Respiratory Syncytial Virus Vaccine

Aka: Respiratory Syncytial Virus Vaccine, RSV Vaccine, Abrysvo, Arexvy, Bivalent RSVpreF Vaccine, mRESVIA

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II. Indications

  1. Infants (on separate pages; this pages addresses adult RSV Vaccines)
    1. See Palivizumab (Synagis) for high risk infants
    2. See Nirsevimab for universal Vaccination in infants
  2. All adults age 75 years and older
  3. Adults 50 to 74 years old AND risk for severe RSV
    1. Heart, lung or Kidney disease
    2. Diabetes Mellitus with organ injury (e.g. Neuropathy)
    3. Body Mass Index (BMI) >=40 kg/m2
    4. Immunocompromised
  4. Pregnant Women
    1. CDC recommends Pfizer Bivalent RSVpreF Vaccine (Abrysvo) ONLY
    2. Do NOT use Arexvy in pregnant women (associated with Preterm Labor)
    3. Give single dose at 32 to 36 weeks during RSV season (U.S. Sept to Jan)

III. Contraindications

  1. Children
    1. Other RSV Immunizations are indicated in children (Nirsevimab, Palivizumab)

IV. Background

  1. RSV has long been recognized as a cause of severe respiratory illness in infants (typically october to march)
  2. As Respiratory Panel testing became more common in 2020s, RSV was recognized as important in older adults
    1. Older adults may experience similar rates of morbidity and mortality with RSV as with Influenza
    2. As of 2023, RSV causes 160k hospitalization and 10k deaths yearly in U.S, over age 65 years

V. Medications

  1. Abrysvo (RSVpreF)
    1. Bivalent (RSV A and B) stabilized prefusion F Protein subunit Vaccine
    2. Provided in drug/diluent dual-chamber "Act-O-Vial" (instead of 2 vials) as of 2025
    3. Stored in refrigerator
  2. Arexvy (RSVPreF3)
    1. Single stabilized prefusion F subunit Vaccine that protects against RSV A and B
    2. Stored in refrigerator
  3. mRESVIA
    1. mRNA RSV Vaccine
    2. Available in prefilled syringes that require no reconstitution
    3. Stored in freezer and must be thawed in the refrigerator or at room Temperature for 45 to 155 min before injection

VI. Dosing: Adults

  1. Older Adults or Risk Factors
    1. Best administered in late summer or early fall (depending on local RSV season)
    2. RSV Vaccine (Abrysvo, Arexvy) or mRESVIA: 0.5 ml IM for single dose
  2. Pregnancy
    1. Only Abrysvo (NOT Arexvy) is FDA approved for use in pregnancy
    2. Administer to unvaccinated mothers at 32 to 36 weeks, in September to January
      1. Allows for RSV passive Antibody protection in newborns and young infants
    3. Infant may also receive Clesrovimab or Nirsevimab (best at age <7 days) under specific circumstances
      1. Mother's RSV Vaccine was prior to current pregnancy
      2. Mother's RSV Vaccine was within 2 weeks of delivery

VII. Efficacy

  1. One RSV Vaccine dose appears to protect for 2 years
  2. RSV Vaccine in older adults reduces RSV-related healthcare visits by 85%
  3. RSV Vaccine reduces risk of severe RSV in infants age <6 month (NNT 81)
    1. Kampmann (2023) N Engl J Med 388(16): 1451-64 [PubMed]

VIII. Adverse Effects

  1. Common
    1. Fever
    2. Myalgias
  2. Rare serious effects
    1. Guillain Barre Syndrome
      1. Six cases (3 in 18k for GSK Arexvy, 3 in 20k for Pfizer Abrysvo) per package inserts (see below)
      2. Helgeson (2018) Indian J Crit Care Med 22(4):309-10 +PMID: 29743773 [PubMed]

IX. Resources

  1. RSV Vaccination for Pregnant People (CDC)
    1. https://www.cdc.gov/vaccines/vpd/rsv/hcp/pregnant-people.html
  2. Abrysvo (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=be18292e-b1a2-4815-a0ed-003efaa6bea3
  3. Arexvy (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e50f275-002e-413f-a840-66ee3cb3740c
  4. mRESVIA (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=e5c837e7-41e8-496a-9c85-6b0453b35948

X. References

  1. (2025) Presc Lett 32(10): 56-8
  2. (2024) Presc Lett 31(8): 44-5
  3. (2023) Presc Lett 30(9): 49-50

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