Helen Branswell , 2025-04-16 22:45:00
A committee of independent vaccine experts voted Wednesday to recommend lowering the age at which adults can get a vaccine against respiratory syncytial virus, potentially opening up access to these vaccines for adults in their 50s who are at high risk of severe illness from RSV.
The Advisory Committee on Immunization Practices voted to recommend that any RSV vaccine for adults that is licensed by the Food and Drug Administration for high-risk adults aged 50 to 59 be recommended for use in that age group. If the recommendation is accepted by the Centers for Disease Control and Prevention — which the ACIP advises — insurance companies will have to cover the cost of the vaccine for eligible individuals.
How quickly that might happen is unclear. ACIP recommendations must be approved by the director of the CDC, and at present, the agency does not have a director. Susan Monarez, who had been serving as acting director until she was proposed as the nominee for the position, has not yet been through the Senate confirmation process.
A spokesperson said the CDC’s chief of staff Matthew Buzzelli would take receipt of the six recommendations from the committee that arose from Wednesday’s meeting.
Jeremy Faust, a Boston emergency room physician and public health expert who writes the Substack column Inside Medicine, reported last week that legal experts say that in the absence of a CDC director, health secretary Robert F. Kennedy Jr. could sign off on the committee’s recommendations.
In addition to the RSV vaccine vote, the committee also recommended use of a new meningococcal vaccine from GSK, a chikungunya vaccine from Bavarian Nordic, and voted to tweak a previous recommendation for another chikungunya vaccine, made by Valneva.
If accepted by the CDC, the vote on the use of RSV vaccines in people in their 50s would initially apply to vaccines sold by GSK and Pfizer. Moderna is in the process of applying to the FDA to extend the license for its RSV vaccine to include high-risk people aged 50 to 59, and the new policy — if approved — would cover it as well.
A cost analysis generated by the CDC and researchers from the University of Michigan suggested that use of these expensive vaccines in selected members of this age demographic could be cost saving. In particular, it was suggested that people who have undergone lung transplantation, or who have heart failure, chronic obstructive pulmonary disease, chronic kidney disease, or severe obesity should be considered for RSV vaccination in their 50s.
Michael Melgar, a CDC vaccines researcher, said around 30% of U.S. adults aged 50 to 59 would qualify.
The present CDC recommendation for use of these vaccines in older adults is that anyone aged 75 and older should get the shot and anyone aged 60 to 74 who is at high risk of severe illness from RSV should too. The ACIP has been slow to recommend broader use of RSV vaccines for older adults because of a couple of concerns.
Two of the vaccines — the Pfizer and GSK products — appear to be linked to an elevated risk of Guillain-Barré syndrome. (There have been no reports of GBS among people who received the Moderna vaccine.)
Another concern relates to the fact that it is still not known how often these vaccines will need to be given, and whether getting an additional dose at some later date will adequately boost protection. The data to date suggest that while additional doses do lead to an increase in antibodies, antibody levels do not return to the levels seen after a first shot with these vaccines.
At present the recommendation for RSV vaccines is that they are a one-time shot, though it is widely expected that at some point there will be a recommendation for additional shots later.
The committee also voted to recommend use of a new chikungunya vaccine, Vimkunya, for travelers and scientists who work on the chikungunya virus in laboratories. The vaccine, made by Bavarian Nordic, is licensed for use in people aged 12 and older.
Chikungunya infection, which is triggered by the bite of an infected mosquito, causes fever, and muscle and joint pain that can be severe, and in some cases long lasting. Transmission has been recorded in about 120 countries globally, though the disease occurs in outbreaks that are unpredictable in their frequency.
The recommendation is that the vaccine can be used in people who are traveling to a country where an outbreak is underway. The committee further recommended that use of the vaccine could be considered in people who are traveling to a place where the risk of transmission is elevated, if the person will be staying in the location for a period of six months or longer.
The committee previously had recommended use of another chikungunya vaccine, made by Valneva. The earlier recommendation had stressed use in people 65 and older, who are at increased risk of having serious illness if they contract the virus.
But six reports of serious side-effects in older adults after vaccination — five of which required hospitalization — prompted the committee to amend that recommendation on Wednesday. While it did not recommend against use of the Valneva in people 65 and older, the recommendation — if accepted, will feature a precaution about use of the vaccine in that age group.
The committee also recommended use of GSK’s pentavalent — five in one — vaccine to protect against meningitis, MenABCWY, for people aged 16 to 23 for whom a vaccine protecting against meningitis B is recommended, and for people aged 10 and older at increased risk of developing meningococcal disease because of underlying medical conditions.