Understanding RSV's Impact on Older Adults
Respiratory Syncytial Virus (RSV) is a common, contagious respiratory virus that typically causes mild, cold-like symptoms in healthy people. However, for certain vulnerable populations, including infants and older adults, an RSV infection can be much more severe, leading to serious lower respiratory tract diseases such as pneumonia and bronchiolitis.
For adults aged 60 and over, the risk of severe illness, hospitalization, and even death from an RSV infection increases significantly. This is primarily due to age-related changes in the immune system and the higher prevalence of underlying medical conditions, such as chronic heart disease, chronic lung disease (like COPD and asthma), and diabetes. These factors weaken the body's ability to fight off infections, making a preventative measure like vaccination extremely important.
The FDA-Approved RSV Vaccines for Seniors
As of recent recommendations, there are three FDA-approved RSV vaccines available for adults. The Centers for Disease Control and Prevention (CDC) does not have a preferential recommendation for any one brand for eligible older adults, meaning the 'best' option can depend on individual circumstances and shared clinical decision-making with a healthcare provider. The current choices include:
- Arexvy (GSK): Approved for adults 50 years and older.
- Abrysvo (Pfizer): Approved for adults 18 years and older, and also approved for use in pregnant individuals to protect newborns.
- mResvia (Moderna): Approved for adults 60 years and older, and also for adults aged 18 to 59 at increased risk.
Comparing Your RSV Vaccine Options
With multiple options available, it's helpful to understand the key differences between the vaccines. While all have shown high effectiveness against severe RSV disease, their specific compositions and target populations differ slightly.
RSV Vaccine Comparison Table
| Feature | Arexvy (GSK) | Abrysvo (Pfizer) | mResvia (Moderna) |
|---|---|---|---|
| Vaccine Type | Recombinant protein | Recombinant protein (bivalent) | mRNA |
| Adjuvant | Yes (contains an adjuvant to enhance immune response) | No | No |
| Composition | Uses prefusion F protein from RSV | Uses prefusion F protein from both RSV A and B strains | Uses mRNA to instruct cells to produce prefusion F protein |
| Key Approval | Adults 60+ (and 50-59 at increased risk) | Adults 60+ (and 18-59 at increased risk), and pregnant women | Adults 60+ (and 18-59 at increased risk) |
| Protection Length | Studies showed durable protection through ~23 months | Studies showed durable protection through ~18 months | Studies showed durable protection through ~12 months (ongoing) |
| Coadministration | May increase common side effects when given with other vaccines | May increase common side effects when given with other vaccines | May increase common side effects when given with other vaccines |
Which RSV Vaccine Should You Choose?
Since the CDC does not recommend one vaccine over the others for eligible older adults, the decision often comes down to personal health factors, preferences, and availability. A conversation with your doctor is the most crucial step.
Here are some factors to discuss with your healthcare provider:
- Risk Factors: Are you aged 75 or older, or are you between 60 and 74 with underlying conditions like chronic lung or heart disease, diabetes, or severe obesity? Your risk profile helps determine eligibility and the importance of vaccination.
- Allergies: While rare, if you have a history of a severe allergic reaction to any component of a specific vaccine, it should be avoided. Your doctor can review the ingredients with you.
- Availability: Your pharmacy or doctor's office may only stock one or two of the available vaccines. In many cases, getting the available vaccine is the best option rather than delaying protection.
- Vaccine Type: While all are effective, some individuals may have a personal preference for a specific type (e.g., mRNA technology vs. recombinant protein). It's important to note that Abrysvo is the only one that can also be used during pregnancy to protect infants, which is not relevant for older adults but highlights a key difference in use cases.
Effectiveness and Side Effects
Real-world studies and clinical trials have shown high effectiveness for all three vaccines in preventing severe RSV illness and hospitalization in older adults. For example, during the 2023–2024 RSV season, real-world data indicated high effectiveness against hospitalizations for both Arexvy and Abrysvo in adults 60 and older. Because mResvia was more recently licensed, real-world data is still emerging, but clinical trials showed strong initial efficacy.
Common side effects for all vaccines are typically mild and short-lived, including:
- Pain, redness, and swelling at the injection site
- Fatigue
- Headache
- Muscle or joint pain
Side effect profiles are generally similar, though minor differences exist. It is always best to discuss any concerns with your doctor.
Timing and Coadministration
The CDC recommends that eligible older adults who have not previously received an RSV vaccine can get it at any time. However, to ensure protection during peak RSV season (which typically starts in the fall), getting vaccinated in late summer or early fall is ideal. The RSV vaccine is currently administered as a single dose for eligible seniors and is not recommended annually at this time, though the CDC will continue to evaluate data regarding the need for future doses.
It is possible to receive the RSV vaccine at the same time as other shots, such as the flu or COVID-19 vaccine. While this may slightly increase the chance of experiencing common side effects, it does not impact the effectiveness of the vaccines. Your healthcare provider can help you decide if coadministration is right for you, considering your overall health and preference.
Conclusion
In summary, there is no one-size-fits-all answer to what is the best RSV vaccine for seniors? The most effective approach is to speak with a healthcare provider to determine your eligibility and discuss the options. The key takeaway is that vaccination is a powerful tool to protect against severe RSV disease, and getting any of the three approved vaccines is a crucial step for eligible older adults. For additional guidance, the CDC's official RSV vaccine guidance provides comprehensive information for healthcare professionals and patients alike.
