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Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention
National Center for Immunization and Respiratory Diseases
RSV Vaccination Implementation Update
Carla Black, PhD
Surveillance and Epidemiology Branch
Immunization Services Division, NCIRD, CDC
Advisory Committee on Immunization Practices
February 29, 2024
Data reported by jurisdiction Immunization Information Systems
Vaccination coverage estimates by demographic characteristics and high risk
conditions, National Immunization Survey
Doses administered in pharmacies and physician offices, by product type, IQVIA
Vaccination attitudes and concerns, CDC Omnibus Surveys
RSV vaccine implementation considerationsPresentation Outline
2
Data Reported by Jurisdiction Immunization
Information Systems (IIS)
Percent of Adults 60 Years and Older Who Have Received ≥1 Dose RSV Vaccine
Reported by Jurisdiction Immunization Information Systems, Through December 2023
•Among the currently reporting 37 state and city IIS jurisdictions, RSV vaccination coverage among adults 60 years and older ranged from 4.6% to 17.9%
4
National Immunization Survey (NIS) Data
Update
National Immunization Survey -Adult COVID Module (NIS -ACM) Methods
•The NIS- ACM is a random- digit -dial cellular telephone survey of adults age ≥18 years in the U.S.
•Respondents are sampled within all 50 states, District of Columbia, five local jurisdictions (Bexar County TX,
Chicago IL, Houston TX, New York City NY , and Philadelphia County PA), Puerto Rico and the U.S. Virgin Islands (sampled in 2023 only).
•Data are weighted to represent the non- institutionalized U.S. population.
oEstimates from the NIS -ACM may differ from estimates based on other data sources, and are subject to errors resulting
from incomplete sample frame (exclusion of households without cell phones), selection bias (survey respondents may
be more likely to be vaccinated than non -respondents), and errors in self -reported vaccination status. Estimates are
weighted to selected sociodemographic characteristics of the U.S. population to reduce possible bias from incomplete
sample frame and selection bias.
•All responses are self- reported.
•Enhanced weekly estimates:
oCoverage estimates are based on all interviews through the current week and represent approximately the cumulative
percent vaccinated by mid -week. Each week, estimates for prior weeks are recalculated using the additional interviews
conducted that week (combined with all previous interviews).
oEstimates for vaccination intent are based on interviews conducted that week and are adjusted to the cumulative vaccination coverage estimate for that week.
•Kaplan -Meier estimates:
oBased on interviews conducted September 24, 2023 –January 27, 2024
oKaplan -Meier estimation procedure used to estimate RSV vaccination coverage through end of December 2023
•Additional information available at: About the National Immunization Surveys6
4.8 5.2 6.5 8.2 9.1 11.4 12.6 13.5 13.9 15.9 16.7 17.0 17.3 17.4 20.2 20.6 20.9 21.4 22.420.9 21.8 20.0 19.6 17.516.917.8 16.6 14.415.6 14.2 12.214.8 16.815.8 14.4 15.4 11.713.350.4 50.345.547.842.742.843.5 45.042.640.4 38.8 39.238.041.6 37.5 38.8 35.1 39.438.324.0 22.728.124.430.7 28.8 26.1 24.829.1 28.1 30.3 31.6 29.824.2 26.5 26.1 28.6 27.5 26.1
0255075100Weighted %• Among adults aged ≥60 years responding to the National Immunization Survey through February 3, 22.4% (95% CI: 21.1- 23.6) reported having received an RSV vaccine.
• 13.3% (95% CI: 11.5- 15.1) of adults ≥60 years said they definitely will get vaccinated, and 26.1% (95% CI: 23.7 -28.4) said they probably or definitely will not get
vaccinated.
Probably or definitely will not get RSV vaccine
Probably will get RSV vaccine or unsureDefinitely will get RSV vaccineReceived RSV vaccineRSV Vaccination Status and Intent Among Adults 60 Years and Older
National Immunization Survey-Adult COVID Module (NIS -ACM)
Weekly RSV Vaccination Status and Intent Among
Adults Age ≥60 Years, NIS -ACM (n = 97,574)
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12.4*22.53.2*14.0*12.9*16.714.5*24.4*29.1*24.9*19.4*24.0*11.11.7*19.720.414.220.0
0 20 40 60 80 100Multi/Other, non-HispanicWhite, non-Hispanic (Ref)NH/OPI, non-HispanicHispanicBlack, non-HispanicAsian, non-HispanicAI/AN, non-Hispanic80+75-7970-7465-6965+60-64 (Ref)50-59**MaleFemale (Ref)Overall 50+**Overall 60+
Weighted % (95% CI)RSV vaccination coverage among adults 60 years and older, by end of December 2023
National Immunization Survey-Adult COVID Module (NIS -ACM)
(N = 91,680)
AI/AN: American Indian or Alaska Native; NH/OPI: Native Hawaiian or Other Pacific
Islander; CI: 95% confidence interval; Ref: Referent category .
*Statistically significant at p<0.05 compared to the referent category.**This bar only among age 50+, all other bars age 60+ only.•20.0% (95% CI: 19.1- 20.9) of adults ≥60
years reported having received an RSV
vaccine by the end of December 2023.
•Vaccination was highest among older
adults and white non- Hispanic adults.
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2.6*11.7*38.52.5*30.517.918.3*20.4*23.2
0 20 40 60 80 100No COVID vaccinations1+ (not updated)Updated COVID vaccine (Ref)Did notReceived flu vaccine (Ref)Smoker (current/former)SVI: HighSVI: ModerateSVI: Low (Ref)
Weighted % (95% CI)17.88.1*32.722.228.423.5*23.0*29.3*24.527.7*25.1*
0 20 40 60 80 100None of the above (Ref)NeurologicalLiver diseaseImmunocompromisedHIV infectionHeart conditionsDiabetesChronic lung diseasesChronic kidney diseaseCancer1+ chronic conditions
Weighted % (95% CI)RSV vaccination coverage among adults 60 years and older, by end of December 2023
National Immunization Survey -Adult COVID Module (NIS -ACM)
Immunocompromised includes immunocompromised state, solid organ or blood stem cell
transplant, sickle cell disease or thalassemia; Neurological includes stroke or cerebrovascular hemorrhage, dementia or other neurological, Down syndrome.SVI: Social Vulnerability Index; CI: 95% confidence interval; Ref: Referent category .
*Statistically significant at p<0.05 compared to the referent category.•Adults ≥60 years with 1+ chronic conditions had significantly higher RSV vaccination coverage (25.1%) than those with no chronic conditions (17.8%).
•RSV vaccination coverage was higher among those who have received a flu vaccine or who have received the updated 2023- 24 COVID -19
vaccine.
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30.0*23.9*20.0*14.318.4*24.0*18.6*14.04.1*20.614.720.9*21.0*28.220.423.820.017.9*21.718.2*20.914.9*24.1
0 20 40 60 80 100Advanced degreeCollege graduateSome collegeHigh school or less (Ref)Income unknownAbove poverty, >=$75KAbove poverty, <$75KBelow poverty (Ref)UninsuredInsured (Ref)Rural (Ref)SuburbanUrbanHHS Region 10HHS Region 9HHS Region 8HHS Region 7HHS Region 6HHS Region 5HHS Region 4HHS Region 3HHS Region 2HHS Region 1 (Ref)
Weighted % (95% CI)RSV vaccination coverage among adults 60 years and older, by end of December 2023
National Immunization Survey-Adult COVID Module (NIS -ACM)
(N = 91,680)
•RSV vaccination coverage was highest
in HHS regions 10 (28.2%; AK,ID,OR,WA ) and
1 (24.1; CT,ME,MA,NH,RI,VT ).
•Adults in rural areas had lower vaccination coverage (14.7%).
•Adults with health insurance had significantly higher vaccination
coverage (20.6%) than adults without
insurance (4.1%).
•RSV vaccination increased with increasing household income and
education.
HHS Regions
1: CT,ME,MA,NH,RI,VT 6: AR,LA,NM,OK,TX
2: NJ,NY,PR,VI 7: IA,KS,MO,NE
3: DE,DC,MD,PA,VA,WV 8: CO,MT,ND,SD,UT,WY
4: AL,FL,GA,KY,MS,NC,SC,TN 9: AZ,CA,HI,NV,GU
5: IL,IN,MI,MN,OH,WI 10: AK,ID,OR,WAAI/AN: American Indian or Alaska Native; NH/OPI: Native Hawaiian or Other Pacific Islander; CI: 95% confidence interval; Ref: Referent category .
*Statistically significant at p<0.05 compared to the referent category. 10
19.8 8.5 14.7 57.1
0.0 20.0 40.0 60.0 80.0 100.060+ years
Weighted %RSV vaccine received with flu vaccine RSV vaccine received with COVID vaccine RSV vaccine received with flu + COVID vaccines None of the aboveCoadministration among adults 60 years and older who received an RSV vaccine, January 2024
National Immunization Survey -Adult COVID Module (NIS -ACM)
•Among adults ≥60 years who received an RSV vaccine,
•19.8% received RSV + Flu vaccines at the same visit
•8.5% received RSV + COVID vaccines at the same visit
•14.7% received RSV + Flu + COVID vaccines at the same visit
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84.288.883.9 84.387.7 85.8 84.788.584.6 83.3 82.0 84.411.07.713.4 14.812.111.6 12.510.415.2 15.4 17.6 13.64.8 3.4 2.7 0.9 0.2 2.6 2.9 1.0 0.2 1.3 0.4 2.0
0%20%40%60%80%100%Weighted %Other non-medical
Medical
Pharmacy
Medical: includes doctor's office, health department, clinic or health center, hospital, mass vaccination site, or "other" me dically -related place .
Other non -medical: includes workplace, high school/college/university, or "other" nonmedically -related place.Place of RSV Vaccination Among Vaccinated Adults Age ≥60 Years, NIS -
ACM, November 2023 -February 2024Place of RSV vaccination among vaccinated adults 60 years and older
National Immunization Survey -Adult COVID Module (NIS -ACM)
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IQVIA Data Update
RSV vaccine doses administered in retail pharmacies, long -term care pharmacies, and
American Medical Association (AMA) physicians’ medical offices* based on claims
submitted to insurers and cash payments (pharmacies only).
IQVIA data include raw (actual) number of doses administered at a sample of
pharmacies and medical offices of a sample of AMA physicians.
oIQVIA uses a proprietary projection methodology to estimate the projected number of vaccinations administered
inallpharmacies and medical offices of all AMA physicians.
National medical offices projected estimates are based on 2,866 (48%) of the 5,979
AMA physicians that IQVIA monitors who provide RSV vaccinations.
oRange for states is 0% – 73%
oProjected estimates are updated monthly and do not mature until about two months. This results in an increase or
decrease in the initial or subsequent estimates for a given week (up to ~10% based on initial evaluations)IQVIA Methodology
IQVIA data products used: Custom Longitudinal Prescription Claims ( LRx) for retail pharmacies, Custom Medical Claims (Dx) for physician medical offices, SMART National Prescription
Audit (NPA)*Physicians are a sample of AMA’s proprietary list of physicians. 14
National retail pharmacy projected estimates are based on a sample of 40,469 (97%)
of the 41,583 pharmacies that IQVIA monitors that provide RSV vaccinations.
oRange for states is 94% – 100%
oHigher confidence in the accuracy of national estimates for pharmacy data compared with physician office
data
Data are notavailable for vaccinations administered in:
oOther medical settings ( e.g. public health clinics, hospitals)
oNon -medical, non -pharmacy settings ( e.g. workplace, community settings)IQVIA methodology (cont )
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Weekly Cumulative Projected RSV Vaccinations Administered in Retail Pharmacies and
Physician Medical Offices, Adults 60 years and older, August 12, 2023 – February 3, 2024.
Data Source: IQVIA*
*Data Source: IQVIA Custom Weekly LRx and Custom Weekly Dx . Data are available Respiratory Syncytial Virus (RSV) Adult Vaccinations Administered | CDC
**IQVIA SMART NPA; Data pulled 2/12/24. This is a subset of vaccinations administered in long -term care settings .
•As of February 3 , 2024, a combined total of 9.65 million RSV vaccinations were administered in retail pharmacies (9.36
million) and physician medical offices (291,599).
•An additional 164,254 RSV vaccinations were administered in long -term care pharmacies.**
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Weekly and Cumulative Projected RSV Vaccinations Administered in Retail Pharmacies by Product,
Adults 60 years and older, August 12, 2024 – February 2, 2024. Data Source: IQVIA*
•Of the total 9,360,148 RSV vaccinations administered, 2,933,112 (31%) were Abrysvo (Pfizer) and 6,427,035
(69%) were Arexvy (GSK).
*IQVIA Custom Weekly LRx; File delivery date 2/8/24 .17
Cumulative Projected RSV Vaccinations Administered in Pharmacies, by Age Group and
Product, August 4, 2023 – February 2, 2024. Data Source: IQVIA*
*Data Source: IQVIA SMART National Prescription Audit (NPA) Weekly Extended Insights. Information about these sources is availab le via IQVIA.
**An additional 1,543 ABRYSVO and 2,860 AREXVY doses were administered to unspecified ages.•As with all persons 60 years and older, for each age group, about 30% received Abrysvo (Pfizer) and 70% received Arexvy (GSK).
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Weekly and Cumulative Projected RSV Vaccinations Administered in Physicians’ Medical
Offices by Product, Adults 60 years and older, August 12, 2024 - February 3, 2024
•Of the total 291,598 RSV vaccinations administered, 130,720 (45%) were Abrysvo (Pfizer) and 160,877 (55%)
were Arexvy (GSK) .
*IQVIA Custom Weekly Dx ; File delivery date 2/20/24 .
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Cumulative Projected RSV Vaccinations Administered in Physicians’ Medical Offices, by Age
Group and Product, U.S., August 4, 2023– February 3, 2024. Data Source: IQVIA*
*IQVIA Custom Weekly Dx ; File delivery date 2/20/24 .•Of the 291,598 doses administered, Arexvy was administered in 53% of adults 60 -64 years and 56% among 65
and older
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Cumulative Raw (Actual)* RSV Vaccinations Administered Alone or On the Same Day with
Influenza and/or COVID Vaccinations, in Retail Pharmacies and Physicians’ Medical Offices Combined, Adults 60 years and older, August 2023 – December 2023
*Raw estimates are based on actual sample of pharmacies and medical offices and thus will be different than projected estimat es
presented elsewhere. IQVIA was unable to provide projected estimates due to complexity of analysis. Vaccination(s) received Number (%) of persons
receiving vaccinations
RSV only (without flu and/or COVID) 3,635,795 (52.0%)
RSV and flu 1,557,403 (22.3%)
RSV and COVID 852,591 (12.2%)
RSV, flu, and COVID 943,676 (13.5%)
Total 6,989,465•Of the ~7 million doses of RSV administered through end of December, 52% were administered alone
and 48% with either flu or COVID vaccination or all three vaccine on the same day.
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Comparison of NIS and IQVIA Projected Doses Administered by Setting
•Number of doses reported from the NIS projected by applying the vaccination coverage estimates and reported place of
vaccination to the 2022 U.S. Census population of persons 60 years and older
•IQVIA data do not capture all medical settings and settings other than medical and pharm.acy .
•NIS-based estimate for number of doses administered in pharmacies is 14.9 million compared with 9.4 million doses based on
IQVIA’s projected estimate. NIS-based estimate for all medical settings is 2.4 million compared with 0.29 million in physicians’
medical offices .
*Data Source: IQVIA SMART NPA and Custom Weekly Dx . NIS ACM Weekly enhanced coverage estimates by week ending February 3, 2024, and
reported place of vaccination for persons interviewed during the week ending February 3, 2024. 22
Comparison of NIS and IQVIA Projected Estimates to Determine Possible Range of
Vaccination Coverage and Persons Vaccinated
*Data Source: IQVIA SMART NPA and Custom Weekly Dx . NIS ACM Weekly enhanced coverage estimates by week ending February 3, 2024, and
reported place of vaccination for persons interviewed during the week ending February 3, 2024.•The IQVIA projected total for physicians’ medical offices and pharmacies combined is 9.7 million (cover age 12.2%).
•Based on adjusting IQVIA pharmacy estimates by the proportion of people vaccinated in pharmacies reported from the NIS , 11.1
million doses were administered in all settings (coverage 14.1%).
•Based on applying NIS vaccination coverage estimates to the 2022 U.S. Census population of persons 60 years and older , 17.7
million doses of RSV vaccine were administered in all settings (coverage 22.4%).
•Using data from both sources, estimated range of persons vaccinated is approximately 11 –18 million and estimated percent of
persons vaccinated is 14% –22% .
Cumulative number of RSV vaccine doses administered (left bars) and cumulative RSV vaccination coverage (right bars), among persons 60 years and older, as of week ending February 3, 2024.
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RSV Vaccination Attitudes, Omnibus Surveys,
January 2024
Data for this analysis were collected through the IPSOS KnowledgePanel and NORC
AmeriSpeak Omnibus Surveys, which use probability -based panels to survey a
nationally representative sample of U.S. adults aged 18 years and older.
CDC fields questions about vaccination status, intent, knowledge, attitudes, beliefs, and
behaviors on each survey for 2 waves each month, for a combined sample size of ~4,000 respondents.
Data were weighted to represent the non -institutionalized U.S. population and mitigate
possible non- response bias. All responses are self -reported.Omnibus Survey Methods
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4.6%
2.6%
2.5%
2.4%
2.3%
1.9%
1.5%
1.0%
0 25 50 75 100Side
effects
Don't know enough
about RSV or vaccine
Haven't
had time
Not worried
about RSV
Too close to
COVID vaccine
Vaccine
fatigue
No HCP
recommendation
Other
reason
Weighted % (95% confidence interval)Received/definitely will get
(N=391)
84.0% reported "No concerns or issues"25.8%
23.0%
11.8%
7.7%
7.5%
6.2%
6.1%
5.9%
0 25 50 75 100No HCP
recommendation
Don't know enough
about RSV or vaccine
Vaccine is
too new
Unsure if need
or eligible
Haven't
had time
Too close to
COVID vaccine
Side
effects
Vaccine
fatigue
Weighted % (95% confidence interval)Probably will get/unsure
(N=490)
34.5% reported "No concerns or issues"28.2%
23.0%
21.2%
20.7%
15.7%
15.6%
11.9%
10.6%
0 25 50 75 100Do not trust
gov. or pharma
Don't know enough
about RSV or vaccine
Vaccine is
too new
Not worried
about RSV
Side
effects
No HCP
recommendation
Vaccine is not
effective
Do not
need it*
Weighted % (95% confidence interval)Probably/definitely will NOT get
(N=445)
26.4% reported "No concerns or issues"Top RSV Vaccination Concerns and Issues Among Adults ≥60 Years of Age, by
Status/Intent, Omnibus Surveys, January 5 -29, 2024 (N=1,326)
Other response options included: "Cost/insurance issues ," "Already had RSV*," "HCP recommended against," "Medical reasons*," "Afraid of needles," "Vaccine not available."
*Option not offered to those who already received the vaccine.26
Implementation Considerations
Takes time to integrate into systems, gain wide access, increase awareness
among healthcare providers, and normalize among the population.
RSV is recommended based on SCDM.
SCDM recommendations are difficult to implement.
Coadministration messaging is complex and may result in missed opportunities for
vaccination.
Insurance plans have a year to cover the vaccine and not all plans may cover RSV
vaccine in its first year.
Vaccines are costly, meaning a costly upfront investment to carry the vaccine.
RSV vaccine is billed under Medicare Part D.
Residents of long -term care have additional, specific challenges.Potential factors contributing to relatively low vaccination
coverage among people ages 60 years and older
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Frequent speaking engagements with healthcare providers to provide education on
recommendations and answer questions
Social media and other consumer resources to promote vaccination
Resources to increase clinician knowledge of RSV vaccination recommendations and coadministration recommendations
Regular communication with CMS to communicate challenges with billing
Regular collaboration and communication with long -term care partners
Planning analysis on shared clinical decision makingWhat is CDC doing to increase coverage or RSV vaccination
in people ages 60+?
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For more information, contact CDC
1-800- CDC- INFO (232- 4636)
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 o f the Centers for Disease Control and Prevention.
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any use by other CDC CIOs or any external audiences.Thank you!