RSV in Older Adults: Recognizing Risk Factors and Missed Opportunities for Vaccination

Respiratory syncytial virus (RSV) is increasingly recognized as a major cause of respiratory illness in older adults, particularly those with chronic medical conditions or frailty. RSV poses a significant health burden, frequently causing hospitalizations, prolonged recovery, and, in some cases, serious complications.¹

In May 2023, the FDA approved the first RSV vaccines for older adults: Arexvy (GSK) and Abrysvo (Pfizer).² Additionally, in May 2024, mResvia (Moderna) was approved for the prevention of RSV-related lower respiratory tract disease in adults aged 60 and older.³

These vaccines provide health care professionals, particularly pharmacists, with preventive measures to reduce severe RSV illness. The CDC Advisory Committee on Immunization Practices (ACIP) recommends a single dose for all adults aged 75 years or older and for adults aged 50 to 74 years who are at increased risk of severe RSV disease.⁴ Furthermore, pharmacists play a key role in RSV prevention by recognizing vulnerable patients, coordinating timely vaccinations, and helping to lower the risk of severe illness and hospitalization in older adults.

The Burden of RSV in Older Adults

RSV infection in older adults can result in serious complications, including lower respiratory tract disease (LRTD), pneumonia, and worsening of chronic conditions such as asthma, chronic obstructive pulmonary disease (COPD), and heart failure. CDC surveillance from the RSV-NET system during the 2022–2023 season found that over half (54%) of RSV-associated hospitalizations occurred in adults aged 75 years and older, and approximately 17%, nearly 1 in 5, of hospitalized patients were residents of long-term care facilities.⁵ These findings emphasize that RSV affects older adults similarly to influenza.

However, because RSV vaccination has only recently been prioritized, awareness and uptake remain lower compared with influenza or pneumococcal vaccines.⁶ As a result, the ACIP updated its guidance to recommend a single lifetime dose of the RSV vaccine for all adults aged 50 years and older, including those with high-risk medical conditions. Despite these recommendations, as of early 2025, vaccination coverage remains suboptimal. According to the CDC, among adults aged 75 years and older, RSV vaccination coverage increased from 28.8% to 47.5% during the 2024–2025 season.⁷ These findings highlight the urgent need to enhance awareness and increase RSV vaccine uptake.

Barriers to Vaccine Uptake and Missed Opportunities

Despite vaccine efficacy data, RSV vaccination rates remain low due to several factors. Coverage under Medicare Part D, rather than Part B like influenza or COVID-19 vaccines, creates billing confusion for patients and providers, which often results in missed opportunities.¹¹ Many older adults have limited awareness of RSV and its vaccines, and clinicians often do not consistently discuss RSV during routine immunization visits, even though provider recommendations strongly influence uptake. Although the CDC permits RSV vaccines to be administered with influenza or COVID-19 vaccines, coadministration can cause a slightly higher rate of mild local or systemic reactions, prompting some providers to separate doses and potentially reduce adherence.¹ Moreover, vaccination timing can be challenging because RSV peaks in the fall and winter alongside influenza, which can lead to a missed dose. Pharmacist-led initiatives and clinic-based vaccination programs can help increase coverage.

The Role of Pharmacists in Closing the Gap

Pharmacists are uniquely positioned to increase RSV vaccine uptake among older adults. They can screen and identify at-risk patients, such as those aged 75 years and older or individuals with chronic conditions, during prescription pickups or medication therapy management sessions.¹ Patient education is another critical role; pharmacists can compare RSV risk to influenza risk, helping patients understand the potential severity of RSV and the importance of vaccination.² They can also clarify coverage details, reassuring patients that RSV vaccines are provided without cost under Medicare Part D.¹ Promoting coadministration with influenza or COVID-19 vaccines, when appropriate, can improve convenience and reduce missed opportunities, consistent with CDC guidance.³ Additionally, pharmacists working in long-term care facilities can coordinate vaccination campaigns, protecting some of the most vulnerable populations.

RSV remains a frequently overlooked health risk for older adults, particularly those with chronic conditions, frailty, or advanced age. With vaccines now available, pharmacists are well-positioned to support immunization efforts. By identifying at-risk patients, addressing barriers, and reinforcing the value of vaccination at every encounter, pharmacists can play a meaningful role in helping reduce RSV-related hospitalizations in this population.

REFERENCES

1. RSV in adults. CDC. July 8, 2025. Accessed November 20, 2025. https://www.cdc.gov/rsv/adults/index.html

2. Respiratory syncytial virus (RSV). FDA. Updated October 22, 2024. Accessed November 20, 2025. https://www.fda.gov/consumers/covid-19-flu-and-rsv/respiratory-syncytial-virus-rsv

3. McCullough M. FDA-approved vaccines for protection from severe respiratory syncytial virus (RSV) infection. Medical and Regulatory Affairs Club at UNC-Chapel Hill. Accessed November 20, 2025. https://medrac.web.unc.edu/2025/02/rsv-vaccines/

4. Vaccines for adults. CDC. July 8, 2025. Accessed November 20, 2025. https://www.cdc.gov/rsv/vaccines/adults.html

5. Havers FP, Whitaker M, Melgar M, et al. Characteristics and outcomes among adults aged ≥60 years hospitalized with laboratory-confirmed respiratory syncytial virus – RSV-Net, 12 states, July 2022-June 2023.

6. Britton A, Roper LE, Kotton CN, et al. Use of respiratory syncytial virus vaccines in adults aged ≥60 years: updated recommendations of the Advisory Committee on Immunization Practices – United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73(696-702). doi:10.15585/mmwr.mm7332e1

7. 2025-2026 respiratory disease season outlook. CDC. August 25, 2025. Accessed November 20, 2025. https://www.cdc.gov/cfa-qualitative-assessments/php/data-research/season-outlook25-26.html

8. Arexvy [prescribing information]. GSK; August 2025. Accessed November 20, 2025. https://www.fda.gov/files/vaccines%2C%20blood%20%26%20biologics/published/Package-Insert-AREXVY.pdf

9. Abrysvo [prescribing information]. Pfizer; July 2025. Accessed November 20, 2025. https://labeling.pfizer.com/ShowLabeling.aspx?id=19589

10. mResvia [prescribing information]. Moderna; June 2025. Accessed November 20, 2025. https://www.fda.gov/files/vaccines%2C%20blood%20%26%20biologics/published/Package-Insert-MRESVIA_1.pdf

11. Respiratory syncytial virus (RSV) shot. Medicare.gov. Accessed November 20, 2025. https://www.medicare.gov/coverage/respiratory-syncytial-virus-rsv-shot