On August 30th, 2023, the CDC’s Advisory Committee on Immunization Practices (ACIP) recommended a single-dose of the Respiratory Syncytial Virus (RSV) vaccine for adults 60 years old and over. However, they did not give a blanket recommendation, but instead specified that the decision to obtain an RSV vaccine dose should be made using “shared clinical decision-making with your healthcare provider.” Let’s review some of the most common questions about these new vaccines.
What are symptoms of RSV?
RSV typically causes mild cold symptoms in most people but can lead to hospitalization and even death in older people and those with chronic health conditions. It’s a seasonal illness, typically starting in the fall and peaking in the winter. Once a person is infected, the treatment is supportive care, such as over-the-counter medications and maintaining hydration. Most people get better in a week or two.
But when RSV makes its way down into the lungs, causing lower respiratory tract disease, it can cause vulnerable people to develop life-threatening complications, such as pneumonia, and make existing conditions, such as asthma, congestive heart failure, and chronic obstructive pulmonary disease, worse. Lower respiratory tract disease symptoms include new or increased cough, wheezing, sputum production, shortness of breath, and/or tachypnea (abnormally rapid breathing).
Who is at high-risk for severe disease should they become infected with RSV?
The CDC’s ACIP committee did note that besides infants under the age of two, those in the age group of 60 years old and over are at highest risk for severe RSV disease. This is especially true for those with chronic conditions such as lung diseases, heart failure, coronary artery disease, the immunocompromised (this includes everyone diagnosed with CLL or SLL), and other medical conditions.
Why might it be important for someone with CLL or SLL to consider obtaining the RSV vaccine?
In fall 2022, the US witnessed what was dubbed a “triple pandemic” where there was a surge of hospitalizations in adults not only for COVID-19 and influenza, but also RSV infections. By November 2022, RSV was not only surging in children, but the RSV hospitalization rate for older adults was 10 times higher than usual for that time of year. Infectious disease experts are expecting the same type of surges may occur again this fall/winter. Each year, RSV leads to 160,000 hospitalizations in adults 65 and older, and up to 10,000 deaths.
Who are the manufacturers of the approved RSV vaccine?
Currently, there are two RSV vaccines approved for people ages 60 and up. One is from Pfizer named Abrysvo, and one from GlaskoSmithKline (GSK) called Arexvy.
What type of technology was used to create the two FDA-approved RSV Vaccines?
Both vaccines approved for older adults use traditional vaccine development platforms, which are similar to flu shots (not to be confused with the mRNA technology introduced by Pfizer-BioNTech and Moderna to prevent COVID-19). The RSV vaccines work by introducing an inactivated RSV protein into the body, where it fuses to host cells and stimulates the immune system to recognize the actual RSV virus if/when it encounters it to help prevent severe disease.
How effective were the two RSV vaccines in clinical trials?
Both vaccines performed well in clinical trials, according to data presented to the FDA. Arexvy was the first to receive FDA approval in May of 2023. The ongoing trial is following participants through three RSV seasons. Overall efficacy for Arexvy was 82.6% against lower respiratory tract disease during the first season, 77.3% for mid-season, and 67.2% over two seasons. Against severe disease, efficacy was 94.1% during the first season, 84.6% at mid-season, and 78.8% over two seasons. The second vaccine, Abrysvo, showed an efficacy of almost 89% against lower respiratory tract disease in the first year after vaccination, and 78.6% for mid-season
How often is it recommended to get the RSV vaccine?
While data showed that one vaccination could be protective for at least two seasons, no determination has been made yet on how frequently the shots should be given. There are data indicating the vaccine is likely to provide substantial long-term protection through at least one RSV season, and maybe longer.
Are there any side effects of the RSV vaccine?
The most common side effects after RSV vaccination reported from clinical trials included pain, redness, and swelling at the shot’s injection site. Fatigue, fever, headache, nausea, diarrhea, and muscle or joint pain were reported. These side effects were usually mild.
There were some side effects to keep an eye out for. GSK conducted clinical trials in 17 countries and included 24,973 patients. Of those patients, atrial fibrillation occurring within 30 days was reported in 10 vaccine recipients versus four placebo patients. For both Arexvy and Abrysvo, Guillain-Barre syndrome did occur in one recipient of GSK’s clinical trial, and it was likely related to vaccination according to the FDA and trial investigators. Guillain-Barré is a rare disorder that causes muscle weakness and sometimes paralysis. The FDA will require GlaxoSmithKline to continue monitor the incidence of Guillian-Barré in those who receive the vaccination.
Is the RSV vaccine covered by insurance plans?
The vaccine is covered under Medicare Part D, but coverage is less clear for private plans which may choose not to cover it. It’s always a good idea to check with your insurance carrier or pharmacy prior to setting your appointment.
Can I receive the COVID-19, Flu, and RSV Vaccines all at the same time?
There are no data on giving all three shots at the same time. However, there are data on the safety of giving the influenza and COVID-19 vaccine together, which the CDC endorses. There are some evidence from the RSV vaccine clinical trials indicating it is okay to receive the influenza and RSV vaccines at the same time.
Due to the lack of data on receiving all three shots at the same time, most experts are going to recommend making two separate appointments: one to receive the COVID-19 vaccine and influenza vaccine, and a separate appointment to receive the RSV vaccine. Infectious disease experts also recommend getting the RSV vaccine at least two weeks on either side of the COVID-19/influenza combination.
What are some other ways to prevent RSV infection in addition to the vaccine?
RSV is very contagious. It can spread through the droplets released into the air when an infected person coughs or sneezes, or if you touch a contaminated surface, such as counters or doorknobs (where it can live for hours), then touch your nose, eyes, or mouth without washing or sanitizing your hands. Wearing masks will help prevent infection. And since RSV is mainly spread through contact with contaminated surfaces, wash hands often, keep hands away from your face, avoid close contact with people who have cold-like symptoms, clean frequently touched surfaces such as doorknobs and mobile devices, and stay home when you are sick.
Conclusion
It is not a bad idea for those with CLL / SLL to consider getting the RSV vaccine, especially given the number of high-risk adults who were hospitalized last winter with RSV. CLL Society recommends that you talk with your healthcare provider about the risks versus benefits for you personally and participate in shared decision making. Read more about RSV on the CDC’s website.
Keep learning, and please stay safe.
Robyn Brumble, MSN, RN
