RSV Vaccine Resources

Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is recognized as one of the most common causes of childhood illness and the most common cause of infant hospitalization. It causes annual outbreaks of respiratory illnesses in all age groups. In most regions of the United States, RSV season starts in the fall and peaks in the winter, but the timing and severity of RSV season in a given community can vary from year to year.

New RSV vaccines are available for adults 60 and older. CDC recommends that adults 60 and older may receive a single dose of RSV vaccine, using shared clinical decision-making. The decision to vaccinate an individual patient should be based on a discussion between the healthcare provider and the patient. It may be informed by the patient’s risk of severe RSV disease and their characteristics, values, and preferences, the healthcare provider’s clinical discretion, and the characteristics of the vaccine.

Healthcare providers should be aware of underlying conditions that may increase the risk of severe RSV illness and who might most likely benefit from these new vaccines.

RSV vaccine is recommended as a single dose. Studies are ongoing to determine whether (and if so, when) revaccination may be needed over time.

Immunizations to Protect Infants

There are two safe and effective immunizations to prevent RSV lower respiratory tract infection in infants. Either a maternal vaccination or a monoclonal antibody is recommended, but administration of both is not needed for most infants.

Maternal Vaccines for Pregnant People

A new RSV vaccine (Abrysvo, Pfizer) is recommended for pregnant people who are 32–36 weeks pregnant with seasonal administration during September–January in most of the continental United States.

This vaccine provides protection against severe RSV illness to the recipient’s baby for up to 6 months of age. However, the infant’s protection will wane over time.

Healthcare providers of pregnant people should provide information on both maternal vaccines and infant monoclonal antibody products and consider patient preferences when determining whether to vaccinate the pregnant patient or to not vaccinate and rely on administration of nirsevimab to the infant after birth.

Monoclonal Antibody Products for Infants and Young Children

Nirsevimab (Beyfortus) is a monoclonal antibody product that can protect infants and some young children from severe RSV disease. It is recommended for:

Infants under eight months old born during – or entering – their first RSV season (typically fall through spring) if their mother did not receive an RSV vaccine, it is unknown if their mother received an RSV vaccine, or the mother received a vaccine, but the infant was born <14 days after vaccination
Nirsevimab can be considered in rare circumstances even though the mother received an RSV vaccine when, per the clinical judgment of the healthcare provider, the potential incremental benefit of administration is warranted
Pregnant people who may not mount an adequate immune response to vaccination (e.g., people with immunocompromising conditions) or have conditions associated with reduced transplacental antibody transfer (e.g., people living with HIV infection)
Infants who have had cardiopulmonary bypass leading to loss of RSV antibodies
Infants with substantially increased risk for severe RSV disease (e.g., hemodynamically significant congenital heart disease, intensive care admission, and requiring oxygen at discharge)

Some children between the ages of 8 and 19 months are at increased risk of severe RSV disease before their second RSV season. These include:

Children who have chronic lung disease of prematurity who require medical support (chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before the start of the second RSV season
Children with severe immunocompromise
Children with cystic fibrosis who have severe disease
American Indian and Alaska Native children

Immunizations to Protect Adults

Vaccine recommendations

Two RSV vaccines are licensed for adults aged 60 years and older: RSVPreF3 (Arexvy, GSK) and RSVpreF (Abrysvo, Pfizer). For additional details on the Advisory Committee on Immunization Practices (ACIP) recommendations for RSV vaccination, see Adult RSV ACIP Vaccine Recommendations | CDC.

Adults aged 60 years and older:

CDC recommends that adults 60 years of age and older may receive a single dose of RSV vaccine using shared clinical decision-making (SCDM). This means that healthcare providers and their patients should discuss whether RSV vaccination will be beneficial. This recommendation differs from routine age-based and risk-based vaccine recommendations for which the default decision is to vaccinate all persons in a specified age group or risk group. Under SCDM, there is no default. Rather, the decision whether to vaccinate a patient is individually based and informed by discussions between the patient and health care provider (anyone who provides or administers vaccines, including primary care physicians, specialists, physician assistants, nurse practitioners, registered nurses, and pharmacists).

The decision may be informed by a patient’s health status, their risk of severe RSV disease (see Risk Factors for Severe RSV disease below), the health care provider’s clinical judgment, the patient’s preferences, the safety profile of the RSV vaccine products (see Vaccine Safety section below) and other factors. The SCDM recommendation for RSV vaccination is intended to allow providers and patients flexibility based on what is best for each individual patient.

Risk factors for severe RSV disease

Epidemiologic evidence indicates that persons aged 60 years and older who are at highest risk for severe RSV disease and who might be most likely to benefit from vaccination include those with chronic medical conditions such as:

Cardiopulmonary disease,
Kidney disorders,
Liver disorders,
Neurologic or neuromuscular conditions,
Hematologic disorders,
Diabetes mellitus, and
Moderate or severe immune compromise (either attributable to a medical condition or receipt of immunosuppressive medications or treatment); as well as:
Persons who are frail*;
persons of advanced age;
persons who reside in nursing homes or other long-term care facilities and
persons with other underlying conditions or factors that the provider determines might increase the risk for severe respiratory disease.