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New RSV Vaccine Distribution: Who's At The Top Of The List?

As fall approaches, so does respiratory syncytial virus or RSV season. This year, there are more options for those most susceptible to RSV, including a new vaccine and updated RSV vaccine guidance for seniors.

Carina Marquez, MD, associate professor of Medicine in the Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General, Peter Chin-Hong, MD, professor in the UCSF Health Division of Infectious Diseases and Theodore Ruel, MD, chief of the Division of Pediatric Infectious Diseases and Global Health at UCSF Benioff Children's Hospitals, explain what we need to know about the RSV virus and vaccine.

What is RSV?

RSV is a virus that can cause lung and respiratory tract infections such as bronchiolitis and pneumonia. Most RSV infections clear up by themselves in a couple of weeks, but, for some people at high risk, it can cause serious illness leading to hospitalization or death.

Who is most vulnerable to RSV?

Premature infants, newborns and babies – especially those younger than 8 months.

Children younger than 2 years with chronic lung disease or congenital heart disease.

Children with neuromuscular disorders, including those who have difficulty swallowing.

Children of Native American descent.

Adults over 75.

Adults 60-74 with chronic medical conditions such as diabetes, heart or lung disease.

Anyone with a weakened immune system.

How do people contract RSV?

RSV spreads much like the common cold via droplets of saliva released into the air when sick people cough or sneeze. These droplets carry the virus, spreading it when they come in contact with our eyes, noses or mouths.

What are RSV's symptoms?

RSV symptoms are like those of a cold: congestion, fever, cough, wheezing and a sore throat. In young babies, RSV's only signs may be difficulty breathing, irritability and decreased activity. Older adults and babies younger than 6 months may need to be hospitalized if they have trouble breathing, become dehydrated or their symptoms worsen.

What vaccines are available to protect against RSV?

There are now three vaccines available for adults and one for those who are pregnant. This summer, the FDA approved Moderna's mRESVIA RSV vaccine for adults. Last year, the FDA approved Abrysvo (Pfizer) and Arexvy (GSK) to protect seniors from serious illness, and approved Abrysvo for pregnant women in their third trimester during the RSV season, to help safeguard newborns from the virus for up to 6 months. All three are single-shot vaccines.

Who should get vaccinated for RSV?

This summer, the CDC altered its recommended guidance to 75 years for all seniors who have not yet been vaccinated. It still recommends that seniors 60 to 74 get vaccinated if they are immune compromised or have chronic medical conditions and have not yet been vaccinated.

Pregnant women in their last trimester should talk to their health care provider about whether the vaccination is right for them.

How often should adults get the vaccine?

The RSV vaccine isn't needed annually like the flu vaccine, but only once.

What should I know about RSV prevention for infants?

There is no vaccine approved for babies at this time, but there are ways to prevent them from getting very sick:

Asking people sick with a cough and runny nose to wash their hands and avoid close contact with infants.

Vaccinating pregnant women with Abrysvo in their third trimester to stimulate their immune system to make antibodies against RSV. The antibodies pass to the fetus, protecting babies for the first 6 months of life.

Mothers who are not vaccinated can immunize vulnerable infants with Nirsevimab (Beyfortus), an anti-RSV antibody, that can prevent serious RSV in babies. Ask your doctor if your baby should get it.

How long will the new RSV vaccine protect seniors and infants from RSV?

For adults, RSV vaccines show continued protection even two years after immunization. Based on this, the CDC recommends only one dose of the RSV vaccine for seniors right now, but this may change in the future.

In infants, we know that the vaccine given to those who are pregnant protects babies for their first 6 months of life – when they are most at risk for the virus. Beyfortus, the new monoclonal antibody injection, similarly reduces the risk of RSV in infants for about five months – or one RSV season.

Does the new RSV vaccine have any side effects?

In adults, the most frequently reported side effects have been soreness at the injection site, muscle pain, fatigue, headache and joint pain. In the combined clinical trials of the vaccine, 20 out of more than 38,000 people who received the shot reported an abnormal heart rate about two weeks after vaccination. Eight people out of a similar number of folks in the trials who did not take the vaccine said the same. In addition, six people developed rare neurological complications.

Scientists are still figuring out if these irregular heartbeats or neurological complications were linked to the vaccine, but if you have concerns talk to your doctor. What is clear is that the benefit of being protected against RSV for many people far outweighs this possible risk because we don't have good therapies once people get seriously ill with RSV.

Can I take the RSV vaccine alongside flu or COVID-19 shots?

Yes, it is safe to get all three vaccines at the same time. However, it is up to the individual to assess if they will have a reaction to the vaccinations based on their previous history of vaccines. There is no minimum waiting time between doses.

RSV Vaccines Effective, But More People Need To Get Them

Since their introduction last year, researchers have been monitoring the real-world impact of the new respiratory syncytial virus (RSV) vaccines. In a recent commentary in The Lancet, Angela Branche, MD, an infectious diseases researcher at the University of Rochester Medical Center (URMC), details what has been learned during the vaccine's first season.

"The evidence is clear; individuals should get vaccinated if they have conditions that place them at risk for severe disease. For older adults and those with chronic conditions, RSV should be considered as serious as the flu, and they should get vaccinated," said Branche.

RSV is a significant cause of severe respiratory illness among older adults, especially those with underlying health conditions. Worldwide, RSV causes millions of infections, hundreds of thousands of hospitalizations, and tens of thousands of deaths annually in adults aged 60 and older. In the US, adults over 65 experience high rates of RSV-related hospital visits, intensive care unit admissions, and deaths. Older people with RSV are at higher risk of severe illness compared to those with influenza or COVID.

Vaccines Protect Against Severe Symptoms and Keep People Out of the Hospital

In 2023, the FDA approved three RSV vaccines for older adults. Studies have shown these vaccines to be effective, with the Pfizer, GSK, and Moderna vaccines preventing RSV pneumonia and bronchitis in more than 80 percent of participants.

A recent study published in The Lancet assessed the effectiveness of RSV vaccines using data from a large electronic health record network involving the Centers for Disease Control and Prevention (CDC) and multiple US healthcare systems. The study found that RSV vaccines were 80 percent effective in preventing hospitalization, ICU admission, and death among adults aged 60 and older. Vaccine effectiveness was consistent across age groups, including those 75 and older, and among immunocompromised individuals. The study did not find evidence of waning vaccine protection within the season.

However, the uptake of the RSV vaccine in the 2023-2024 winter season was low. An estimated 24 percent of US adults aged 60 years and older received the vaccine, compared to influenza vaccination rates, which approach 50 percent each year for the same group. "Providers were not sure how to apply the shared clinical decision-making recommendations in the first season, and there remains a general lack of knowledge among the medical community and the public on what constitutes a risk for severe disease and who needs to be protected," said Branche.

Boosting Rates and Better Vaccines

Based on these findings, the US Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that advises the CDC, updated guidelines in June 2024 to recommend RSV vaccination for all adults aged 75 and older, those 60 and older in long-term care facilities or with chronic and high-risk health conditions.

"This new data enabled the ACIP to make more definitive recommendations, which will build public confidence in the effectiveness of these vaccines and make implementation a lot easier for providers and pharmacies," said Branche.

New research shows that vaccines that target multiple strains of the RSV virus, called bivalent vaccines, may provide longer protection. URMC infectious disease experts Edward Walsh, MD, and Ann Falsey, MD, helped lead an international study of a bivalent RSV vaccine developed by Pfizer, the results of which were recently detailed in the New England Journal of Medicine. The vaccine effectively prevented severe RSV-related lower respiratory tract illnesses over two RSV seasons, with an overall efficacy of more than 80 percent. The experimental vaccine was particularly effective in individuals aged 60-79.

Grim Warning As Norovirus Cases Surge By 40% In Weeks – As Killer Lung Virus On The Rise Amid 'tripledemic Threat'

NOROVIRUS cases have surged over the past two weeks, raising fears as Brits brace for a trio of rampant winter viruses.

During the summer months, the virus was already on the rise, but recent data indicates that its numbers are now superseding expected levels.

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The most recent UK Health Security Agency (UKHSA) figures show reports of the nasty bug are up by 39 per cent already - with cases predicted to rise further over the coming weeks.

At least 382 lab reports came back positive for the "extremely contagious" norovirus between September 30 to October 13, (weeks 40-41) figures show - up from 274 in the two weeks prior.

This suggests the number of people sick with the bug is more than double what's typically expected for this time of year, the agency said.

It comes as health chiefs fear a "tripledemic" of Covid, flu and respiratory syncytial virus (RSV) this winter.

Brits have been urged to take up "life-saving" NHS jabs to give themselves the best chance of dodging the bugs.

Separate UKHSA stats, published earlier this week, revealed an uptick in RSV infections that have led to more babies being admitted to the hospital with severe chest infections.

RSV is a very common infection that - in some instances - can be deadly, especially for infants and the elderly.

Meanwhile, flu cases are already twice as high among children aged 5 to 14 - compared with the general population prompting experts to urge parents to get their kids vaccinated.

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Scientists have also sounded the alarm over a new, more contagious Covid variant called XEC, which is spreading across several European countries.

Amy Douglas, epidemiologist at UKHSA said: "As we head into the winter season, we are seeing norovirus levels higher than usual, and we expect the virus to spread more in the coming weeks.

How getting vaccinated protects the most vulnerable among us

"Recently, we've seen the biggest rise in cases in adults, especially those aged 65 and over."

First-ever norovirus vaccine to be trialled

Norovirus - also known as the "winter vomiting bug" - is a highly infectious viral illness.

Adults and children who might have the bug are being urged to stay home from work and school.

The figures come as a new vaccine that could stop people from developing the vomiting bug norovirus is being trialled in the UK.

As we head into the winter season, we are seeing norovirus levels higher than usual, and we expect the virus to spread more in the coming weeks

Amy DouglasEpidemiologist

The mRNA vaccine from Moderna has entered its final stages of testing, the Health Secretary has announced, with results so far showing it creates a "strong immune response".

The UKHSA report, based on laboratory test results, suggests that the rise in detected cases may be linked to changes in national disease surveillance methods following the pandemic.

Changes to testing and reporting, and the weather getting colder, are also considered possible factors in the report.

Who is eligible for free Covid, flu and RSV vaccines?

In line with JCVI advice, those eligible for a flu vaccine this year include:

From 3 October:

Those aged 65 years and over

Those aged 18 years to under 65 years in clinical risk groups (as defined by the Green Book)

Those at serious risk, including those with a BMI over 40, diabetes, heart and breathing conditions

Those in long-stay residential care homes

Carers in receipt of carer's allowance, or those who are the main carer of an elderly or disabled person

Close contacts of immunocompromised individuals

Frontline workers in a social care setting without an employer-led occupational health scheme - including those working for a registered residential care or nursing home, registered domiciliary care providers, voluntary managed hospice providers

Those who receive direct payments (personal budgets) or Personal Health budgets, such as Personal Assistants.

From 1 September:

Pregnant women

All children aged 2 or 3 years on 31 August 2024

Primary school-aged children (from Reception to Year 6)

Secondary school-aged children (from Year 7 to Year 11)

All children in clinical risk groups aged from 6 months to less than 18 years

Those eligible for an autumn Covid booster are:

Residents in a care home for older adults

All adults aged 65 years and over

Persons aged 6 months to 64 years in a clinical risk group, as defined in the Green Book, including pregnant women

Frontline health and social care workers and staff in care homes for older adults

Those eligible for an RSV vaccine are:

Pregnant people from 28 weeks onwards

People aged 75 to 79

Not all norovirus cases are reported or tested, so the true number of infections is likely to be much higher.

Most cases are being recorded in the over-65s, though the virus, which triggers sickness and diarrhoea, continues to affect all age groups.

The bug spreads easily through contact with someone who has the virus or with contaminated surfaces or foods.

This makes nurseries, schools, workplaces, hospitals, care homes, cruise ships, and family homes over Christmas perfect breeding grounds.

While most people make a full recovery within a few days, norovirus can lead to dehydration, especially among the very young, the elderly or those with weakened immune systems.

How to stay safe

Thankfully, there are some simple ways to help curb the spread.

The UKHSA urges families to:

Wash their hands regularly with soap and warm water

Wash fruits and vegetables before preparing and eating them

Cook foods thoroughly

Routinely sanitise surfaces

Avoid close contact with people who are obviously sick

And if you, a relative or friend has got norovirus, it's important to remember:

It cannot be treated with antibiotics.

Vomiting and diarrhoea cause your body to lose water and salts, which can lead to dehydration, so drink plenty of fluids.

Stay at home. Do not return to work or send kids to school until 48 hours after symptoms have stopped.

Avoid cooking or preparing meals for others until 48 hours after symptoms have stopped.

Wash all contaminated clothing and bedding using detergent and at 60C.

Disinfect contaminated surfaces with bleach-based cleaning products where possible.

Seek medical attention if symptoms do not improve.

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