Clinical Scorecard: Evaluating the Risk of Respiratory Syncytial Virus in Adults: Considerations for Vaccine Guidelines Across Age Groups

At a Glance

Key Highlights

• Adults with CHF, CAD, COPD, and diabetes have significantly increased risk of RSV hospitalization.
• Black and Hispanic adults have higher RSV hospitalization incidence across age groups compared to other races.
• COPD and CHF increase risk of ICU admission, in-hospital mortality, and 6-month all-cause mortality; age ≥65 alone is not associated with these outcomes.

Guideline-Based Recommendations

Diagnosis

• RSV diagnosis confirmed by polymerase chain reaction testing of respiratory samples within 2 weeks before to 72 hours after hospital admission.

Management

• Current ACIP recommendations advise RSV vaccination for adults aged ≥75 years and adults 60–74 years with specific preexisting medical conditions.
• Shared decision-making is recommended for adults aged ≥60 years regarding RSV vaccination.

Monitoring & Follow-up

• Monitor hospitalized RSV patients for ICU admission and in-hospital mortality, especially those with COPD and CHF.
• Follow-up for all-cause mortality up to 6 months post-hospitalization in high-risk patients.

Risks

• Adults with COPD have a 1.9-fold increased risk of ICU admission or in-hospital mortality.
• Preexisting cardiopulmonary conditions increase risk of severe RSV outcomes.
• Racial and ethnic disparities contribute to higher RSV hospitalization incidence.

Patient & Prescribing Data

Adults aged ≥60 years and those with preexisting high-risk medical conditions; younger adults (<60 years) with risk factors currently not recommended for vaccination by ACIP.

Two RSV prefusion F protein subunit vaccines and one mRNA vaccine licensed for adults ≥60 years show 82.4%–85.7% efficacy against lower respiratory tract disease; early real-world effectiveness against hospitalization is approximately 75%.

Clinical Best Practices

• Consider preexisting medical conditions and racial/ethnic disparities when assessing RSV risk and vaccination eligibility.
• Use shared decision-making for RSV vaccination in adults aged ≥60 years.
• Prioritize vaccination for adults aged ≥75 years and adults 60–74 years with high-risk conditions such as COPD and CHF.
• Ensure timely PCR testing for RSV in hospitalized adults with respiratory symptoms to confirm diagnosis.
• Monitor high-risk patients closely for ICU admission and mortality outcomes.

References

• FDA RSV Vaccine Licensure and Recommendations
• ACIP RSV Vaccine Recommendations 2023-2024
• RSV Hospitalization Incidence and Risk Factors Study