Pharmacists Play Key Role in Advancing RSV Awareness, Testing, and Prevention

Derek Webb, PharmD, member of the Virginia Board of Pharmacy and pharmacy manager at Food City, continued his conversation with Pharmacy Times®, emphasizing the ongoing lack of public awareness about respiratory syncytial virus (RSV) in adults and highlighting the important role pharmacists play in educating patients and promoting testing. He discussed the evolution of RSV prevention, noting that reliable testing and several vaccines are now available for adults, infants, and pregnant women. Webb also explained current vaccine recommendations, clarifying that RSV vaccines are single dose with no booster or repeat dosing currently advised. Finally, he reassured that the RSV vaccines are safe, well tolerated, and comparable in side effects to a flu shot.

Pharmacy Times: What gaps still exist in our understanding of RSV epidemiology in adults, and how could pharmacists contribute to addressing those gaps?

Derek Webb, PharmD: We touched on this earlier, but I want to reiterate that I think there's a lack of public awareness. There's a public awareness deficit that needs to be filled. Again, pharmacists are on the front line in the community setting. We have an excellent stage to be able to talk to these patients and explain how important it is to protect yourself from RSV.

You’ve got this older adult population that sees RSV and thinks, “Oh, that just affects infants.” What we're realizing is the older individuals we vaccinate, the more protection it offers those infants that have no immunity to RSV. So, I think a big part of it is advocacy and patient education.

Also, since about 2014, we have had a relatively reliable test for RSV, and I think there's a place for that in care. I just don't think it's been emphasized enough. When people present to urgent care or pharmacies for testing, you may seriously want to consider an RSV test because the symptom overlap is very common with the flu and the common cold. We need to consider that it could be RSV, which is becoming more prevalent and is very dangerous.

We need to educate, test more frequently, and create better coordination of care between all health care providers.

Pharmacy Times: Looking ahead, how do you see RSV prevention strategies evolving, and what role will pharmacists play?

Webb: I think it's evolved dramatically over the past five years. If you look back with a bird’s-eye view at what we had five years ago, we had one monoclonal antibody for these super high-risk infants. I think it was called palivizumab, although I'm not sure about that. This monoclonal antibody was very difficult to produce; there was a shortage almost all the time, and it was indicated for monthly use during RSV season in these high-risk infants.

Fast forward to today, and we have a much larger menu. There are now two monoclonal antibodies that are dosed once during RSV season for high-risk infants, and they are much more readily available. Giving it once versus every month relieves a lot of the economic and time burden that families with very young infants were facing.

For adults, we had no vaccines five years ago. Now, we have three vaccines: Arexvy, Abrysvo, and the newest, Mresvia, I believe. These are all indicated, as we talked about before, for adults aged 50 to 64 with high-risk chronic conditions that make them prone to severe RSV illness, and for everyone aged 75 and older as a one-time dose. So, the menu has totally changed.

Also, in pregnant women between 32 and 36 weeks of pregnancy, one dose of Abrysvo is indicated to provide some passive immunity to infants born during RSV season. That’s important to note as well.

Pharmacy Times: Is there anything you would like to add?

Webb: The only thing I would add are some clinical pearls—some wisdom from the community pharmacy setting and the questions we get often.

One common question is: a person comes in at age 75, gets an RSV vaccine, and comes back the next year wanting another one. Currently, there is no indication or recommendation to redose the RSV vaccine. It’s a one-time and done deal. Now, bear in mind, it’s only been around for a couple of years, so in my opinion, it’s likely that in a few years we’ll see a recommendation for a booster, but right now, there isn’t one.

In the pregnancy category, as we mentioned, at 32 to 36 weeks of gestation, you can get one dose. It is not recommended to redose for subsequent pregnancies. If it’s the second or third pregnancy, that one dose is still the only dose you get as of right now.

As with most vaccines, we get a lot of questions like, “Can it give me RSV?” Absolutely not. These vaccines are not designed in a way that they can give you active disease. Another common question is, “Does it make you sick?” In my experience at the community level, the RSV vaccine is similar to a flu shot. It has very low reactivity and not a lot of side effects, and people tolerate it very well.

Those are really the big things that we get questions about most every day.