Opinion | RSV vaccines will be available soon. Older adults should ... - The Washington Post
The United States is approaching a public health milestone. With the recent recommendation by the Centers for Disease Control and Prevention to make anyone 60 and older eligible for the newly approved vaccine against the respiratory syncytial virus, this will be the first year that vulnerable individuals can protect themselves against the "tripledemic" of RSV, influenza and the coronavirus.
Together, these viruses could claim tens of thousands of lives this winter. But if older adults receive the vaccines when they become available, such a tragedy might be averted.
The CDC has long recommended the annual flu shot, which has a high uptake among older individuals. Last flu season, 71 percent of those 65 and older received it. Interest in coronavirus boosters is lower, but coming into the fourth full winter of covid, I hope people who are most susceptible to severe covid will get a shot of the booster set to be released in September.
And now, people can add a vaccine for RSV to the mix. In fact, I'd encourage older individuals to get it as soon as that vaccine becomes available, which could be as early as the end of this month.
While RSV is frequently thought of as a threat to young children, it causes far more illness and death among older adults. The CDC reports that every year in the United States, there are up to 160,000 hospitalizations among adults 65 and older because of RSV. The virus claims the lives of 100 to 300 children younger than 5 annually compared with up to 10,000 deaths among older adults.
Most people infected with RSV have mild cold-like symptoms. Many aren't even aware that they have it. RSV is so contagious and so common that the CDC estimates virtually every child contracts it before they turn 2. While prior infection conveys some immunity, it gradually wanes, and people are reinfected multiple times in their lives.
Avoiding RSV altogether will be difficult, though good hand hygiene and masking during peak season can help. The most important measure to reduce severe illness and death from RSV is to safeguard those at highest risk. As with covid and the flu, these are people of advanced age, nursing home residents and individuals who are immunocompromised or have chronic conditions such as heart and lung disease.
Thankfully, there are now two vaccines, both administered as a single dose, that will work to prevent RSV. Both vaccines — Arexvy from GlaxoSmithKline and Abrysvo from Pfizer — have received full approval from the Food and Drug Administration and are highly effective. GSK's vaccine is 88 percent effective against severe RSV infection; Pfizer's is 85 percent.
Importantly, the durability appears strong: At eight to 12 months after the shot, Pfizer's effectiveness remains at 75 percent. GSK's maintains more than 50 percent protection up to 18 months.
It's possible these vaccines might not need to be administered annually. The durability studies are ongoing, but the key takeaway for me is that unlike the coronavirus booster, which has a much shorter window of protection against infection, the RSV vaccine doesn't need to be timed so precisely for maximal impact. Because protection is strong for at least eight months, even if someone gets the RSV vaccine now, it will see them through this winter's anticipated surge.
I would advise eligible individuals to discuss with their doctors about receiving the RSV vaccine as soon as it comes out — before the anticipated spike in RSV cases. That's different from the guidance for influenza and covid. Generally, the CDC recommends that vulnerable people receive the flu shot before the end of October but not before September so that protection lasts throughout the winter. As for covid, the maximal effect of the booster is two weeks to two months after the shot, and I've written before that timing should be based on individual factors, including anticipated exposure during travel and holiday gatherings.
As with every vaccine, the RSV shot comes with risk. Studies show it might be associated with extremely rare inflammatory neurological conditions, as is seen sometimes with other vaccines. These conditions, including Guillain-Barré syndrome, are also associated with the viral illnesses themselves. Further data on the frequency of side effects will be collected once more people receive this vaccine. Despite this uncertainty, the benefits of preventing RSV in vulnerable older adults outweigh the risks.
Allowing the RSV vaccine for the elderly, who bear the brunt of mortality from RSV, is a different risk calculation from inoculating pregnant women to protect their babies. The CDC is expected to make that determination shortly, too.
No matter the outcome of that decision, Americans once again owe a debt of gratitude to vaccine researchers. Thanks to their efforts, the country now has one more tool to prevent severe illness and save the lives of older Americans this winter.
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