Summary of the National Advisory Committee on Immunization (NACI) statement on the prevention of respiratory syncytial virus (RSV) in older adults.

Background: Respiratory syncytial virus (RSV) is a common respiratory virus. In addition to infants, older adults are at higher risk of severe outcomes due to RSV, particularly advanced-age older adults and those with chronic medical conditions. The authorization of three vaccines, one for adults 50 years of age and older (Arexvy) and two for adults 60 years of age and older (Abrysvo and mRESVIA), offers the opportunity to protect older Canadians from RSV disease. This article summarizes guidance from the National Advisory Committee on Immunization (NACI) on the prevention of RSV in older adults.

Methods: NACI established key policy questions and performed an evidence review and synthesis for three new vaccines. In consideration of the burden of illness to be prevented, safety and efficacy of the new immunizing products, economic evidence and ethics, equity, feasibility and acceptability considerations, NACI made evidence-based recommendations.

Results: The three RSV vaccines may provide similar reductions in hospitalizations associated with RSV and medically attended RSV respiratory tract infection for adults 60 years of age and older. However, evidence is limited for other outcomes. These vaccines were well-tolerated in clinical studies, with an acceptable safety profile among older adults. The duration of protection of the RSV vaccine is not yet known, and it is unclear if the protection offered by vaccination can be boosted by subsequent doses of vaccine.

Conclusion: Based on available evidence, NACI recommends RSV immunization programs for adults 75 years of age and older, particularly for older adults with chronic health conditions who are at increased risk of severe RSV disease. NACI also recommends RSV immunization programs for adults 60 years of age and older who are residents of nursing homes and other chronic care facilities. NACI recommends that receiving an RSV vaccine may be considered as an individual decision by adults 50 to 74 years of age, in consultation with their healthcare provider.