RSV Vaccination Protects Seniors and Benefits Public Health, Journal Finds

In a review published in the Journal of Virology, researchers assessed biological and clinical factors that could influence why natural infection fails to provide lasting protection in this population, finding that older adults are more vulnerable to severe RSV infection due to declining lung function, chronic illness, waning immunity, and ineffective antibody responses.¹

Respiratory syncytial virus (RSV) is widely recognized for its substantial impacts on older adults, and despite near-universal prior exposure, individuals aged 60 years and older remain vulnerable to severe RSV infection, hospitalizations, and complications.

Are Older Adults at Heightened RSV Risk?

Annually, an estimated 110,000 to 180,000 individuals 50 years and older are hospitalized due to RSV in the US. Although RSV symptoms typically present as mild and cold-like, some individuals could develop more severe symptoms like pneumonia. Symptoms may include a congested or runny nose, dry cough, low-grade fever, sore throat, sneezing, and headache, whereas symptoms of severe infection include fever, severe cough, wheezing, rapid breathing or difficulty breathing, and bluish skin color.

RSV can also worsen conditions like asthma, chronic obstructive pulmonary disease, or heart failure, leading to hospitalization or fatal outcomes.²

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

However, despite the widespread seropositivity in adults aged 60 years and older, the study authors noted that natural infection-induced immunity fails to prevent severe disease, emphasizing the importance of RSV vaccination to limit the burden of infection across all ages.¹

What Are Risks of RSV Infection in Older Adults?

In the review, researchers examine the roles of structural lung decline, comorbidities, immunosenescence, and impaired antibody responses in shaping susceptibility.¹

Regarding age-related changes in the respiratory system, specifically in the lungs, the researchers hypothesized that loss of alveolar elasticity, chest wall stiffening, and reduced respiratory reserve heightens vulnerability to RSV and other lower respiratory tract infections (LRTI). Additionally, impaired mucociliary clearance, weakened cough strength, and diminished airway surface liquid further compromise mechanical defenses that enable RSV to penetrate deeper into the airways in older adults.¹

While it is known that chronic conditions increase RSV risk in older adults, recent studies have found that chronic obstructive pulmonary disease (COPD) and asthma result in higher rates of respiratory failure among individuals with RSV compared to non-infected individuals. Further results found that RSV can exacerbate COPD by increasing airway inflammation, accelerating lung function decline, and contributing to disease progression.

Cardiovascular disease is also known to significantly increase RSV severity, with data from RSV-NET linking conditions like congestive heart failure, ischemic heart disease, and stroke to higher hospitalization and complication rates. Lastly, chronic kidney disease and diabetes also heighten RSV vulnerability by impairing immune responses, leading to more severe outcomes and complications, such as secondary bacterial pneumonia.¹

As an individual ages, the immune system undergoes immunosenescence, which is a decline that weakens antiviral defense and regulation during RSV infection. The study authors noted that with aging, innate and adaptive immunity is compromised, leading to weakened antibody responses. Together, the changes create a baseline of inflammation and poor antiviral defense, which ultimately causes greater RSV susceptibility, prolonged infection, and worse outcomes in older adults.¹

The findings outlined suggest that older adults face heightened vulnerability to severe RSV because aging weakens lung structure, chronic conditions compound risk, and immune function declines.¹

What is the Importance of RSV Vaccination?

Despite these findings, RSV vaccination in older adults has been shown to provide strong protection against severe disease that aligns with real-world evidence and clinical trial outcomes. Modeling studies indicate that widespread use could cut hospitalizations by 35% to 64%.¹

The findings suggest that wider vaccine adoption, along with continued monitoring of safety, could reduce the global RSV-related morbidity and mortality among older adults at risk for severe RSV.¹

REFERENCES

1. Rzymski P, Poniedziałek B, Zarębska-Michaluk D, Tomasiewicz K, Flisiak R.0.High seroprevalence and high risk: why are older adults more prone to respiratory syncytial virus?. J Virol0:e01432-25.https://doi.org/10.1128/jvi.01432-25

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