Rapid Practice Points for Respiratory Syncytial Virus Vaccines in Non-Pregnant Healthy Adults

The American College of Physicians (ACP) has issued rapid practice points for respiratory syncytial virus (RSV) vaccines in adults who are not pregnant and do not have an immunocompromised condition. It advises adults aged 75 years or older to receive a protein subunit RSV vaccine. In addition, it urges adults aged 60 to 74 years with an increased risk for severe RSV to consider getting a protein subunit RSV vaccine. These recommendations are based on a rapid review by the ACP Center for Evidence Reviews at Cochrane Austria.

RSV causes mild upper respiratory tract infections in most adults, but it can lead to life-threatening lower respiratory tract infections. Starting at around age 50, age-related immune decline increases the likelihood of RSV-related hospitalizations. RSV leads to 170,000 hospitalizations and 14,000 deaths among adults aged 50 years or older each year in the US. Adults aged 75 or older, those residing in long-term care facilities, and those with certain comorbidities have a higher risk for severe infection.

No specific treatment is available for RSV, but new vaccines have emerged, including those using a traditional protein subunit strategy. However, unlike the influenza vaccine, which is offered annually, RSV vaccines are administered only once.

Members of the ACP gathered evidence to weigh the benefits versus harms of the vaccines to create practice points. Benefits included protection from RSV, while harms included the risk for Guillain–Barré syndrome and other serious adverse effects (SAEs) that can result in permanent disability.

The evidence came from eight studies: seven randomized controlled trials with sample sizes ranging from 681 to 131,379, and one nonrandomized study of interventions with 4,746,518 participants. Moderate evidence indicated that the protein subunit vaccines decreased the risk for severe RSV illness (128 fewer per 100,000 people) and RSV-related hospitalization (23 fewer per 100,000 people) after one RSV season. Moderate-certainty evidence also showed that the protein subunit vaccines lowered the likelihood of severe RSV illness (179 fewer per 100,000 people) after two RSV seasons.

First author Amir Qaseem, MD, PhD, shared clinical considerations with Pulmonology Today to keep in mind. “An RSV vaccine can be administered throughout the year, but the ideal time is early fall for both the northern and southern hemispheres,” he said. “The need for repeated vaccines is unknown.”

After one and two RSV seasons, vaccination resulted in no more SAEs than were observed with placebo or no vaccination. Data associating the vaccine with Guillain–Barré syndrome was of insufficient certainty.

The researchers concluded that “the benefits of the protein subunit vaccines outweigh the harms in adults aged 75 years or older and in adults aged 60 to 74 years who are at increased risk for severe RSV.”

Qaseem A, et al. Ann Intern Med. 2026;179(5):734-739. doi:10.7326/ANNALS-25-05485