The RSV Vaccine: Who It Is Recommended For and Why

Why does RSV matter for older adults?

RSV (respiratory syncytial virus) is commonly associated with children, but it causes significant illness in older adults and people with chronic health conditions as well. In older adults, RSV can mimic influenza and lead to pneumonia, worsening of heart failure, COPD exacerbations, and hospitalization.

The disease burden in high-risk adults is comparable in severity to influenza — which is why adult RSV vaccine development became a clinical priority and why the ACIP established formal recommendations beginning in 2023 and updated them in 2024 1Ref 1Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, Havers FP (2023).Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023.Initial 2023 RSV vaccine recommendations for adults 60+; 32–36 weeks maternal vaccine indication; one-time dose guidance; disease burden in older adults comparable to influenza.2Ref 2Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, Ortega-Sanchez IR, Broder KR, Talbot HK, Long SS, Havers FP, Melgar M (2024).Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2024.2024 update: routine recommendation for all adults 75+; direct recommendation (not shared decision-making) for adults 60–74 with specific high-risk conditions; Guillain-Barré syndrome signal noted for protein subunit vaccines; single-dose guidance retained..

Who the current recommendations cover

The 2024 ACIP update divided adult RSV vaccination into clearer risk-based groups 2Ref 2Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, Ortega-Sanchez IR, Broder KR, Talbot HK, Long SS, Havers FP, Melgar M (2024).Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2024.2024 update: routine recommendation for all adults 75+; direct recommendation (not shared decision-making) for adults 60–74 with specific high-risk conditions; Guillain-Barré syndrome signal noted for protein subunit vaccines; single-dose guidance retained.:

Age 75 and older: RSV vaccination is routinely recommended for all adults in this group.

Age 60–74 with increased risk: Vaccination is recommended — not just 'shared decision-making' — if you have one or more of the following: - Chronic cardiovascular or lung disease (COPD, asthma, heart failure) - Diabetes with complications - End-stage renal disease or chronic liver disease - Neurologic conditions affecting breathing - Hematologic conditions or severe obesity - Moderate-to-severe immune compromise - Nursing home residence or frailty

Age 60–74 without high-risk conditions: Shared clinical decision-making still applies in this narrower group.

Pregnant, 32–36 weeks gestation: A single dose of maternal RSV vaccine can pass protective antibodies to the newborn. Discuss timing carefully with your OB, since the gestational window is specific 1Ref 1Melgar M, Britton A, Roper LE, Talbot HK, Long SS, Kotton CN, Havers FP (2023).Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023.Initial 2023 RSV vaccine recommendations for adults 60+; 32–36 weeks maternal vaccine indication; one-time dose guidance; disease burden in older adults comparable to influenza..

Is it a one-time vaccine or annual?

Current ACIP guidance treats RSV vaccination as a single dose for most adults — not an annual vaccine like the flu shot 2Ref 2Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, Ortega-Sanchez IR, Broder KR, Talbot HK, Long SS, Havers FP, Melgar M (2024).Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2024.2024 update: routine recommendation for all adults 75+; direct recommendation (not shared decision-making) for adults 60–74 with specific high-risk conditions; Guillain-Barré syndrome signal noted for protein subunit vaccines; single-dose guidance retained.. Duration of protection is still being studied, and guidance may be updated as longer-term data accumulate.

If you have already received an RSV vaccine, you do not need to repeat it on an annual basis under current recommendations. Your clinician will stay current on any updates to this guidance.

Which RSV vaccines are available?

There are currently three RSV vaccines approved for adults in the U.S., all authorized for adults aged 60 and older 2Ref 2Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, Ortega-Sanchez IR, Broder KR, Talbot HK, Long SS, Havers FP, Melgar M (2024).Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2024.2024 update: routine recommendation for all adults 75+; direct recommendation (not shared decision-making) for adults 60–74 with specific high-risk conditions; Guillain-Barré syndrome signal noted for protein subunit vaccines; single-dose guidance retained.:

• Abrysvo (Pfizer) — also approved for maternal use in pregnancy
• Arexvy (GSK)
• mRESVIA (Moderna) — an mRNA formulation

All three have demonstrated meaningful protection against RSV lower respiratory tract disease in clinical trials. Your clinician or pharmacist will advise on which is available and appropriate for you. The 2024 update noted a possible Guillain-Barré syndrome signal with the protein subunit vaccines (Abrysvo and Arexvy) — discuss your individual history with your clinician if you have concerns 2Ref 2Britton A, Roper LE, Kotton CN, Hutton DW, Fleming-Dutra KE, Godfrey M, Ortega-Sanchez IR, Broder KR, Talbot HK, Long SS, Havers FP, Melgar M (2024).Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2024.2024 update: routine recommendation for all adults 75+; direct recommendation (not shared decision-making) for adults 60–74 with specific high-risk conditions; Guillain-Barré syndrome signal noted for protein subunit vaccines; single-dose guidance retained..

What to do next

The best way to know whether the RSV vaccine is right for you is a direct conversation with a primary care clinician:

• If you are 75 or older: the recommendation is routine — ask about scheduling it.
• If you are 60–74 with chronic conditions: the 2024 update makes vaccination a clear recommendation, not just an option to discuss.
• If you are pregnant: raise it with your OB at your next prenatal visit and ask about the 32–36 week timing window.
• If you are under 60 with no immunocompromising conditions: RSV vaccination is not currently a routine recommendation for your age group.

Medicare Part D and most private insurers cover RSV vaccines for recommended age groups, though coverage details can vary. A pharmacist or your insurance plan can clarify your specific coverage.