Study Shows AOV System Reduces Errors in RSV Vaccine Preparation

Respiratory syncytial virus (RSV) is a significant global health concern, causing severe illness and death, especially among older adults. To aid RSV prevention, the CDC recommends a single dose of the RSV vaccine for all adults aged 75 years and older and for those aged 50 to 74 with a higher risk of severe disease. With 3 RSV vaccines now approved by the FDA—RSVPreF3 (Arexvy; GSK), RSVpreF (Abrysvo; Pfizer), or mRNA-1345 (mRESVIA; Moderna)—2 of which require reconstitution before use.¹

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Due to the volume of RSV vaccines administered, vaccine errors are common. Researchers conducted a cross-sectional study to evaluate the efficiency and usability of different reconstitution systems to improve health care practitioner workflow. In the study, published in Expert Review of Vaccines, the authors compared 2 of these systems, the AOV dual-chamber vial and the V/V system, to assess their differences in preparation time and user preference.¹

“Different vaccine reconstitution processes involve varying time, usability benefits, risk for errors, and user preferences. Vaccine-related errors can result from mistakes in vaccine handling, preparation, or administration,” the authors said in the study.¹

Importance of RSV Vaccination in Older Adults

An estimated 110,000 to 180,000 RSV-related hospitalizations occur annually among adults 50 years and older, accounting for nearly 4000 to 8000 annual deaths. Peak RSV season occurs in the fall and winter, emphasizing timely vaccination for high-risk individuals.²

Typically, RSV symptoms are mild and cold-like, including a congested or runny nose, dry cough, low-grade fever, sore throat, sneezing, and headache. If an individual is infected with severe RSV, they can present greater symptoms, including fever, severe cough, wheezing, rapid or difficult breathing, and bluish skin color.²

Efficiency and User Preferences for RSV Vaccine Preparations

The study was conducted at 2 facilities in the US and evaluated the timing, efficiency, and user preferences of the AOV and V/V systems among experienced health care professionals. The AOV dual-chamber system involves a 2-step press process that includes pressing down on a cap to release a sterile diluent into a chamber with the vaccine powder, then swirling the vial until the powder is dissolved.

The V/V system, in contrast, requires 4 steps, including cleansing both vial stoppers and using a needle and syringe to transfer a liquid adjuvant from 1 vial to another containing the vaccine powder before swirling to dissolve it. In the end, both methods withdraw a 0.5 mL dose with a needle and syringe.¹

A total of 60 participants completed the study and were timed while they completed 4 reconstitution trials with each vaccine system, following a set of noncommercial instructions. Study authors noted that the participants were not aware of which system they were using, and their feedback was collected after the timed trials.¹

The results demonstrated that out of the 60 participants, 92% found the AOV system to be faster, an impression borne out by the comparative mean reconstitution times (88 seconds for AOV; 119 seconds for V/V). Nearly 75% of participants preferred the AOV, with 90% perceiving it as being less prone to needle sticks and medication errors. Study authors noted that further results revealed that 87% of participants felt AOV was safer, 85% believed it was safer, and 82% felt it better fit into their workflow.¹

“The AOV was not only observed to be faster to reconstitute than V/V, it was also described by participants as safer, both for patients, due to less concern for medication error, and for HCPs, due to less risk of needle stick injuries,” the authors said in the study.¹

The findings suggest that the AOV system could be a better fit for pharmacists and health care providers administering RSV vaccines, emphasizing the importance of safe and efficient vaccine management to prevent severe RSV infection.

REFERENCES

1. Moucka, R., Chilson, E., Conrad, B., Weiser, S., Moss, S., & Bruchsaler, M. (2025). Preparation time and usability assessment of commercially available freeze-dried respiratory syncytial virus vaccine presentations. Expert Review of Vaccines. https://doi.org/10.1080/14760584.2025.2559672

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