Q&A: Respiratory therapist discusses RSV vaccines, CDC recommendation

At this point in 2023, several advances have been made to protect individuals from respiratory syncytial virus.

Within the past two months, the FDA has approved the world’s first and second RSV vaccines for people aged 60 years and older. In early May, GSK’s Arexvy received approval, followed by Pfizer’s Abrysvo in late May.

The CDC’s Advisory Committee on Immunization Practices also came together in late June to recommend that adults aged 60 years or older consider receiving one of these vaccinations after talking with their doctor.

To learn more about these recent developments in RSV protection, as well as how to address vaccine hesitancy, Healio spoke with Mandy De Vries, MSc, RRT, RRT-NPS, respiratory therapist and director of education at the American Association for Respiratory Care (AARC).

Healio: Could you discuss the recent recommendation from the CDC’s Advisory Committee on Immunization Practices that adults aged 60 years and older "may receive" a single dose of an RSV vaccine?

De Vries: In May, the FDA approved two different single-dose RSV vaccines by two companies: GSK and Pfizer. Originally the study started with age 65 years and older, but it has come out that individuals aged 60 years and older can get it. The CDC suggests that adults aged older than 60 years may get the vaccines. At this point, the committee has not released a statement stating that they should get the vaccine, but this is part of the normal process. Once it’s approved by the CDC to release and talk about, they don’t always suggest that you should get it, they just suggest that you can or you may get it. That’s completely normal because they like to get a little more data and have a little time before they actually say yes, we truly stand behind this and say you should get it.

Healio: What predisposes older adults to more severe RSV?

De Vries: In pediatrics, we see the risk for RSV up to and around age 2, but a big burden right now with RSV is among U.S. adults that are usually aged 60 years or older. A lot of these cases will come out like a mild cold symptom, but if you are older or have any underlying health conditions, then it can cause hospitalization. Because of COVID-19, I think RSV has reared its ugly head, and it’s kind of switched up the seasonality and symptoms that we’re seeing, so we need to get protection for our older population.

Healio: What does current RSV vaccine data look like?

De Vries: For this vaccination, there are some suggested data out there but because RSV vaccination has come to light recently, there are not enough data past clinical trials. The results of the clinical trials for the GSK vaccine in the adult population showed that it lowered the risk for symptomatic illness by 83% and the risk for severe illness by 94%, which is huge. However, they saw a drop in numbers about 14 months after vaccination, but it was still 77% effective. Clinical trials of Pfizer’s RSV vaccine showed that it was 86% effective but slightly dropped around the 18-month mark after vaccination. For children, there’s nothing out there yet, so it’s hard to say who’s getting it since the vaccine that’s been released is only recommended for adults aged 60 years and older.

Healio: Are there other RSV vaccines in the pipeline? Who are they for and when can we expect them?

De Vries: No dates have been released, but there is a monoclonal antibody developed by AstraZeneca and Sanofi that is anticipated to be approved by the FDA. Clinical trials are always harder with pregnant women, infants and children because it’s difficult to test on them, so that always takes a little longer. I would imagine we would see the adult population gather some data on that for several months before they would release the next one. There is a vaccine for maternal and for pediatric patients approved by the FDA and just waiting on the next steps of approval from the CDC.

Healio: Besides RSV, what other respiratory illnesses are currently rising and causing many people to become sick?

De Vries: Illnesses rising for those aged older than 60 years include rhinovirus enterovirus, adenovirus, coronavirus and the flu, so that’s where all these vaccines have been doing really great. When we weren’t vaccinated, these viruses would appear, and we would lose a lot more of our population. Now with vaccines and herd immunity, we’re seeing considerably fewer people experiencing severe symptoms of hospitalization or mortality. Notably, these illnesses will affect any population, but especially the very young, immunocompromised and older populations.

Healio: If patients are vaccine hesitant, what are your recommendations for clinicians on how to address this? Why should patients, specifically those aged 60 years and older, get the vaccine?

De Vries: When addressing vaccine hesitancy in patients, it’s essential to provide accurate evidence-based information. Get them some data and talk it out. Something that we always suggest and do as respiratory therapists is emphasize the benefits of vaccination against RSV, such as reducing the risk for that severe illness, hospitalization and even complications associated with RSV infection. Additionally, different health care providers can explain the potential impact of RSV on older adults, particularly those with underlying health conditions. Sharing data on the safety and efficacy of vaccines, highlighting successful vaccination campaigns and even just addressing specific concerns or misconceptions can help alleviate vaccine hesitancy. Each patient has the right to decide if they want to get vaccinated or not — that’s what’s so beautiful in the U.S. — but I think overall that decision needs to come from evidence-based medicine, research, data and literature, and how can patients make that decision if we don’t provide them with that? Making sure that we provide patients with this information in an easy way to understand can help them make the right informed decision for themselves. It’s scary to put a foreign thing in your body. Nothing is going to be 100% perfect, but the fact that the data are showing that it’s helping is something they need to consider, especially if they have those underlying risk factors.

We like to say vaccines are more of a recent thing in history, so for a lot of the older population, vaccines weren’t really readily available when they were young and growing up and their parents didn’t do it. A lot of hesitancy around vaccines in older adults is surrounded by the fact that it's different. As they get older and different risk factors come up, such as COPD, asthma, blood conditions and a bad liver or kidney, their body can’t fight things on its own. Reading that research and data sometimes will help them understand that for the majority of people with vaccination it can improve symptoms and actually help you not feel those symptomatic things that could cost you your life if you don’t look deeply enough. Overall, they need to have control of their own health.

Healio: As a respiratory therapist, can you share some ways patients can protect themselves from respiratory illnesses?

De Vries: Whether you're vaccinated or not, there are several good practices to adopt to protect yourself from getting sick, and these include:

• washing your hands for at least 20 seconds with soap and water;
• using alcohol-based hand sanitizer;
• keeping your hands off your face;
• avoiding touching your eyes, your nose and your mouth with unwashed hands;
• avoiding contact with sick people;
• covering your coughs and sneezes;
• making sure to clean and disinfect surfaces; and
• staying home when we’re sick.

Staying home when you’re feeling sick is important especially as the country is trying to go back to work. Since so many people were virtual and are now starting to go back, we need to remember to do all these practices. Additionally, bosses need to be okay when we have signs or symptoms of RSV or any illness. They should be supportive and let team members stay home while they get through that, so we’re not spreading infection.