RSV vaccines: Questions patients may have and how to answer

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Most Moms-to-Be Interested In RSV Vaccination During Pregnancy

More than half of women who are pregnant or planning to become pregnant are very likely to get vaccinated against respiratory syncytial virus (RSV) during pregnancy, according to a study published online April 25 in Pediatrics.

Jennifer K. Saper, M.D., from the Ann & Robert H. Lurie Children's Hospital of Chicago, and colleagues characterized interest in RSV vaccination during pregnancy among women who were pregnant or planning to become pregnant. A cross-sectional online survey was conducted among individuals aged 18 to 45 years who were currently pregnant or trying to become pregnant in March 2023.

Overall, 1,528 of the 1,619 completed surveys were analyzed. The researchers found that 54 percent of respondents indicated being "very likely" to get vaccinated against RSV during pregnancy. The strongest predictor of vaccination likelihood was the perception of RSV as a serious illness. Predicted proportions of those "very likely" to vaccinate against RSV followed a similar pattern in the full regression model (63, 55, and 35 percent if RSV infection was perceived as serious and likely, serious and unlikely, and not serious, respectively).

"Educational efforts about protection against RSV illness in infants through vaccination during pregnancy and the consequent positive health implications for children may be a key component of public health and health care strategies to encourage RSV vaccination among pregnant individuals," the authors write.

Abstract/Full Text

COVID, Flu And RSV Vaccines Are Lifesavers. Why Aren't More Older Adults Getting Them?

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For the first time, we have vaccines that can protect older adults against three leading—and sometimes fatal—respiratory viral diseases: influenza, COVID and respiratory syncytial virus (RSV). This is a breakthrough; studies show that these vaccines are effective at protecting older adults from severe disease outcomes, including hospitalization and death.

Yet some seniors—including many who live in nursing homes—aren't getting these vaccines. And the prevaccine days of the COVID pandemic showed us how deadly respiratory illness could be among older people in group settings. As scientists at the Centers for Disease Control and Prevention, we have been tracking vaccination rates among older people. Given how easily these diseases are spread, and the possibility of severe disease with long and complex hospitalizations, we must do more to help inoculate them.

As this winter respiratory virus season winds down, it's crucial we start planning for the next one. We can use the lessons we've learned from the vaccine rollouts for flu, COVID and RSV to give seniors the best shot at protection.

Older adults have a higher risk of severe disease and death from these respiratory virus infections compared to other age groups. Both their first-line innate immune responses and their slower, infection-specific adaptive immune responses decline. This decline, combined with higher rates of chronic diseases such as heart disease and diabetes and—for people who live in long-term care facilities—an increased chance of disease spread, leaves older folks at risk for severe disease and death.

Improving the use of these vaccines through the fall and winter respiratory illness seasons could mean healthier seniors and fewer visits to urgent care and the emergency department and fewer hospitalizations.

In 2022–2023, experts estimate that flu vaccination prevented nearly 31,000 hospitalizations and 2,500 deaths among people ages 65 and older. COVID vaccination greatly lowered rates of hospitalizations and deaths among adults ages 65 years and older too. And in clinical trials, the new RSV vaccines had an efficacy of 83 to 89 percent in preventing symptomatic RSV in the lower respiratory tract in adults ages 60 years and older.

The CDC's latest data show that as of late March, 74 percent of adults age 65 years and older had gotten the flu vaccine and just 42 percent had received the updated COVID vaccine. Although coverage for influenza vaccine is trending slightly higher than at this point last year, COVID vaccine coverage remains about as low as last year. Among those ages 60 years and older, 24 percent had gotten an RSV vaccine. As of late March, only 43 percent of nursing home residents had received an updated COVID vaccine; as of December 10, 72 percent had received an influenza vaccine and 10 percent had received an RSV vaccine.

The fact that nearly three quarters of older adults received a flu vaccine this season, as opposed to less than half for the COVID vaccine, shows us that we have a lot of work to do to help people get up-to-date on COVID vaccines. And there is more to be done to help people and their providers understand whether an RSV vaccine is right for them.

The CDC surveyed unvaccinated older folks to better understand their reasons for not getting vaccinated, and the results varied. People 65 and older who said they were probably or definitely not going to get the influenza vaccine were concerned primarily about vaccine effectiveness and side effects and said they were not worried about the flu. For the COVID vaccine, participants most often shared concerns about heart-related or unknown serious side effects, followed by concerns about effectiveness and having "vaccine fatigue," meaning they were likely burned out on vaccine information. The primary reasons for people age 60 and older not getting the RSV vaccine were not being worried about RSV, not knowing enough about RSV or the RSV vaccine, and the vaccine being "too new."

These reasons for not getting vaccinated and the differences across vaccines are perhaps understandable in the context of where we are in the vaccine rollouts. Influenza vaccines have been licensed in the U.S. Since the 1940s. In contrast, COVID vaccines were introduced little more than three years ago, and while these vaccines have undergone the most rigorous safety monitoring in U.S. History, some people still have misconceptions about the vaccines' safety.

In addition, the vaccine fatigue expressed by respondents to the CDC survey is a genuine challenge. In the early days of COVID vaccines, older adults enthusiastically accepted vaccination. But over time, fewer and fewer seniors have been willing to get additional recommended doses. Many people are also less concerned about COVID itself, despite the fact that many people are still dying from it each day in the U.S.

RSV vaccines were licensed in 2023—and from prior new vaccine rollouts we know that it can take years for vaccination coverage to increase. Moreover, instead of recommending that all adults 60 years and older get vaccinated, the CDC recommended that people and their health care providers have a conversation to determine if RSV vaccination is right for them. As a result, not all eligible adults are likely to get the vaccine.

Plus it is hard for some people to access vaccines. On one hand there is ample supply of all three vaccines, and they are covered by Medicare and many private insurance plans at no out-of-pocket cost. Still, there are around 400,000 people age 65 and older who are uninsured. Nonetheless, the health care provider or facility has to absorb the up-front costs of purchasing vaccines and then seek reimbursement for vaccination.

Furthermore, disparities in access to health care among ethnic and racial groups make getting respiratory vaccines challenging for some communities in the U.S. For example, during the 2022–2023 season, influenza vaccination coverage among adults ages 65 years and older ranged from 54 percent in American Indian/Alaska Native people to 71 percent in non-Hispanic white people.

There also are barriers to receiving these three vaccines within a relatively short period of time. Even though the CDC says that influenza, COVID and RSV vaccines can be given at the same time, not everyone is open to that. Furthermore, each of these vaccines became available at different points in time during this past season, which made it more difficult for people to receive these vaccines at once. For some, it may not have been a priority or a possibility to return for a follow-up visit for additional vaccines that they were unable to receive on prior visits.

Long-term care facilities face additional unique challenges to vaccinating residents, including the monumental task of strengthening vaccine confidence and demand not only among residents but also among staff at the facilities and family members involved in residents' medical decisions. In addition, long-term care facilities may not have the necessary infrastructure, staffing and financial resources to routinely offer vaccines to residents. Furthermore, the end of the Public Health Emergency and transition from a federal COVID vaccine distribution system to a commercialized market ended certain regulatory flexibilities and continued the shift to more sustainable channels for vaccinating residents, though with fewer dedicated resources.

The relatively high influenza vaccination coverage among older adults suggests that it is possible to get more older people vaccinated for all recommended vaccines. The CDC is working to improve access to adult vaccines through programs such as the Bridge Access Program, which provides COVID vaccines at no cost to uninsured or underinsured adults. The CDC is working to strengthen confidence in and demand for vaccines; to communicate the benefits of vaccination to the public, and to use data to target vaccination efforts. In addition, because a strong recommendation from a health care provider remains the leading reason why people choose to get vaccinated, the CDC has worked to equip providers with resources on vaccine recommendations and on having effective conversations with patients about vaccines.

It will take ground-up efforts across every community, vaccination provider location and household around the U.S. To ensure that older adults get not only the respiratory virus vaccines but all recommended vaccines.

The views expressed in this article do not necessarily represent those of the Centers for Disease Control and Prevention.

This is an opinion and analysis article, and the views expressed by the author or authors are not necessarily those of Scientific American.

Future Parents More Likely To Get RSV Vaccine When Pregnant If Aware That RSV Can Be A Serious Illness In Infants

A nationwide survey of people who were pregnant or trying to become pregnant found that overall 54 percent expressed interest in the RSV vaccine during pregnancy. Perceiving RSV as a serious illness in infants was the strongest predictor of likely vaccination during pregnancy. Likelihood to receive the RSV vaccine during pregnancy was also higher among parents with a child at home already. Findings were published in the journal Pediatrics.

Respiratory syncytial virus (RSV) is a leading cause of infection among infants, frequently resulting in hospital or intensive care admission. RSV infection severe enough to require hospitalization has been associated with long-term wheezing and higher risk of future hospitalization for asthma symptoms compared with children not hospitalized with RSV as infants. Almost all children in the United States will contract RSV within the first two years of life.

RSV vaccination during pregnancy has been demonstrated to help prevent RSV-related hospitalizations in infants. The vaccine is now FDA approved and recommended during pregnancy.

"Our study was conducted prior to the RSV vaccine approval, with the goal to use the findings to inform educational efforts on the new recommendations," said lead author Jennifer Kusma Saper, MD, MS, researcher at Mary Ann & J. Milburn Smith Child Health Outcomes, Research and Evaluation Center at Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, and Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. "Research results on the vaccine effectiveness also were not publicly available at the time of the survey. Raising awareness of RSV infection as likely and potentially serious for young children, especially for infants under 6 months, and that it can be prevented with a vaccine during pregnancy, may help promote RSV vaccine uptake."

The study included a diverse and representative sample of 1,528 participants. Overall, 40 percent of respondents perceived that RSV illness among children is both serious and likely, whereas 45 percent perceived RSV illness as serious but not likely, and 16 percent did not view RSV illness as serious. Twenty percent said they had never heard of RSV.

Sixty-three percent of respondents who thought that RSV illness was both serious and likely reported they would be very likely to get vaccinated against RSV during pregnancy, while only 31 percent of those who thought RSV illness was not serious (regardless of whether they thought it was likely) would do so.

"Our findings clearly show that in order to increase RSV vaccination during pregnancy and spare infants from potentially severe infection, future parents need to be well informed about the serious risks RSV may pose to their child," said Dr. Saper.

Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through Stanley Manne Children's Research Institute, which is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is a nonprofit organization committed to providing access to exceptional care for every child. It is ranked as one of the nation's top children's hospitals by U.S. News & World Report. Lurie Children's is the pediatric training ground for Northwestern University Feinberg School of Medicine.

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