The American College of Physicians (ACP) recommends adults age 75 and older receive one dose of respiratory syncytial virus (RSV) vaccine, according to a statement yesterday. In its guidelines, published in Annals of Internal Medicine, the ACP said that adults age 60 to 74 may consider receiving an RSV vaccine if they have medical conditions that increase their risk of serious disease.
The Infectious Diseases Society of American (IDSA) also published RSV vaccine guidance yesterday.
As many as 23,000 annual deaths
Although most people with RSV develop symptoms similar to a cold, some people can become very sick and die from the virus, which tends to spread in fall and winter. Data published last month by the Centers for Disease Control and Prevention (CDC) showed that RSV was associated with 190,000 to 350,000 hospitalizations from July 1, 2024, to June 30, 2025, as well as 10,000 to 23,000 deaths.
Adults are more likely to develop severe RSV infection if they are 75 years or older or living in a long-term care facility, according to the ACP, whose members are internal medicine specialists who treat adults. Other risk factors include conditions such as chronic kidney, liver, or lung disease; cardiovascular disease; blood diseases such as sickle cell disease; diabetes; or obesity.
Both recommendations refer only to people who are not pregnant or immune-compromised. In addition, the ACP recommendation includes only RSV vaccines made with conventional technology, such as Arexvy, made by GSK, and Abrysvo from Pfizer, both approved in 2023.
The ACP didn’t make any recommendation for Moderna’s mResvia, approved in 2024, because the vaccine is relatively new and there wasn’t sufficient evidence to evaluate its benefits and risks, said Jason Goldman, MD, the group’s president.
The ACP currently recommends a single RSV shot, as opposed to the annual vaccination recommended for influenza and COVID-19 vaccines. Scientists don’t yet know how the protection from a single dose will last, although protection appears to wane over time. Depending on the results of clinical trials, future recommendations may call for additional vaccine doses.
Medical societies filling the gap
In the past, medical societies typically aligned their recommendations with those of the CDC and its advisory panel, the Advisory Committee on Immunization Practices (ACIP). Goldman and numerous other public health leaders have dismissed recent advice from the ACIP, including a vote to stop recommending universal vaccination with the hepatitis B vaccine at birth, as unscientific and untrustworthy.
Medical societies decided to publish their own rapid reviews of the science for vaccines protecting against respiratory disease “in the absence of a vaccine committee that we could trust,” Goldman said.
The IDSA’s guidelines focus on RSV vaccines for people with weakened immune systems, including people who have diseases that dampen their immune response or those who take immune-suppressing medications, including drugs given to people who’ve received organ transplants or who are being treated for cancer.
In its statement, the IDSA noted that two studies showed that RSV vaccination reduced associated hospitalization in this population by 70%. Additional evidence from older adult populations showed the RSV vaccine to be 81% effective at preventing critical illness. Household members of immunocompromised people should also receive RSV vaccines, according to the IDSA.
“Given the substantial reduction in severe disease and low likelihood of serious harm, the panel issued a strong recommendation for age-appropriate RSV vaccination in adults and adolescents with compromised immunity,” authors wrote. “For immunocompromised patients <18 years, shared decision-making is advised.”
According to the IDSA, the greatest risk associated with RSV vaccines is Guillaume-Barré syndrome (GBS), an immune response that can lead to paralysis. The IDSA said there are about 11 additional cases of GBS for every 1 million people vaccinated against RSV, compared with unvaccinated people.
The American College of Obstetricians and Gynecologists recommends pregnant women be vaccinated against RSV between from 32 to 36 of pregnancy, which helps protect newborns against the virus. Women only need to be vaccinated once. If they become pregnant again, their infants should be immunized.
The American Academy of Pediatrics generally recommends RSV immunization for infants under eight months old born during or entering their first RSV season if their mothers weren’t vaccinated during pregnancy. The RSV immunization for newborns is not a vaccine, but an injection of ready-made antibodies that can protect infants immediately.
