CDC universally recommends RSV vaccines for oldest US adults
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Key takeaways:
- The CDC’s vaccine advisors voted unanimously to recommend RSV vaccination for all adults aged 75 years or older.
- They also recommended vaccination for adults aged 60 to 74 years with risk factors for severe RSV.
The CDC’s vaccine advisors voted unanimously Wednesday to recommend that everyone aged 75 years or older get vaccinated against respiratory syncytial virus.
The Advisory Committee on Immunization Practices (ACIP) also voted unanimously to recommend RSV vaccination for people aged 60 to 74 years who are at high risk for severe RSV disease.
The votes supplant a weaker recommendation made by the CDC last year that said people aged 60 years or older should talk to their provider about getting vaccinated against RSV.
Following the ACIP vote, CDC Director Mandy Cohen, MD, MPH, signed off on the recommendations, making them official. Cohen said the vaccines “provide an extra layer of protection” for patients at highest risk for severe RSV.
“There was very strong desire to move away from shared clinical decision-making after hearing a lot of comments that it made it difficult for physicians and pharmacists to implement RSV vaccines,” Healio | Infectious Disease News Editorial Board Member William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center and former medical director of the National Foundation for Infectious Diseases, said in an interview after the votes.
“So, they looked over their data and went to the highest risk group and voted to make it routine that everybody age 75 and older receive a single dose.”
‘Shared clinical decision-making in sheep's clothing’
Both recommendations received unanimous support from the 11-member ACIP voting body. The committee clarified that only people who have not already received an RSV vaccine shout get a shot.
Adults aged 60 to 74 years who are not at an increased risk for severe RSV disease are no longer included in the recommendations.
The CDC will publish clinical considerations describing medical conditions and other risk factors for severe RSV disease for providers to reference. Online, the agency lists cardiopulmonary disease, kidney disorders, liver disorders, neurologic or neuromuscular conditions, hematologic disorders, diabetes and moderate or severe immune compromise as risk factors for severe RSV in adults aged 60 years or older.
Schaffner said the risk-based approach “is not a lot easier than shared clinical decision-making.”
“It's really shared clinical decision-making in sheep's clothing,” he said. “It's as difficult for doctors and pharmacists as shared clinical decision-making.”
Backtracking?
The ACIP reviewed updated data on the available RSV vaccines, including from Pfizer’s RENOIR trial, which showed that RSV vaccine, Abrysvo, was 89% (95% CI, 52%-97%) effective at preventing hospitalizations and emergency department visits caused by RSV-related lower respiratory tract disease (LRTD) in a study population that was 57% people aged older than 75 years and 14% immunocompromised.
Updated data for GSK’s Arexvy showed that, over 2 years, the vaccine was 67.7% effective (95% CI, 52.3%-78.7%) at preventing RSV-related LRTD with a season covariate and 73.3% (95% CI, 60.7%-82.4%) without. Among study participants aged 70 years and older, the vaccine was 74.6% (95 CI, 52.6%-87.5%) and 79.1% (95% CI, 81.3%-89.7%) effective.
Moderna presented data that showed its recently approved vaccine, mResvia, was 78.7% effective against RSV-related LRTD with two or more symptoms among adults aged 60 years or older and 80.9% effective against RSV-related LRTD with three more symptoms. Further analysis of 18-month data showed a vaccine efficacy of 50.3% and 49.9%, respectively.
While the committee ultimately voted in favor of these changes to RSV vaccine recommendations, concerns were voiced before the vote regarding “backtracking” by removing older adults without underlying conditions or risk factors from the recommendations.
“It is OK for us to reevaluate vaccines and use them as they are needed. We're one of the few countries that does not do that,” ACIP chair Helen Keipp TalbotMD, MPH, professor of medicine at Vanderbilt University, said during the meeting. “That only lends us credibility in saying, ‘We have reviewed this. This is the right use of medical funds. This is the right way to save lives. This is the right way to reduce risk of vaccines.’”
The ACIP did not hold a vote on whether to recommend RSV vaccination for patients aged 50 to 59 years despite the FDA’s recent decision to extend the approval of GSK’s vaccine for high-risk patients in that age group.
References:
- CDC. ACIP presentation slides: June 26, 2024. https://www.cdc.gov/vaccines/acip/meetings/slides-2024-06-26-28.html. Accessed June 26, 2024.
- CDC. Health care providers: RSV vaccination for adults 60 years of age and over. https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html. Last reviewed March 1, 2024. Accessed June 26, 2024.
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