The Centers for Disease Control and Prevention (CDC) has narrowed its recommendations for older adults who should get the respiratory syncytial virus (RSV) vaccine. It now says only adults 75 and older, or people 60 to 74 who are at high risk, should get the vaccine.
That’s partly because the vaccine may slightly increase the risk of a rare side effect that can sometimes lead to paralysis or death.
VRS circulates seasonally and hospitalizes between 60,000 and 160,000 elderly people in the United States each year. An estimated 6,000 to 10,000 people in this age group die each year from RSV infection. first vaccine against RSV was approved last year, and a total of three have now been approved for use in people aged 60 and over: GSK’s Arexvy, Pfizer’s Abrysvo and, more recentlyModerna’s mResvia.
Initially, the CDC said all adults ages 60 and older could receive one dose of one of these RSV vaccines after discussing it with their doctor.
Related: FDA approves first RSV vaccine for use during pregnancy to stop infection in newborns
Now, “based on currently available data,” the CDC’s Advisory Committee on Immunization Practices has concluded that the benefits of RSV vaccination do not clearly outweigh the potential risks in adults ages 60 to 74 who do not have risk factors for severe RSV. However, people in this age group who do have risk factors may still benefit.
With that in mind, “providers should continue to exercise flexibility in offering RSV vaccine to patients they determine are at increased risk for severe disease, even if they do not fall into an explicitly named risk category,” the CDC noted in a statement. Morbidity and Mortality Weekly Report published Tuesday (August 6).
So, people aged 60 to 74 can still consider the vaccine if they are high risk of serious RSV infectionsThis would apply to people with chronic heart disease or weakened immune systems, as well as those living in long-term care facilities such as nursing homes.
Adults who have already received an RSV vaccine “should not receive another dose,” the report said.
The updated recommendations were issued due to higher than expected rates of vaccine-related Guillain-Barré syndrome (GBS). GBS can cause tingling, numbness, and muscle weakness and sometimes progress to paralysis. In severe cases, the disease can affect the muscles that support breathing and can be life-threatening.
Trials of GSK and Pfizer’s RSV vaccines in older people highlighted this increased risk. However, those trials were too small to confirm that the shots themselves increased GBS rates. Now that the shots have been in widespread use for about a year, a clearer picture has emerged: the rate among vaccinated people is higher than the expected background rate of GBS in this age group.
For a vaccine without GBS-associated risk, one would expect to see about 2 cases per 1 million doses administered, while the Pfizer vaccine was linked to about 5 cases per 1 million, Live Science has already reported.
So the data suggest that the overall risk of developing the disease is still quite low, but this slight increase in risk is nonetheless a factor that experts have taken into account when re-evaluating their vaccine recommendations.
(It should be noted that there was no increase in GBS in trials of Moderna’s RSV vaccine – but that vaccine was only recently approved, so broader monitoring has not yet been conducted.)
The new CDC guidelines do not recommend that people discuss the risks and benefits of vaccines with their doctor. Now, the recommendations are explicitly based on age and known risk factors. The benefits are clear, especially for people 75 and older, the CDC says.
Previous recommendations were less straightforward and doctors found them “confusing and time-consuming” to implement, the report notes. As a result, RSV vaccination coverage was similar for adults with risk factors and those without, when ideally at-risk populations would see higher rates.
By spring 2024, an estimated 20% to 25% of U.S. adults aged 60 and older will have received an RSV vaccine.
This article is provided for informational purposes only and is not intended to offer medical advice.
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