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RSV Recommendations for Older Adults
RSV in Older Adults: Understanding the Risks and Recommendations

Released: March 20, 2025

Expiration: March 19, 2026

Carolyn Bridges
Carolyn Bridges, MD, FACP
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Key Takeaways
  • Older adults are at an increased risk for severe respiratory syncytial virus (RSV).
  • Although RSV vaccination will have most efficacy if administered in late summer or early fall (due to the seasonal nature of the virus), we should offer the one-time RSV vaccination to eligible adults at any time throughout the year.
  • RSV vaccination is recommended to be administered to all adults aged 75 years or older as well as adults aged 60 to 74 years at risk of severe disease.

In the United States, respiratory syncytial virus (RSV) causes seasonal outbreaks of respiratory illness nearly every winter, and those at greatest risk of severe illness and hospitalization include infants and older adults.  Although many healthcare professionals (HCPs) recognize the risk of RSV-related hospitalization among infants, less are aware of the risk for older adults. This lack of awareness may be due to decreased prioritization of testing of older adults in clinical settings, as well as a lack of antiviral treatment options. 

Why Vaccinate: Incidence, Hospitalization, and Morbidity
Like influenza, most RSV infections cause mild upper respiratory illnesses and occur frequently—3% to 7% of older and high-risk adults infected with RSV annually—but they provide ample opportunity for severe outcomes.

Here is an example. Data from a 7-year prospective surveillance system estimated that RSV hospitalization rates for adults aged 65 years or older ranged from 85,000 to 136,000 per year, excluding the 2020-21 COVID-19 pandemic year. The highest rate of RSV hospitalization was among adults 75 years or older, ranging from 245 to 411 per 100 000 adults. Among RSV-hospitalized adults, these older adults accounted for 46% of all hospitalizations, 39% of all intensive care unit (ICU) admissions, and 59% of all in-hospital deaths. Among all adults hospitalized with RSV, approximately 20% were admitted to the ICU, 13% required mechanical ventilation, and 5% died.

Whom to Vaccinate: Recommendations and Risk Factors
Three RSV vaccines are now available in the United States and the CDC recommends vaccination against RSV for everyone aged 75 years or older and those aged 60 to 74 years at increased risk for severe disease. The CDC and its Advisory Committee on Immunization Practices express no preference among the 3 available vaccines, though only 1 vaccine is licensed and recommended for use in pregnant women.

To determine if your patients aged 60 to 74 should receive an RSV vaccine, read the below list of applicable risk factors for severe disease:

  • Chronic cardiovascular disease like heart failure or coronary artery disease
  • Chronic lung/respiratory disease like chronic obstructive pulmonary disease, emphysema, or asthma
  • End-stage renal disease or dependence on renal replacement therapy
  • Diabetes that is complicated by comorbidities like chronic kidney disease, retinopathy, neuropathy, other end-organ damage, or that requires insulin or SGLT2 inhibitor treatment
  • Neurologic/neuromuscular conditions that cause impaired airway clearance or weakness of respiratory muscles like poststroke dysphagia or muscular dystrophy
  • Chronic liver disease like cirrhosis
  • Chronic hematologic conditions like sickle cell disease or thalassemia
  • Severe obesity (BMI of 40 kg/m2 or greater)
  • Any moderate to severe immunocompromising condition
  • Nursing home residency
  • Other conditions or risk factors like frailty that would increase the risk for severe RSV due to viral respiratory infection

When to Vaccinate
RSV is a seasonal illness (November to March) for most states in the US. The CDC suggests that the one-time RSV vaccination will have the most benefit if administered in late summer or early fall.

However, an RSV vaccine may be given at any time of the year, especially for patients seen in clinic who may not return later in the year. Vaccinating when the opportunity presents itself can help reduce missed opportunities for prevention.

RSV vaccines can be given at the same visit as other vaccines. HCPs should always consider patient preferences and their ability to return for additional vaccinations, potential for increased reactogenicity, and other factors when counseling patients.

Your Thoughts
How often are you vaccinating older adults against RSV in your practice? You can get involved in the conversation by posting a comment below.