Dear Immunization Partners,

In May 2023, the Food and Drug Administration (FDA) approved the first two vaccines for prevention of Respiratory Syncytial Virus (RSV) lower respiratory tract disease for use in adults ages 60 years and older. On June 21, 2023, the Advisory Committee on Immunization Practices (ACIP) recommended that person’s ages 60 years and older may receive a single dose of RSV vaccine, using shared clinical decision-making.  On June 29, 2023, CDC Director Rochelle Walensky endorsed the ACIP recommendations.

On July 21, 2023, the CDC published a Morbidity and Mortality Weekly Report (MMWR) with recommendations for the new adult RSV vaccines Arexvy (GSK), and Abrysvo (Pfizer) titled: Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023

Clinical Guidance:

Per ACIP recommendations, adults ages 60 years and older may now receive a single dose of either RSV vaccines, using shared clinical decision-making with their healthcare providers. Shared clinical decision-making is intended to allow flexibility for providers and patients to consider individual risk for RSV disease, while considering patient preferences. 

These vaccines are the first ones licensed in the United States to protect older adults (ages 60 years and older) against RSV and will be available soon.  

RSV Vaccination Timing:

RSV vaccination is currently approved and recommended for administration as a single dose; sufficient evidence does not exist at this time to determine the need for revaccination. Optimally, vaccination should occur before the onset of the RSV season. For the 2023–24 season, clinicians should offer RSV vaccination to adults aged 60 years and older using shared clinical decision-making as early as vaccine supply becomes available and should continue to offer vaccination to eligible adults who remain unvaccinated. Given the possibility of an early surge in RSV cases this fall and winter, similar to the early onset of heavy RSV circulation during 2022, providers are encouraged to review the clinical guidance for using RSV vaccine.

Vaccine Administration, Including Coadministration with Other Vaccines:

Coadministration of RSV vaccines with other adult vaccines during the same visit is acceptable. Providers should separate injection sites by at least 1 inch if possible and consider administering vaccines that are associated with an enhanced local reaction in separate limbs. Administering RSV vaccine with one or more other vaccines at the same visit might increase local or systemic reactogenicity.

When deciding whether to coadminister, providers should consider whether the patient is up to date with currently recommended vaccines, the feasibility of the patient returning for additional vaccine doses, risk for acquiring vaccine-preventable disease, vaccine reactogenicity profiles, and patient preferences.

Precautions and Contraindications:

• RSV vaccination should be delayed for persons experiencing moderate or severe acute illness with or without fever (precaution).
• RSV vaccines are contraindicated for and should not be administered to persons with a history of severe allergic reaction, such as anaphylaxis, to any component of the vaccine.

Resources: (CDC is in the process of developing webpages and products)

• Respiratory Syncytial Virus Infection (RSV) – For Healthcare Providers
• RSV Vaccines and Preventable Diseases webpage  
• RSV Vaccine Fact Sheet 
• RSV Vaccine FAQs for Healthcare Providers  
• RSV Vaccine Shared Clinical Decision-Making (SCDM)

CDC will host a Current Issues in Immunization Webinar in September of 2023 to discuss these new recommendations. Please continue to visit the Current Issues in Immunization Webinar webpage for updates on the RSV vaccines and additional information as it becomes available. 

Thank you for all you do.

Oakland County Health Division, Immunization Action Plan