A Review of Respiratory Syncytial Virus Vaccines in the Older Adult.

Background Respiratory syncytial virus (RSV) can cause severe illness, particularly in older adults, leading to thousands of hospitalizations and deaths annually among individuals aged 65 and older. In May 2023, the U.S. Food and Drug Administration (FDA) approved two vaccines, Arexvy® (RSVPreF3) and Abrysvo® (RSVpreF), for the prevention of RSV-related lower respiratory tract disease (LRTD) in adults aged 60 years and older. In May 2024, the FDA approved a third RSV vaccine, mRESVIA® (mRNA-1345). In June 2024, the Centers for Disease Control and Prevention (CDC) updated its guidance to recommend a single dose of an RSV vaccine for all adults aged 75 years and older, as well as those aged 60 to 74 years old with risk factors for severe disease. Clinical trials have demonstrated that all three vaccines are safe and effective in reducing RSV-related morbidity and mortality. Objective To review the literature describing the safety, efficacy, tolerability, and clinical application of RSV vaccines in older adults. Data Sources Primary literature identified through PubMed, the U.S. clinical trial registry, and CDC resources from 2021 to 2025, with an emphasis on randomized clinical trials and key studies supporting FDA approval. Data Synthesis Arexvy® (RSVPreF3), Abrysvo® (RSVpreF), and mRESVIA® (mRNA-1345) have demonstrated efficacy in reducing the risk of RSV-associated LRTD and severe RSV-associated LRTD in adults aged 60 years and older. Reported adverse effects include injection-site pain, myalgia, fatigue, and headaches. Economic analyses suggest that all three vaccines are potentially cost-effective. Conclusion RSV poses a significant risk of morbidity and mortality, especially in older adults. Arexvy® (RSVPreF3), Abrysvo® (RSVpreF), and mRESVIA® (mRNA-1345) have been shown to effectively prevent LRTD caused by RSV in individuals aged 60 and older. Pharmacists play a vital role in supporting CDC recommendations, educating patients and optimizing preventive health strategies.