Despite new RSV shots, most older adults remain unvaccinated

This year, the Food and Drug Administration approved the first two vaccines that can protect older adults against respiratory syncytial virus, which causes at least 6,000 deaths and 60,000 hospitalizations annually among adults 65 and older.

This winter will be the first opportunity to see how the RSV vaccines work for older adults in the real world – provided those at highest risk get vaccinated.

But while cases have risen nationwide in recent months, only 14.8 percent of adults 60 and older have been vaccinated against the virus. That’s what the Centers for Disease Control and Prevention says this month.

The CDC, citing a need for more data on potential safety issues that have arisen during clinical trials, has not made a blanket recommendation for every person age 60 and older to get the shot this year. Instead, health officials have said vaccination should be targeted at people most at risk of severe disease, including people with underlying medical conditions and people 75 and older, among others.

Still, experts said they hoped vaccination rates would be much higher by now and pointed to a host of obstacles to the new vaccinations. After the prolonged urge for Covid injections, people can feel this “vaccine fatigue” said Dr. Kathleen Linder, an infectious disease specialist at Michigan Medicine. The pandemic has also fueled vaccine hesitancy, she added. In addition, experts noted that some people with private insurance have been billed more than $300 to get the RSV vaccine, which could deter others from seeking the shot.

“We haven’t organized ourselves optimally,” said Dr. William Schaffner, professor of infectious diseases at the Vanderbilt University School of Medicine. “This first year is a training year. We will have to figure out how to do this better in the future.”

Many older adults may also be unaware of the serious threat RSV poses to them, says Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco. “People have this idea that RSV is a childhood disease,” he said. Although the virus usually causes cold symptoms in most people, it can lead to serious lung problems such as pneumonia and even death in older adults, infants, and people with weakened immune systems.

What you should discuss with your doctor

In clinical trials, the vaccines – one developed by Pfizer and another by GSK – reduced the risk of lower respiratory diseases, such as pneumonia due to RSV, in the first virus season after vaccination. Vaccination may be especially critical for people with diabetes conditions such as chronic heart or lung disease or a weakened immune system.

“If you’re at high risk, it’s a no-brainer,” said Dr. Chin-Hong.

The older you are, the greater your risk for severe RSV. The virus is especially dangerous for people 75 and older, said Dr. Camille N. Kotton, an infectious disease physician at Massachusetts General Hospital and a member of the CDC Advisory Committee on Immunization Practices. If you live in an environment like a nursing home, you are also at greater risk.

However, it’s not clear that every healthy 60-year-old with no underlying medical conditions would “really benefit” from the vaccine, said Dr. Kotton.

If you are 60 years or older, experts recommend talking to your doctor or pharmacist about your risk and whether the injection is right for you.

People who get vaccinated can experience fatigue, fever and pain at the injection site. Clinical trials of the vaccines also showed a “very small but somewhat concerning” safety signal, Dr. Kotton.

Of the approximately 38,000 older adults who received either vaccine in clinical trials, 20 experienced atrial fibrillation and six were reported to have developed neurological complications in the weeks after vaccination, including encephalitis and a rare autoimmune disease called Guillain-Barré -syndrome.

“At this time, there is not enough information to determine whether these findings are simply due to chance, or whether they represent an increased risk of neurological side effects,” says Dr. Michael Melgar, a medical officer with the CDC’s Coronavirus and Other Respiratory Viruses. Division, wrote in an email.

So far, however, safety data from the more than five million doses administered to people 60 and older are reassuring, said Dr. Sarah S. Long, a professor of pediatric infectious diseases at Drexel University College of Medicine and a member of the CDC Advisory Committee on immunization practices. “We’ll keep looking and I think it will become clear,” she said.

If you’re interested in the RSV vaccine, you may want to get the shot sooner rather than later, especially as the holidays loom, said Dr. Seth Cohen, medical director of infection prevention at the University of Washington Medical Center.

You may also want extra protection if you are 60 or older and come into contact with young children, who may be more likely to have the virus and also at risk of serious complications.

“Having this vaccine is a major victory in our fight to keep people out of the hospital and protect older people during respiratory virus season,” said Dr. Cohen.