Q&A: What PCPs need to know about the new RSV vaccines

Key takeaways:

• The ACIP recently recommended people aged 60 years or older talk to their doctors about getting a vaccine to protect against RSV.
• The president of the AAFP told Healio what primary care physicians should know.

Amid breakthroughs in medical science, it is critical that physicians have all the information they need to consult patients and help them decide on the best course of action.

Following years of failed attempts by medical scientists to develop one, the FDA finally approved the world’s first vaccine against respiratory syncytial virus (RSV) in early May, and a second approval came in early June. Last week, the CDC’s Advisory Committee on Immunization Practices (ACIP) voted to recommend that people aged 60 years or older “may receive” one of the two RSV vaccines in consultation with their physician. The CDC has not yet made an official decision based on the ACIP’s input.

The reason the ACIP did not take a stronger position and recommend that adults “should” get vaccinated is because although individuals may benefit from immunization, the data do not clearly show that the vaccines would have a population-level impact, the CDC explained.

As physicians prepare for patient questions surrounding the new vaccines ahead of the upcoming RSV season, Healio spoke with American Academy of Family Physicians President Tochi Iroku-Malize, MD, MPH, MBA, FAAFP, to learn more.

Healio: What should primary care physicians know about the vaccines?

Iroku-Malize: Although ACIP has voted to recommend the vaccines for adults 60 years and older, the AAFP is awaiting the CDC’s approval and we are encouraged by ACIP’s recommendations. The recommendations are based on shared decision-making, which means physicians and patients will work together to determine whether the vaccine is right for the patient.

Older adults, especially those with chronic and underlying health conditions, are at higher risk for severe disease and serious complications from RSV.

According to the CDC, RSV leads to around 60,000 to 160,000 hospitalizations and 6,000 and 10,000 deaths among adults aged 65 and older. If approved by the CDC, the RSV vaccines could lead to less serious illness and fewer hospitalizations and deaths from RSV among older adults. ACIP’s recommendations on the RSV vaccines for older adults mark an important milestone and bring us one step closer to making an important public health tool available.

Healio: What’s the difference between the two vaccines? Which ones should PCPs choose for their patients?

Iroku-Malize: Both RSV vaccines have been proven effective at preventing lower respiratory tract illness caused by RSV and were recommended by ACIP for adults aged 60 and older. The difference between the vaccines is the efficacy shown in clinical trials. Arexvy, the RSV vaccine developed by GSK, was found to be 82.6% effective against RSV-related lower respiratory tract disease (LRTD) and 94.1.% effective against severe disease.

Pfizer’s RSV vaccine, Abrysvo, was 85.7% effective at reducing the risk of developing RSV-related LRTD with three or more symptoms and 66.7% effective against LRTD with two or more symptoms. It was 62.1% effective against acute respiratory illness related to RSV. Both vaccines will be considered for approval by the CDC, and if approved, decisions about which vaccine to give patients will be made at the practice level.

Healio: When will these be routinely used in practice? Are there any foreseen issues with rollout?

Iroku-Malize: They could potentially be available by this fall ahead of the next RSV season. Family physicians are well equipped to counsel and administer vaccines because they are able to receive ample supply.

Healio: What common questions do you think patients might ask about the vaccines and how should physicians address them?

Iroku-Malize: The first question on patients’ minds will likely be whether they should get the RSV vaccine. Family physicians should talk to patients about any underlying health conditions they have and whether there are factors that put them at greater risk for more severe illness. Together, the physician and patient can decide the best course of action and whether the vaccine will benefit the patient.

Patients may also have questions about potential side effects of the vaccines. The most common side effects in clinical trials were injection site pain, fatigue, muscle pain and headache. As family physicians, we let our patients know that these are common vaccine side effects, which occur because the vaccine is doing its job by activating the immune system. Symptoms are usually mild and should go away in a day or two.The most important thing for us to communicate with our patients is that vaccines are safe, effective and save lives.

Healio: How should PCPs address vaccine hesitancy and educate patients about the vaccines?

Iroku-Malize: Family physicians are a trusted source of information for their patients and local communities.In the age of social media, misinformation about many topics is rampant, and vaccines are no exception. I encourage everyone to seek information from a trusted source, like their family physician, to make the best decisions about their own and their family’s health. I urge all patients to talk to their family physician. We’re equipped with all the prevention tools — vaccine administration, counseling and education — so patients can make informed decisions about their health.

Healio: Is there anything else you would like to add?

Iroku-Malize: Vaccines are a critically important public health tool for people at every age. They provide protection against potentially deadly diseases and help build a community of immunity. Immunizations are among the most cost-effective and successful ways to keep ourselves, our families and our communities healthy. To stop the spread of dangerous diseases and protect ourselves and the vulnerable who aren’t able to get vaccinated, everyone must do their part and stay up to date on recommended vaccinations. Family physicians play a crucial role in making sure that happens.

References:

• Papi A, et al. N Engl J Med. 2023;doi:10.1056/NEJMoa2209604.
• RSV surveillance and research. https://www.cdc.gov/rsv/research/index.html. Accessed June 27, 2023.
• Walsh EE, et al. N Engl J Med. 2023;doi:10.1056/NEJMoa2213836.