Who Should Get the RSV Vaccine?

Ever since the coronavirus became mainstream, there has been more of an emphasis on receiving vaccinations to provide immunity against viruses such as COVID-19 and the flu. More recently, a vaccine to treat respiratory syncytial virus (RSV) has gained significant attention, resulting in approval by the Food and Drug Administration (FDA) to protect certain populations who are more susceptible to complications from RSV. We will discuss who should consider getting the RSV vaccine and why it’s crucial for their health.

"RSV vaccinations and monoclonal antibodies are effective ways to help protect vulnerable patients from serious illness and/or hospitalization due to RSV. It is great that these options are available to help defend against this virus for those who need it most," says Brandi Bass, MSN, APRN-CNP, FNP-C, a provider at INTEGRIS Health Medical Group Downtown.

What is RSV and how does the vaccine work?

RSV is a common viral infection that affects the respiratory system, including the nose, throat, lungs and breathing passages. RSV comes from the Paramyxoviridae family, a group that also includes the mumps and measles. The virus can replicate anywhere in the respiratory tract, mainly the breathing tubes and lungs. This replication then causes swelling and inflammation that makes you sneeze, cough or have trouble breathing.

RSV spreads either through respiratory droplets when the virus becomes airborne through coughing or sneezing, but you can also become infected when touching a contaminated surface. In most adolescents and adults, RSV acts like a mild version of the cold and produces a cough, congestion, runny nose, sneezing, sore throat or fever.
But in babies and older adults – babies have underdeveloped immune systems and older adults lose immunity as they age – the virus can travel to the lower respiratory tract (trachea, bronchi, bronchioles and alveoli) and cause wheezing and difficulty breathing.

Older adults and those who are immunocompromised are more at risk of RSV developing lower respiratory tract disease (LRTD), which can cause pneumonia and swelling of the lungs’ small airway passages (a condition called bronchiolitis). It can also further complicate pre-existing conditions such as heart disease, asthma and chronic obstructive pulmonary disease (COPD).

RSV is common among young children – 70 percent of infants will become infected with RSV before they turn one and almost all children will have it by the time they turn two – because it’s easily transmitted in daycare settings. Infants are at an increased risk of hospitalization since RSV can cause apnea (when breathing temporarily stops).

In fact, as many as 80,000 children under the age of five are hospitalized each year due to RSV, according to the American Lung Association. An additional 60,000 to 160,000 adults over 65 are also hospitalized.

Types of RSV vaccines

Researchers have attempted to produce an RSV vaccine for quite some time with minimal results to show. 

That is up until recently when they discovered a protein called RSV fusion (F), which triggers the immune system to produce antibodies. 

The RSV vaccine works by delivering inactivated strands of the virus into the body. The proteins attach to host cells and initiate an immune system response. Your immune system then remembers this response so it can act swiftly and strongly when or if an RSV infection occurs.

Currently, there are two vaccines (Arexvy and Abrysvo), along with a monoclonal antibody treatment (nirsevimab), to help protect against RSV.

Arexvy: In May 2023, the FDA approved Arexvy as the first vaccine to prevent symptoms associated with RSV in adults 60 years or older. A large clinical trial was conducted as part of the approval process, and the results found the RSV vaccine reduced the risk of developing lower respiratory tract disease by 83 percent and severe lower respiratory tract disease by 94 percent. Arexvy includes an adjuvant, which is an ingredient added to vaccines to enhance the immune system response.

Abrysvo: In August 2023, the FDA approved Abrysvo to be used in both adults over the age of 60 and pregnant women to prevent RSV in infants. Women who receive the vaccine can transfer immunity to their newborn child for up to six months. Clinical trials found this particular vaccine reduced severe lower respiratory tract disease by 82 percent in the first three months after birth and 69 percent within the first six months after birth.

Nirsevimab: This drug is a type of monoclonal antibody, not a vaccine, to be administered to infants and toddlers under the age of two. Antibodies are a type of passive immunity – they don’t necessarily prevent disease, rather, they reduce the disease’s severity by prepping the immune system for future RSV attacks. In regards to RSV, nirsevimab binds to the F protein and prevents it from infecting cells by clearing the virus from your body. Clinical trials showed the antibodies reduced the need for infants to seek medical attention by 76 percent and reduced the need for hospitalization by 77 percent.

Who is the RSV vaccine for?

In general, the following groups of people should consider receiving the RSV vaccine:

• Infants and young children
• Adults over the age of 60
• People who fall under the high-risk category
• Pregnant women

Infants and toddlers: The Centers for Disease Control and Prevention (CDC) recommends babies under the age of eight months receive nirsevimab. The shot can protect babies for about five months, which is the average length of RSV season (fall to winter). Additionally, the CDC also recommends at-risk infants between the ages of eight months and 19 months receive nirsevimab. The at-risk category includes babies with chronic lung disease, babies who have compromised immune systems, babies with cystic fibrosis and American Indian and Alaska Native babies. Babies born during RSV season can either receive an antibody shot while still in the hospital or during the first week of life when following up with a pediatrician. 

Adults over 60: The CDC recommends adults over the age of 60, especially those with an underlying medical condition or who are immunocompromised, receive either Arexvy or Abrysvo. As many as 10,000 older adults die each year from RSV, a number that can be reduced by receiving the vaccine.

High-risk individuals: Old age isn’t the only risk factor in developing severe complications from RSV. Certain pre-existing health conditions will increase your risk of developing lower respiratory tract disease. Examples include heart disease, chronic lung disease, cancer, diabetes, liver disease or vascular diseases.

Pregnant women: Abrysvo can be administered to pregnant women in their third trimester (between 32 weeks and 36 weeks gestation). The vaccine provides immunity for newborns for up to six months, as the RSV antibodies are capable of transferring from the mother to the developing fetus in the womb. The vaccine takes about two weeks to initiate a full immune system response, so babies born at least two weeks after the mother is vaccinated will be protected at birth.

Although it may not be discussed as much as the COVID-19 vaccine or flu vaccine, the RSV vaccine can play a crucial role in protecting hundreds of thousands of Americans from severe respiratory illness caused by the RSV virus. Contact your health care provider to inquire about a vaccination schedule that is right for you.

Brandi Bass, MSN, APRN-CNP, FNP-C, is a primary care provider with the INTEGRIS Health Medical Group Downtown in Oklahoma City. She is accepting new patients. Click here to schedule an appointment.