April 26, 2024
Respiratory Syncytial Virus (RSV) is a growing concern for older adults, especially those who are frail and/or have chronic illnesses or conditions. A recent AMDA On-The-Go podcast offered an update on RSV vaccines and recurrent recommendations from the RSV Advisory Committee on Immunization Practices (ACIP) with host Diane Sanders-Cepeda, DO, CMD, and guest Ann Falsey, MD.
Dr. Falsey started by discussing the concerns about RSV in PALTC. She said, “I think most of the listeners are familiar with RSV, but many people tend to still think of it as primarily a pathogen in young children. It turns out that if you test for RSV in adults and older adults, it's actually quite common.” She observed that it can cause significant illness in the older adult population, and sometimes it's hard to recover from the virus, particularly if the person has any underlying heart or lung problems, diabetes, chronic kidney disease, and/or physical frailty. She observed, “Those are the folks who really get into trouble with RSV, and in that group, it can cause anything from a cold to pneumonia and respiratory failure.”
RSV vaccines have been in the works for 60 years, and Dr. Falsey said, “We have some really good products.” Pfizer and GSK have protein-based vaccines much like the flu vaccine. “Clinical trials in people over the age of 60 showed very convincingly that [the vaccines] prevented somewhere between 80% and 85% of lower respiratory tract infection,” she said. She added that Moderna is making an RNA vaccine product that appears to be just as effective in trials. This vaccine is expected to be available next fall.
Last year, ACIP voted to recommend that older adults (age 60 and over) may receive a single dose of an RSV vaccine using “shared clinical decision-making.” Dr. Falsey talked a little about how that works. She said, “Ideally if you were an older person living in the community, you would go to your physician—who knows your medical history very well—and have a discussion on the risks and the benefits of the vaccine.” When someone is in a long-term care facility, she said, they could still do this if they have decision-making capacity. If not, that discussion might be with the family. She stressed that every facility is different and may have its own policies and protocols regarding RSV vaccines. For instance, a facility may not recommend the vaccine for younger residents who are basically healthy.
While decisions about the RSV vaccine should be person-centered, Dr. Sanders-Cepeda stressed the potential seriousness of the virus for nursing home residents. She said, “RSV is one of the reasons why we see a high rate of ER visits and hospitalizations every winter. We know our nursing facility residents are at high risk.” Dr. Falsey agreed: “Skilled nursing residents, in particular, are the frailest of the frail, and the hospitalization rates per 100,000 are extremely high in that group. We also know that every winter, the virus is brought into facilities despite everybody trying to be very careful with masking and telling people not to visit when they're sick.”
Drs. Sanders-Cepeda and Falsey agreed that the lack of involvement of nursing home patients in the big RSV trials is a concern, and they emphasized the need for this patient population to be better represented in large studies. Lack of research involving frail older adults might be one reason behind the hesitation of practitioners and family members to recommend or request the RSV vaccine for some patients. At the same time, Dr. Falsey noted that it’s likely a common concern that these vaccines may not work quite as well as they do in healthy older people. However, she said, “We expect that these vaccines will have some protective efficacy, and there's pretty good evidence that the duration of the protection is at least two years.”