines.

“The monoclonal antibody is not a vaccine. But since it’s for prevention of RSV, some people may have bunched the two together,” Barron said.

People who need an RSV vaccine this fall shouldn’t have any trouble getting it, Barron said.

If I need an RSV vaccine, is it OK to get it at the same time as I get my annual flu and COVID-19 vaccines this fall?

Yes. It’s safe to get multiple vaccines at the same time.

Barron is a big fan of convenience. She encourages her patients not to worry too much about the exact timing of their vaccines. If you’re already seeing your doctor this fall, go ahead and get your vaccines at that time. (Learn all about the new 2024-25 COVID-19 vaccine that people should get this fall.)

How common is RSV?

RSV is probably much more common that we know. That’s because it’s unusual to test for RSV unless a child or adult gets so sick that they need to be hospitalized.

“We know that kids are disproportionately affected by RSV, and most parents will get it if their kids get the croup,” Barron said.

“But if you come in to see your doctor, and you say, I have a cold or bronchitis, we might give you something for it, but we’re not typically going to test for RSV. So that’s the end of the story,” she said.

It’s more common these days to test for RSV, especially for anyone who needs hospital care. But additional data in the future may provide a more complete picture of how widespread RSV infections area.

What are the names of RSV vaccines?

The U.S. Food and Drug Administration (FDA) approved the first RSV vaccine in May of 2023. It’s called Arexvy, and the drug manufacturer is GlaxoSmithKline.

FDA officials approved a second RSV drug last year. Pfizer created a drug called Abryzvo. It’s currently the only RSV vaccine which is approved for use during pregnancy.

There’s also a third vaccine aimed at fighting RSV. It’s called mResvia, is made by Moderna and received FDA approval in May of 2024.

Why are RSV vaccines important?

In older adults, RSV can cause serious illness, hospitalization and deaths. For people in high-risk groups, the new RSV vaccines can keep people healthy or if a person gets RSV, the symptoms likely will be milder.

About the author

Katie Kerwin McCrimmon is a proud Coloradan. She attended Colorado College thanks to a merit scholarship from the Boettcher Foundation and worked as a park ranger in Rocky Mountain National Park during summers in college.

Katie is a dedicated storyteller who loves getting to know UCHealth patients and providers and sharing their inspiring stories.

Katie spent years working as an award-winning journalist at the Rocky Mountain News and at an online health policy news site before joining UCHealth in 2017.

Katie and her husband, Cyrus — a Pulitzer Prize-winning photographer — have three adult children and love spending time in the Colorado mountains and traveling around the world.