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Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
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ACIP Adult RSV Work Group Clinical Considerations
Respiratory Syncytial Virus (RSV) in Adults 60 and older
Michael Melgar, MD
Amadea Britton, MD
Co-Leads, Adult RSV Vaccine Work Group
Coronavirus and Other Respiratory Viruses Division (CORVD)
Advisory Committee on Immunization Practices (ACIP)
June 26, 2024
2▪Transition from the current shared clinical decision -making recommendation
▪Adults aged 60 –74 years at increased risk of severe RSV disease
▪Timing of RSV vaccination for the 2024 –2025 RSV season
▪Coadministration of RSV vaccines with other vaccinesOverview
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Transition from the current shared clinical
decision -making (SCDM) recommendation
4▪All adults aged 75 years and older should receive a single
dose of RSV vaccination .
▪All adults aged 60–74 years with certain chronic medical
conditions or other factors that increase risk of severe RSV
disease should receive a single dose of RSV vaccination .
▪These recommendations would replace the SCDM
recommendation, meaning that adults aged 60 –74 years
without risk factors for severe RSV disease, are no longer
recommended to receive RSV vaccination. Work Group recommends a transition away from shared
clinical decision -making (SCDM). What does this mean?
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Adults aged 60 –74 years at increased
risk of severe RSV disease
6Chronic medical conditions associated with increased
risk of severe RSV disease
Lung disease
Cardiovascular disease
Moderate or severe immune compromise
Diabetes Mellitus with end -organ damage
Other chronic medical conditions that a
healthcare provider determines increases risk
of severe disease due to respiratory infection Neurologic or neuromuscular conditions
Chronic kidney disease, advanced
Hematologic disorders
Liver disorders
6Severe obesity
(body mass index ≥40 kg/m2)
7Other chronic medical conditions that a
healthcare provider determines increases risk
of severe disease due to respiratory infection While recommendation is intended to be broad enough to implement, note that less
severe stages of Diabetes mellitus, Obesity, and Chronic Kidney Disease are excluded
given limited evidence of association with severe RSV disease.
Lung disease
Cardiovascular disease
Moderate or severe immune compromise
Diabetes Mellitus with end -organ damageNeurologic or neuromuscular conditions
Chronic kidney disease, advanced
Hematologic disorders
Liver disorders
Severe obesity
(body mass index ≥40 kg/m2)
8•Chronic cardiovascular disease (e.g., heart failure,
coronary artery disease, congenital heart disease;
excluding isolated hypertension )
•Chronic lung disease (e.g., chronic obstructive
pulmonary disease [COPD], emphysema, asthma,
interstitial lung disease, cystic fibrosis)
•Chronic kidney disease, advanced (e.g., stages 4 –5,
dependence on hemodialysis or other renal
replacement therapy)
•Diabetes mellitus with end -organ damage (e.g.,
diabetic nephropathy, neuropathy, retinopathy, or
cardiovascular disease)
•Severe obesity (body mass index ≥40 kg/m2)
•Decreased immune function from disease or drugs
(i.e., immunocompromising conditions *)•Neurologic or neuromuscular conditions (e.g.,
neuromuscular conditions causing impaired airway
clearance or respiratory muscle weakness; excluding
history of stroke without impaired airway clearance )
•Liver disorders (e.g., cirrhosis)
•Hematologic conditions (e.g., sickle cell disease,
thalassemia)
•Frailty
•Residence in a nursing home or other long -term
care facility
•Other chronic medical conditions or risk factors
that a health care provider determines would
increase the risk of severe disease due to
respiratory infectionChronic medical conditions and risk factors for a risk -based recommendation for RSV
vaccination in adults aged 60 –74 years
*List of immunocompromising conditions would match the existing list from the COVID -19 vaccination Interim Clinical Consideratio ns:
https://www.cdc.gov/vaccines/covid -19/clinical -considerations/interim -considerations -us.html#immunocompromised
9Other factors associated with increased risk of
severe RSV disease
Residence in a nursing home or other long -term care
facility (L TCF)*
Frailty
Other factors determined to increase risk of severe disease due to
respiratory infection
*Long -term care facilities do NOT include retirement communities or senior independent living communities in which residents are able to perform activities of
daily living without assistance.
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Other considerations
11▪RSV vaccination should be given
ONL Y to adults who have not yet
received a dose of RSV vaccine.
▪At this time, it is anticipated that
adults may need additional doses of
RSV vaccine in the future, but ideal
revaccination timing is not yet
known. Adults who have already
received a dose of RSV vaccine
DO NOT need to receive
another dose this year. RSV vaccination will have the
most benefit if given in late
summer or early fall .
▪This means from August to
October in most of the United
States.
▪Note this is not a formal
seasonal recommendation for
RSV vaccination. Older adults
may continue to receive RSV
vaccination year -round.
12In accordance with General Best Practice Guidelines for
Immunization, coadministration of RSV vaccines with other
adult vaccines is acceptable.*
*ACIP Timing and Spacing Guidelines for Immunization | CDC This includes giving RSV vaccines simultaneously with
seasonal influenza vaccines, COVID -19 vaccines,
pneumococcal vaccines, Td/Tdap, and recombinant zoster
vaccine (Shingrix) .Co-administration of RSV vaccines and other vaccines
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For more information, contact CDC
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TTY: 1 -888 -232-6348 www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Photographs and images included in this presentation are licensed solely for CDC/NCIRD online and presentation
use. No rights are implied or extended for use in printing or any use by other CDC CIOs or any external audiences.