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Patient was hemoccult positive with anemia but colonoscopy and EGD were negative. What test would you order next? 

A Rare Finding of Lymphangiomatosis: Case Report 

During the first 2 seasons that a vaccine against 

 in the US, only 16.4% of eligible individuals received the immunization, according to a new study of more than 260 million adults.

found that although vaccination was relatively low across all the subgroups evaluated in the study, uptake modestly increased with age and was somewhat higher for adults with 

e. The rate was also somewhat higher among adults who received other vaccines, but long-standing disparities in vaccine uptake persisted based on race, ethnicity, and social determinants of health. Study authors voiced concerns about the reach of current vaccination efforts and emphasized the need for targeted strategies to improve coverage among vulnerable populations.

The CDC currently recommends a single lifetime dose of any of the 3 FDA-approved RSV vaccines, RSVPreF3 (Arexvy; GSK),

 for all adults aged 75 years and older and for individuals aged 50 to 74 years who are at increased risk of severe illness. Arexvy was the first RSV vaccine approved by the FDA in May 2023 for adults aged 60 years and older,

 however, their indications have been updated since their initial approval. 

For the retrospective analysis, researchers tapped IQVIA’s open-source pharmacy (LRx) and medical (Dx) claims data of adults aged 60 and older. Eligible individuals had at least one claim between January 1 and December 31, 2023; for those not vaccinated in 2023, at least one claim from January 1, 2024, to February 28, 2025, was required to ensure ongoing data availability.

The evaluation period began on August 1, 2023 and continued through February 1, 2025. During a baseline period of 12 months leading up to August 1, 2023, researchers collected demographic, socioeconomic, and clinical characteristics. They measured vaccine uptake monthly and cumulatively as the proportion of eligible adults receiving an RSV vaccine, with follow-up ending at first vaccination or study end.

Approximately 78 million adults met eligibility criteria, according to the study, culled from the 262 million with at least one claim in 2023. Of those, only 12.8 million older adults, representing 16.4% of the eligible population, received an RSV vaccine during the study period. Uptake showed a gradual increase with age; rates were higher among adults aged 75 and older compared to younger seniors, reflecting risk-based recommendations. Moreover, individuals with at least one potential risk factor for severe RSV—such as cardiovascular disease (29.6%) or diabetes (25.4%)—were more likely to get vaccinated.

Racial, socioeconomic, and regional disparities uncovered in the data included

: Non-Hispanic Black and Hispanic adults had significantly lower vaccination rates than non-Hispanic White and Asian peers. Multivariable analysis showed odds ratios (OR) for vaccination of 0.7 and 0.65, respectively, compared with non-Hispanic White adults.

: Higher income levels and educational attainment strongly correlated with increased vaccination likelihood. Adults in the highest income brackets and with college degrees had ORs of approximately 1.5 to 1.7 relative to lower-income or less-educated groups.

: Urban residents and those with certain insurance types (e.g., Medicare Part D) tended to have higher vaccination rates; regional differences also emerged, with the South trailing slightly behind other regions.

Of note, the data also showed that receiving other adult vaccines during the study period robust predictor of receiving the RSV vaccine. Adults who received at least one non-RSV vaccine were nearly 24 times more likely (OR  23.8) to receive the shot.

Among the study’s limitations, authors acknowledge that reliance on claims data may underreport vaccinations given in hospital or inpatient settings and miss those administered outside the billing system. Data ended in February 2025, excluding later vaccinations, and the observational design limits causal inferences about factors influencing uptake.

The low vaccination rate of 16.4% among US adults aged 60 and older underscores significant gaps in RSV immunization efforts, the authors conclude. They emphasized the need for targeted interventions that address social inequities and improve outreach to under-vaccinated groups. As RSV continues to pose a threat to older adults, expanding access to vaccination remains essential to reducing severe disease burden and improving public health outcomes.

La EM, McGuiness CB, Singer  D, Yasuda M,  Chen CC. RSV vaccination uptake among adults aged 60 years and older in the United States during the 2023–2025 vaccination seasons.

2025;21(1). doi:10.1080/21645515.2025.2535755 

Arexvy. [Package insert]. GSK;2024. Accessed August 14, 2025.  https://gskpro.com/content/dam/global/hcpportal/en_US/Prescribing_Information/Arexvy/pdf/AREXVY.PDF 

Abrysvo. [Package insert]. Pfizer;2023. Accessed August 14, 2025.  https://labeling.pfizer.com/ShowLabeling.aspx?id=19589 

mRESVIA [Package insert]. Moderna; 2025 [accessed 2025 Jun 17]. https://www.fda.gov/media/179005/ 

Halsey G. FDA approves world's first vaccine against respiratory syncytial virus.

 May 3, 2023. https://www.patientcareonline.com/view/fda-approves-world-s-first-vaccine-against-respiratory-syncytial-virus 

Halsey G. Pfizer wins FDA approval for vaccine against RSV in older adults. 

. June 1, 2023. https://www.patientcareonline.com/view/pfizer-wins-fda-approval-for-vaccine-against-rsv-in-older-adults 

Halsey G. FDA approves Moderna's mRESVIA, first mRNA vaccine against RSV, for adults aged ≥60 years. 

. June 3, 2024. https://www.patientcareonline.com/view/fda-approves-moderna-s-mresvia-first-mrna-vaccine-against-rsv-for-adults-aged-60-years

Fewer than 1 in 5 eligible older adults in the US received the RSV vaccine during the first 2 seasons it was available, and uptake was lower based on SDOH. 

Toolkits

Initial RSV Vaccine Uptake Low Among Older Adults, Disparities Persist, Study Reveals 


These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite.

These 2 patients presented with a swollen hand and rapidly proximally progressive edema secondary to a bite. What creature did the biting?

Swollen Hands-What’s Biting?

A 68-year-old man presented with two growths on his chest, which he said had been slowly expanding over the past 2 years. They were occasionally tender and had bled with minimal trauma.

Can you identify the 2 slowly expanding growths on the chest of this 68-year-old man?

Clinical Topics

Pearly Pink Chest Lesions 

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. Several areas of excoriation were noted. He had recently run through a field of tall grass but denied any other exposure history.

A 9-year-old boy presented with a 1-week history of pruritus and rash on his elbows, knees, back, and legs. He had recently run through a field of tall grass but denied any other exposure history. Your Dx?

What Cause of This Itchy Rash?

A 4.5-cm annular lesion on this patient’s hand is similar to lesions found elsewhere on his body. The patient reports no symptoms. The skin is smooth and without scale. Visible is a ring of firm multiple papules. Treatment with a steroid ointment was unsuccessful.

The patient has similar lesions elsewhere on his body. Treatment with a topical steroid was unsuccessful. Can you ID?

A Ring of Firm Multiple Papules 

This full-term male infant is the product of an unremarkable pregnancy and a normal spontaneous vaginal delivery. His physical exam is otherwise normal. The right-sided groin swelling shown below is soft and compressible. It is unclear whether the testicle is contained within the affected hemiscrotum.

A compressible groin swelling is the only abnormal feature after full-term gestation and unremarkable delivery. Your Dx?

Hannah Graham, MD

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