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April 13, 2025
5 min read
Key takeaways:
- Having acute RSV raised the risk for death within a year by 2.7 times among Danish adults.
- There are three RSV vaccines available for use in the United States, but uptake has been sluggish.
VIENNA — After decades of fits and starts, scientists finally got the world’s first vaccines against respiratory syncytial virus across the finish line in 2023.
There are now three RSV vaccines licensed for use in the United States, but uptake of the shots has been sluggish and research has showed that many adults are either unaware of them or do not think they are eligible to get one.
Worse, many have never even heard of the infection.
Two new developments could improve both RSV awareness and vaccine uptake: findings from a large Danish study that highlight just how long-lasting the impact of an RSV infection can be, and an upcoming vote of CDC advisors that could increase the number of adults who are eligible to be vaccinated.
‘Striking’ results
The Danish study showed that having an RSV-associated acute viral infection nearly tripled an adult’s risk for death within 1 year, according to results presented at ESCMID Global, an annual meeting hosted by the European Society of Clinical Microbiology and Infectious Diseases.
It also showed that an RSV-associated acute viral infection worsened patients’ existing respiratory conditions, increased rates of ICU admission and drove up hospital costs.
The findings convey just how serious RSV can be, said William Schaffner, MD, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center.
“It demonstrated even more illness and death due to RSV infection in adults than previous studies,” Schaffner, who was not involved in the research, told Healio.
Led by researchers from GSK, which manufactures an RSV vaccine, and Copenhagen University Hospital, the study enrolled 5,289 adults diagnosed with RSV-associated acute respiratory infection in Denmark between 2011 and 2022 and compared their clinical outcomes over the course of 1 year with the outcomes of 15,867 controls.
The study included anyone aged 18 years or older, but the median age of participants was 63 years.
Within a year, participants who had an RSV-associated acute respiratory infection were 2.7 times likelier to have died than participants in the control arm, the researchers found. Moreover, patients in the RSV arm who had existing COPD or asthma experienced exacerbations of those conditions at rates that were 3.1 and 4.6 times higher, respectively, than participants in the control arm.
The rate of hospitalization in the RSV group was 57% — more than twice as high as it was among controls, the study showed. And RSV nearly quadrupled a participant’s risk for ICU admission and increased hospital costs by 2.5 times.
Study researcher Maria João Fonseca, PhD, an epidemiologist who works at GSK, called the findings “striking.”
“Even after the acute phase, patients continued to experience worse outcomes compared to the general population,” Fonseca said in a press release announcing the findings. “This underscores just how serious and enduring the effects of [RSV-associated acute respiratory infection] can be.”
Vaccine uptake has been slow
It took decades to produce what is now an abundance of tools to protect Americans against an infection that hospitalizes more than 100,000 older adults every year and is the leading cause of hospitalization among infants.
Yet, RSV vaccines have seemingly been met with a ripple of enthusiasm.
A survey of more than 6,700 adults aged 60 years or older who were hospitalized (not for RSV) in 20 U.S. states during the first year that RSV vaccines were available showed that only around 10% of them were vaccinated against RSV, according to findings published earlier this month in JAMA Network Open. CDC data published in November indicate that the rate may have been between 30% and 40% this past season, on par with influenza vaccination. [Editor’s note: See infographic in this story.]
Slow uptake of a new vaccine is not necessarily uncommon. Experts have characterized early RSV vaccination rates as lower than what they would have liked, but not necessarily lower than what they would have expected.
“All new vaccines take some time to be accepted,” said Schaffner, a Healio | Infectious Disease News Editorial Board Member.
Another issue is that many Americans seem not to be aware of the vaccines — or RSV itself. Almost half of respondents in the JAMA Network Open study either did not know about the vaccines or were unsure of their existence, and nearly 80% were unclear of their eligibility to receive one, or thought that they were not eligible. A 2022 survey of U.S. adults at high risk for severe RSV showed that only around 43% had ever heard of the infection, according to results published in Human Vaccines & Immunotherapeutics.
Schaffner noted even more reasons specific to RSV that have impeded RSV vaccination.
CDC guidance does not restrict RSV vaccination to any particular time of year, but the agency does say that late summer or early fall is the best time for older adults to get one of the shots. That overlaps with the general timing of seasonal influenza vaccination, and for recent COVID-19 booster recommendations, Schaffner noted.
“That’s three jabs — quite a bit for some people, particularly so in an environment of general vaccine hesitancy,” he said.
As of now, the RSV vaccines are once-in-a-lifetime shots. Eligible adults who have already received one of the vaccines are not recommended to get another one. The same goes for women who were vaccinated during a previous pregnancy, who are not recommended to get revaccinated during subsequent pregnancies. This adds another wrinkle to vaccination efforts, Schaffner said.
“Doctors and other providers must be mindful whether their patients previously have received an RSV vaccine,” Schaffner said. “Given that the vaccine can be given in pharmacies and other locations, it may be difficult to determine the vaccination status of some patients.”
Expanded vaccine recommendations may be coming
There is a thought that stronger and broader recommendations for the RSV vaccines could increase uptake.
The CDC’s recommendations are a bit stronger now than they were when the JAMA Network Open study was conducted. Since the middle of last year, the agency has recommended RSV vaccination for all adults aged 75 years or older and for anyone aged 60 to 74 years with risk factors for severe RSV.
Prior to that, in initial recommendations made in 2023 after the first two vaccines were approved, the CDC said only that people aged 60 years or older should talk to their doctors about getting one of the vaccines — a so-called shared clinical decision-making recommendation that the agency has applied to other vaccines in the past. The difference is a matter of language: Shared clinical decision-making recommendations say that a certain group “may” get a vaccine; stronger recommendations specify that they “should” receive a vaccine.
As of last year, adults aged 60 to 74 years who are not at an increased risk for severe RSV disease are no longer part of the CDC’s recommendations for the vaccines. So, who is left in the 60-to-74 age group? Online, the agency lists more than 10 conditions that can increase someone’s risk for severe RSV, including chronic heart or lung disease, end-stage renal disease, diabetes, a weakened immune system and living in a nursing home. (The CDC instructs vaccinators to take a patient’s word for it — medical documentation of the condition is not necessary to administer the shot.)
The recommendations may soon be expanded. On April 16, the CDC’s Advisory Committee on Immunization Practices is scheduled to vote on whether to lower the age that a patient at high risk for severe RSV can get one of the vaccines to 50 years. Schaffner said he expects the committee to vote to expand the recommendation.
References:
- CDC. Clinical overview of RSV. https://www.cdc.gov/rsv/hcp/clinical-overview/index.html. Updated Aug. 30, 2024. Accessed April 12, 2025.
- CDC. RSV vaccine guidance for older adults. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/older-adults.html. Updated Aug. 30, 2024. Accessed April 12, 2025.
- CDC. RSV vaccine guidance for pregnant women. https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/pregnant-people.html. Updated Aug. 30, 2024. Accessed April 12, 2025.
- Fonseca MJ, et al. Abstract 03800. Presented at: ESCMID Global; April 11-15, 2025; Vienna.
- La EM, et al. Hum Vaccin Immunother. 2024;doi:10.1080/21645515.2024.2303796.
- Surie D, et al. JAMA Netw Open. 2025;doi:10.1001/jamanetworkopen.2025.2841.
Sources/Disclosures
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Fonseca MJ, et al. Abstract 03800. Presented at: ESCMID Global; April 11-15, 2025; Vienna.
Disclosures:
Fonseca reports being employed by GSK. Schaffner reports no relevant financial disclosures.
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