Improving RSV Vaccine Coverage Could Prevent Thousands of Severe Cases in Older Adults

Although the US has recommended routine respiratory syncytial virus (RSV) vaccination for adults aged 75 years and older since mid-2024, uptake remains low. Countries such as Scotland have achieved notably higher vaccination coverage within this same age group.¹

In a study presented at IDWeek 2025, which took place from October 19 to October 22, 2025, in Atlanta, GA, researchers evaluated the potential public health and economic benefits the US could obtain if RSV vaccine uptake was like Scotland's. This includes modeling reductions in RSV-related illness, hospitalizations, and associated health care costs under high coverage scenarios.¹

RSV Prevalence in Older Adults

An estimated 110,000 to 180,000 individuals aged 50 years and older are hospitalized due to RSV in the US, presenting more severe pneumonia-like symptoms. This includes fever, severe cough, wheezing, rapid breathing or difficulty breathing, and bluish skin color. RSV also could worsen conditions like asthma, chronic obstructive pulmonary disease, or heart failure, leading to hospitalization or fatal outcomes.²

To aid disease prevention and severe RSV infections, the CDC currently recommends a single dose of any of the 3 FDA-approved RSV vaccines—RSVPreF3 (Arexvy; GSK), RSVpreF (Abrysvo; Pfizer), or mRNA-1345 (mRESVIA; Moderna)—for all adults 75 years and older, along with individuals aged 60 to 74 years who are at increased risk of severe illness. Arexvy was the first RSV vaccine approved by the FDA in May 2023 for adults 60 years and older, followed by Abrysvo, also in May 2023, and mRESVIA in May 2024; however, their indications have been updated since their initial approval.³

RSV Vaccination Rates in Older Adults

RSV vaccination rates among older adults remain low despite new vaccines. Previous findings published by investigators in Human Vaccines & Immunotherapeutics demonstrate that limited RSV vaccination uptake was found during the 2023 to 2025 RSV seasons, identifying disparities in vaccination interest.⁴

The results demonstrated that nearly 12.8 million adults aged 60 years and older received an RSV vaccine between August 2023 and February 2025. Updated age was higher among those with chronic conditions or risk factors for severe RSV. However, vaccination rates were lower among non-Hispanic Black and Hispanic adults compared with non-Hispanic White and Asian adults and higher among individuals with greater income and educational attainment.⁴

Public Health and Economic Outcomes Linked With RSV

In the current study, researchers developed a cohort model to estimate the public health and economic impact of RSV and the effects of routine immunization during the first vaccine season. The model evaluated severe outcomes, including RSV-related hospitalizations, emergency department visits, and deaths, along with associated medical costs. The study authors noted that vaccine effectiveness was based on US real-world data from the 2023-2024 season, and 2 uptake scenarios were assessed that reflected the US and Scotland rates.¹

In scenario 1, which demonstrated a 23.6% US vaccination uptake, the results identified 83,469 RSV hospitalization episodes, 54,864 RSC emergency department episodes, and 8713 RSC-related deaths. Overall, medical care costs reached a total of $2.3 billion. In scenario 2, Scotland reported a 68.6% vaccination uptake, with 46,326 RSV hospitalization episodes, 30,823 RSV emergency department episodes, and 4836 RSV-related deaths. Medical costs were lower, totaling $1.3 billion, which represents 44% reductions in all public health and economic outcomes in a single RSV season.¹

According to the findings, if US RSV vaccine uptake among adults aged 75 years and older matched Scotland’s rates, about 40,000 hospitalizations, 250,000 emergency department visits, and 4000 deaths could have been prevented. The study authors highlight the need to boost vaccination among older adults, acting as an effective prevention measure against severe RSV outcomes. 1

REFERENCES

1. Sato R, Chilson E, Quinn E, Averin A. What if Adult RSV Vaccine Uptake in the US was High Like in Scotland? Missed Opportunities to Reduce Public Health and Economic Burden of RSV. Presented: IDWeek 2025; October 21, 2025; Atlanta, Georgia. Accessed October 30, 2025 via IDWeek’s online conference platform.

2. RSV in Adults. CDC. News release. Updated July 8, 2025. Accessed August 7, 2025. https://www.cdc.gov/rsv/adults/index.html

3. RSV Vaccines. CDC. News release. August 30, 2024. Accessed April 17, 2025. https://www.cdc.gov/rsv/vaccines/index.html

4. Ferruggia K. Pharmacy Times. RSV Vaccine Uptake Remains Low Among US Adults 60 Years and Older. August 13, 2025. Accessed October 30, 2025. https://www.pharmacytimes.com/view/rsv-vaccine-uptake-remains-low-among-us-adults-aged-60-years-and-older