Do Not Underestimate RSV or Your Importance in Recommending Vaccines

RSV Creates More Morbidity and Mortality in Adults Than Most Patients Realize

In July 2023, the widely accessed and utilized Morbidity and Mortality Weekly Report (MMWR) from the CDC published the recommendations from the Advisory Committee on Immunization Practices (ACIP) on respiratory syncytial virus (RSV) vaccine and provided baseline statistics for RSV’s societal burden, reporting an estimated 60,000 to 160,000 hospitalizations and 6000 to 10,000 deaths annually among adults 65 years and older.¹ In comparison, influenza produced a higher, though similar, level of morbidity and mortality in adults 65 years and older during the 2022-2023 season, with a CDC-estimated 192,000 hospitalizations and 15,400 deaths.²

Immunizing older adults and those with medical frailty against influenza has become standard practice and part of our regular seasonal emphasis on getting immunized against respiratory diseases. With RSV vaccines’ clinical trial evidence of efficacy ranging from 75% to 85% for 2-season protection,¹ substantially outpacing the effectiveness of our typical armament of influenza vaccines in a given year, it is understandable why practitioners would keep the RSV vaccination front of mind alongside other fall-centric vaccines with which it may be co-administered.

ACIP Recommends a 1-Time Dose With Emphasis on Shared Decision-Making

Along with considering the vaccination administration year-round as a 1-time dose, ACIP’s recommendation of “shared decision-making” is a note of import for pharmacists, as ACIP is clear in its recommendations that a long list of patient-specific at-risk conditions and circumstances can guide the pharmacist in practice.

Specifically, the CDC MMWR publication of ACIP recommendations said the following: “Adults with certain medical conditions, including chronic obstructive pulmonary disease, asthma, congestive heart failure, coronary artery disease, cerebrovascular disease, diabetes mellitus, and chronic kidney disease, are at increased risk for RSV-associated hospitalization, as are residents of long-term care facilities, and persons who are frail or of advanced age [incidence of RSV-associated hospitalization among adults increases with age, with the highest rates among those aged ≥75 years]. RSV can also cause severe disease in persons with compromised immunity, including recipients of hematopoietic stem cell transplantation and patients taking immunosuppressive medications [eg, for solid organ transplantation, cancer treatment, or other conditions].”¹

ACIP seems rightly sensitive to the consideration of individualized decision-making, taking into consideration other factors we’ve come to understand about vaccine literacy, uptake, hesitancy, and carefully listening to patient concerns during the COVID-19 pandemic and now-endemic experience as health care professionals at the front lines of vaccination efforts.

The CDC MMWR continues, “The decision to vaccinate a patient should be based on a discussion between the health care provider and the patient, which might be guided by the patient’s risk for disease and their characteristics, values, and preferences; the provider’s clinical discretion; and the characteristics of the vaccine.”¹

Translation for pharmacists: Your role in educating on the morbidity and mortality of RSV, alongside the effectiveness findings and the patients’ health and environmental considerations, is being called upon. You are a trusted source of information and recommendations and entrusted to participate actively in shared decision-making.

RSV Awareness and Discussions Are Particularly Absent in Underserved Populations

These discussions, often starting with education about the prevalence and potential poor outcomes associated with previously underdiscussed diseases, are even more important in underserved populations for which newer treatments and evidence-based medicine practices often take much longer to permeate into practice. Additionally, underserved populations have historically had poorer outcomes, with the at-risk conditions noted by ACIP as important considerations in favor of receiving the RSV vaccine.

Breaking Through Access Barriers

Setting aside the hesitancy that is prevalent in RSV vaccination,3 as with COVID-19 and all other vaccines on some level, the roughly 16 million American older adults who do not have Part D coverage and those who are too young or not eligible for Medicare but seek out the vaccine can expect out-of-pocket costs, often with a substantial price tag, even though the RSV vaccine may be considered as important as the influenza and COVID-19 vaccinations, which are mandated not to have any out-of-pocket costs by statute. Keeping patients informed about the value and importance of the RSV vaccine and watching for changes in insurance coverage, including new Medicare eligibility, is prudent for the practicing pharmacist in the community.

References

1. Melgar M, Britton A, Roper LE, et al. Use of respiratory syncytial virus vaccines in older adults: recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep. 2023;72(29):793-801. doi:10.15585/mmwr.mm7229a4

2. Preliminary estimated influenza illnesses, medical visits, hospitalizations, and deaths in the United States — 2022-2023 influenza season. CDC. Updated November 22, 2023. Accessed May 22, 2024. https://www.cdc.gov/flu/about/burden/2022-2023.htm

3. Houle SKD, Andrew MK. RSV vaccination in older adults: addressing vaccine hesitancy using the 3C model. Can Pharm J (Ott). 2023;157(1):39-44. doi:10.1177/17151635231210879