The American College of Physicians (ACP) issued updated vaccine practice points for physicians advising adults aged 75 or older should receive a protein subunit respiratory syncytial virus (RSV) vaccine. Individuals aged 60-74 at increased risk for severe RSV may consider receiving the protein subunit RSV vaccine, the ACP added in the clinical guidelines published in Annals of Internal Medicine.1
• Although the evidence was insufficient in adults aged 18 to 59 years who were not pregnant or immunocompromised but were at increased risk for severe RSV, clinicians may consider RSV vaccination based on clinical judgment.
• In adults aged 60 to 74 years who are not at increased risk for severe RSV, the increased risk for developing Guillain–Barré syndrome following administration of a protein subunit RSV vaccine (about 1 per 100 000 person-years) needs to be balanced with the relatively low likelihood of preventing RSV-related hospitalization (30 per 100 000 person-years).
• Discuss adverse events, such as the risk for Guillain–Barré syndrome, and minor and short-term harms, such as fever or injection site soreness.
• Adults aged 75 years or older, those living in a long-term care facility, or those with a comorbid condition (including but not limited to chronic kidney, liver, or lung disease; cardiovascular disease; hematologic conditions [for example, sickle cell disease]; diabetes; obesity; or a combination of these conditions) are at increased risk for severe RSV.
• An RSV vaccine can be administered throughout the year, but the ideal time is early fall for both the Northern and Southern Hemispheres.
• As opposed to other respiratory virus vaccines that are administered annually, the RSV vaccine is currently administered only once. The need for additional vaccination is unknown.
• Some adults may prefer coadministration of RSV and other respiratory virus vaccines, such as an influenza vaccine, which might increase vaccine uptake.
• Adults with recent or active RSV infection should recover before being vaccinated.
• Emphasize that preventive actions (using an alcohol-based hand sanitizer or handwashing with soap and water, appropriately covering sneezes and coughs, and avoiding close contact with others if experiencing an RSV-like illness) can reduce the spread of RSV in combination with vaccination.
Annually, an estimated 170 000 US adults aged 50 years or older will be hospitalized and 14 000 deaths will occur due to RSV, according to the ACP. Among adults, severe RSV infection is more likely among those aged 75 years or older, those who live in a long-term care facility, or those with comorbidities (eg, cardiovascular disease, diabetes, obesity).2
The practice points were developed by the ACP Population Health and Medical Science Committee. The clinical guideline addresses the efficacy, comparative effectiveness, and harms of RSV vaccines in adults aged 18 years and older who were not pregnant or immunocompromised.1
“Unlike other respiratory virus vaccines that are administered annually, such as influenza vaccines, RSV vaccines are currently administered only once, and the need for repeated vaccination is unknown and is being studied,” the committee wrote.1
“Based on the ACP rapid review and application of epidemiologic data to subgroups of interest, the ACP PHMSC concluded that the benefits of the protein subunit vaccines outweigh the harms in adults aged 75 years or older and in adults aged 60 to 74 years who are at increased risk for severe RSV,” the authors stated. “The benefits shown in the ACP rapid review included reducing the risk for RSV-related hospitalizations and severe RSV illnesses in adults aged 60 years or older.”1
References:
- Qaseem A, Obley AJ, Harrod CS, et al. Respiratory syncytial virus vaccines in adults who are not pregnant or immunocompromised: Rapid practice points from the American College of Physicians. Ann Intern Med. Published online March 3, 2026. doi:10.7326/ANNALS-25-05485
- ACP advises all adults 75 or older get a protein subunit RSV vaccine. News release. American College of Physicians. Published March 2, 2026. Accessed March 2, 2026. https://www.eurekalert.org/news-releases/1117652?
