Respiratory syncytial virus (RSV) is a common virus that affects the lungs, making breathing difficult. It is also more common in the spring and fall seasons. The virus is common in children under 2 years, though people of all ages can get it. Illness caused by RSV is often more severe for young and premature infants, as well as older adults with poor health.
While most children who contract RSV experience mild symptoms, the CDC estimates that each year, between 58,000 and 80,000 children younger than age 5 years are hospitalized due to RSV infection.
Adults at the highest risk for severe RSV illness include:
The CDC estimates that RSV causes approximately 60,000-160,000 hospitalizations and 6,000-10,000 deaths among older adults every year.
Many older adults may not know that they should get an RSV vaccine. Incorporating your patients' vaccination needs into their regular visits — whether for chronic disease management, wellness exams or acute care — can help normalize getting vaccinated as part of comprehensive care.
A strong, clear recommendation from a health care professional is the best predictor of whether a patient will get vaccinated.
The AAFP RSV recommendations for pregnant patients:
Hear from family physician LaTasha Seliby Perkins, MD, FAAFP, on maternal RSV vaccination guidelines and recommendations and ways to overcome vaccine hesitancy.
Updated Guidance for Healthcare Providers on Increased Supply of Nirsevimab to Protect Young Children from Severe Respiratory Syncytial Virus (RSV) during the 2023–2024 Respiratory Virus Season
The Centers for Disease Control and Prevention (CDC) issued Health Alert Network (HAN) Health Advisory 499 to provide guidance for prioritization of nirsevimab given limited supply. Nirsevimab (Beyfortus, Sanofi and AstraZeneca) is a long-acting monoclonal antibody immunization recommended for preventing RSV-associated lower respiratory tract disease in young children. Given the recent increase in nirsevimab supply and the manufacturers’ plan to release an additional 230,000 doses in January, CDC advises healthcare providers to return to recommendations put forward by CDC and the Advisory Committee on Immunization Practices (ACIP) on use of nirsevimab in young children. Infants and children recommended to receive nirsevimab should be immunized as quickly as possible. Healthcare providers should not reserve nirsevimab doses for infants born later in the season when RSV circulation and risk for exposure to RSV may be lower. RSV activity remains elevated nationwide and is continuing to increase in many parts of the country, though decreased activity has been observed in the Southeast.
Recommendations for Healthcare Providers
Administration of both nirsevimab and RSV vaccination for pregnant patients is not needed to protect most infants.
Additional background information and recommendations for healthcare providers can be found at the CDC Health Alert Network.
The AAFP endorses the following RSV vaccination recommendations from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention:
The RSV vaccine is not currently an annual vaccine, so people who have previously received it do not need to get another dose.
Information on Respiratory Syncytial Virus (RSV) Vaccine Administration Errors in Young Children and Pregnant Patients
Vaccine administration errors are known to occur and are routinely monitored through the Vaccine Adverse Event Reporting System1 (VAERS). Since approval of RSV vaccines and the monoclonal antibody nirsevimab, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) have received reports of the Pfizer (Abrsyvo) or GSK (Arexvy) RSV vaccines being administered in error to young children. CDC and FDA have also received reports of the GSK RSV vaccine (Arexvy) being administered in error to pregnant patients. As of January 17, 2024, the number of reports received by VAERS suggests that these types of errors are uncommon in young children less than 2 years of age (25 reports) and pregnant patients (128 reports) relative to an estimated 1 million infants protected from RSV either through infant receipt of nirsevimab or through vaccination of pregnant patients.2
In August and September 2023, CDC and the Advisory Committee on Immunization Practices recommended two RSV prevention products to prevent RSV-associated lower respiratory tract disease in infants. Nirsevimab (Beyfortus, Sanofi, and AstraZeneca) is only recommended for infants and some young children at increased risk for severe RSV disease. RSV vaccines (Pfizer Abrysvo, GSK Arexvy) are NOT approved for use in infants or young children. Pfizer (Abrysvo) is the only RSV vaccine recommended for pregnant patients. The GSK RSV vaccine (Arexvy) is NOT approved for use during pregnancy.
Most reports of administration errors in young children occurred in infants younger than 8 months. Administration errors for both young children and pregnant patients occurred in outpatient settings, including doctor’s offices; administration errors of the GSK RSV vaccine (Arexvy) in pregnant patients also occurred in pharmacies. Most of these administration error reports described no adverse event. When an adverse event was concurrently reported to VAERS, most reports were classified as nonserious1. CDC, FDA, and other federal agencies continue to monitor the safety of RSV vaccines and reports of vaccine administration errors and will share information with the public as it becomes available.
Recommendations for Healthcare Providers who Have Administered Incorrect RSV Vaccine Products to Their Patients
1 VAERS (managed by CDC and FDA) is a passive surveillance system that is used to detect possible vaccine safety problems and also monitors for vaccination errors. VAERS reports may contain information that is incomplete, inaccurate, coincidental, or unverifiable and VAERS is not designed to determine if a vaccine caused a health problem. VAERS data are updated frequently and may change. VAERS reports that meet certain criteria are classified as serious.
2 Calculated using the National Immunization Survey Adult COVID Module (NIS-ACM) nirsevimab coverage data, Vaccine Safety Datalink RSV maternal vaccination coverage data, and CDC Wonder birth data through December 2023. Several assumptions were applied (number of eligible persons, application of coverage estimates to eligible cohort, and no child-parent dyad receiving both immunizations).
Source: CDC's Jan. 22, 2024 COCA Now clinician outreach email
Get trusted insight into new RSV vaccine recommendations for your patients 60 and older.
Read more about RSV in AAFP's other publications and evidence-based journals.
Stay up to date on the latest developments regarding RSV from the AAFP.
Dr. Anne Schneider, a family physician and AAFP Vaccine Science Fellow, discusses the importance of vaccines, provides updates from the June 2024 ACIP meeting, and shares strategies to boost vaccine confidence. The episode emphasizes the role of family physicians in educating patients about vaccines and using credible resources to stay informed.