CDC Issues Shared Clinical Decision-Making Guidance for RSV Vaccines in Older Adults

CDC Updates RSV Vaccine Recommendations for Adults Aged 60 and Older

The CDC revised its guidance on respiratory syncytial virus vaccines for older adults. The agency replaced its 2023 approach of shared clinical decision making for everyone 60 and older with age and risk based standards. All adults 75 years and older now qualify for one dose. Adults 60 to 74 years qualify if they have certain conditions associated with higher risk of severe RSV illness. [1] [2]

The changes followed a March 2024 vote by the Advisory Committee on Immunization Practices and CDC adoption of those recommendations. They rest on effectiveness and safety data gathered during the first season after the vaccines became available. Three products hold FDA approval for this use. [3]

Evolution of Guidance

The 2023 CDC recommendation called for clinicians and patients to weigh RSV vaccination together for any adult 60 years or older. [2] The 2024 document drops that universal step for adults 75 and older. It ties vaccination for the 60 to 74 group to individual risk factors instead.

That adjustment came after officials reviewed real world data from the 2023 to 2024 RSV season. The MMWR report lists chronic heart or lung disease, diabetes, and moderate or severe immune compromise among the conditions associated with increased risk. [1]

Approved Vaccines

The FDA approved Arexvy in May 2023 as the first RSV vaccine for older adults. [3] Abrysvo and mResvia later gained approval for adults 60 and older. The CDC lists all three in its recommendations and does not state a preference among them.

What this means

The criteria focus on groups that data associate with higher RSV hospitalization rates. First season effectiveness results informed the split between universal and risk based categories. Information on how long protection lasts past one season stays limited. Surveillance systems continue to gather uptake figures and safety signals.

Key takeaways

• The CDC recommends one dose of RSV vaccine for all adults aged 75 years and older. [1]
• Adults aged 60 to 74 years qualify for vaccination only if they face increased risk of severe RSV disease. [1]
• The 2023 shared clinical decision making approach for all adults 60 and older has been replaced. [2]
• Arexvy, Abrysvo, and mResvia are the three FDA approved RSV vaccines recommended for this population. [3]
• Available evidence indicates benefits outweigh potential risks that include rare cases of Guillain Barré syndrome. [1]

Limitations

Recommendations rest on first season vaccine effectiveness data. Duration of protection beyond one RSV season remains under study. Risk factors were drawn from observational studies and may shift with further real world evidence. Vaccine uptake and rare adverse event rates continue to be monitored through existing surveillance systems.

FAQ

How do the 2024 RSV recommendations for older adults differ from the 2023 guidance?
The 2024 update sets a direct recommendation for everyone 75 and older and limits the 60 to 74 group to those with defined risk factors. The 2023 version applied shared clinical decision making across all adults 60 and older. [1] [2]

What specific risk factors qualify adults aged 60 to 74 years for RSV vaccination?
The MMWR lists chronic cardiopulmonary conditions, diabetes, and immunosuppression among the factors associated with higher risk of severe RSV disease. [1]

Which RSV vaccines are currently approved and recommended by CDC for adults 60 years and older?
Arexvy, Abrysvo, and mResvia hold FDA approval and appear in the CDC recommendations. [3]

What evidence supported the change in recommendations for adults aged 75 years and older?
Post licensure effectiveness and safety data from the 2023 to 2024 season informed the shift to age and risk based criteria. [1]

Sources / References

[1] Updated Recommendations on Use of Respiratory Syncytial Virus Vaccines in Adults Aged ≥60 Years, United States, 2024. MMWR (CDC). https://www.cdc.gov/mmwr/volumes/73/wr/mm7312a3.htm

[2] Use of Respiratory Syncytial Virus Vaccines Among Older Adults, United States, 2023. MMWR (CDC). https://www.cdc.gov/mmwr/volumes/72/wr/mm7229a4.htm

[3] FDA Approves First Respiratory Syncytial Virus (RSV) Vaccine. U.S. Food and Drug Administration (FDA). https://www.fda.gov/news-events/press-announcements/fda-approves-first-respiratory-syncytial-virus-rsv-vaccine