RSV Vaccine Now Recommended for At-Risk Adults Aged 50–59 Years

Mai Dang, PharmD, Community-University Health Care Center (CUHCC)

The Centers for Disease Control and Prevention (CDC) updated the 2025 Adult Immunization Schedule to recommend a one-time respiratory syncytial virus (RSV) vaccine for adults aged 50–59 years with chronic conditions that increase the risk of severe RSV disease. Previously, recommendations were age-based for all adults ≥60 years old, guided by shared clinical decision-making, with the strongest emphasis on those ≥75 because of their higher hospitalization risk. High-risk conditions include chronic heart or lung disease, end-stage renal disease or dialysis, and diabetes mellitus complicated by kidney disease, end-organ damage, or requiring insulin or a sodium-glucose cotransporter-2 inhibitor. Other qualifying conditions are neurologic disease impairing airway clearance, chronic liver or hematologic disorders, body mass index ≥40, moderate-to-severe immunocompromise, and nursing-home residence. 

Eligibility may be determined by patient self-attestation without requiring documentation to receive the RSV vaccine. Per CDC, vaccination is ideally given in late summer through early fall (August–October), prior to the typical RSV season, which runs from October through March.  Available vaccines include Arexvy® (GSK), Abrysvo® (Pfizer), and mResvia® (Moderna), each given as a one-time dose (not annual), with no preference to which RSV vaccine is given. The RSV vaccines may be coadministered with influenza, COVID-19, or other adult vaccines during the same visit, and if patients prefer to space them out, no minimum interval is required. Individuals who received one dose previously (including last year) are considered fully vaccinated and should not receive another dose of the RSV vaccine. 

Evidence supporting this expansion includes the MONeT trial (n=678), which demonstrated that Abrysvo® produced non-inferior neutralizing titers in adults 18–59 years with chronic conditions compared with adults ≥60 years, with mostly mild-to-moderate side effects. Moderna’s mResvia® showed similarly strong immune responses in this age group without reported cases of Guillain-Barré syndrome (GBS) or myocarditis during follow-up. Real-world studies in older adults have further supported vaccine use, with effectiveness estimates of 73–83% against RSV hospitalization. However, safety monitoring has identified rare GBS cases with Arexvy® and Abrysvo® (~7–9 per million doses), leading to label warnings. mResvia® has not shown this signal but is associated with more local and systemic reactions. Overall, the CDC limited expansion to ages 50–59 due to the higher burden of severe RSV in this group and with evidence showing favorable benefit-to-risk balance. For clinical practice, pharmacists and primary care providers should proactively identify eligible adults and incorporate RSV vaccination into preventive care discussions, reassuring patients that the small risks are outweighed by the substantial benefits of preventing severe RSV disease.

Published on November 17th, 2025.

References

  1. Centers for Disease Control and Prevention. Adult immunization schedule addendum. CDC. Published August 7, 2025. Accessed August 24, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-addendum.html
  2. Centers for Disease Control and Prevention. RSV vaccines for adults. CDC. Updated July 18, 2025. Accessed August 24, 2025. https://www.cdc.gov/rsv/vaccines/adults.html
  3. Davis M, Towner W, DeHaan E, et al. Bivalent RSVpreF vaccine in adults 18 to <60 years old
  4. with high-risk conditions. Clin Infect Dis. 2025;80(4):911-920. doi:10.1093/cid/ciae550
  5. Advisory Committee on Immunization Practices (ACIP). Meeting slides. CDC. April 2025. Accessed September 11, 2025. https://www.cdc.gov/vaccines/acip/meetings/slides-2025-04.html
  6. U.S. Food and Drug Administration (FDA). Post-marketing surveillance of RSV vaccines. FDA. 2024–2025. Accessed September 11, 2025. https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics
  7. Ison MG, DeVincenzo JP, Gessner BD, et al. Safety and efficacy of RSV perfusion F vaccines in older adults. N Engl J Med. 2023;388:1465–1477. doi:10.1056/NEJMoa2214524
  8. Patel MM, Gaglani M, Budd AP, et al. Effectiveness of RSV vaccines in older adults during the 2023–24 RSV season. MMWR Morb Mortal Wkly Rep. 2024;73(12):455–461. doi:10.15585/mmwr.mm7312a2