The RSV vaccine is slowly reaching its target: older Americans

Toby Gould was an early adopter. In September, Mr. Gould, 78, went to a pharmacy in Hyannis, Mass., to get one of the new vaccines against respiratory syncytial virus, known as RSV. He has asthma, which would increase the risk of serious illness if I were to be infected.

Carol Kerton, 64, knew RSV could be dangerous: Her 3-year-old granddaughter had such a bad case that she was rushed to the emergency room. Ms Kerton was vaccinated in September at a local supermarket in Daytona Beach, Florida.

Sam Delson, 63, received an RSV vaccine last month in Sacramento. His doctor recommended it, he said, “because I’m over 60 and have a somewhat compromised immune system” after a long-ago bout with cancer.

They are the exceptions. So far, only about 15 percent of Americans over 60 have received one of two new RSV vaccines, which the Food and Drug Administration approved in May and are the first vaccines against the disease. Only 16 percent more said they definitely plan to, according to the Centers for Disease Control and Prevention.

In contrast, more than 62 percent of adults over 65 received the recommended flu shot this fall, and a third received the updated Covid-19 vaccine.

“This is a new vaccine and people are trying to figure out whether they need it or not,” said Dr. Priti Malani, a geriatrician and infectious disease specialist at University of Michigan Health.

That is if they even know about RSV vaccines. A national survey this summer of people ages 60 to 80 found that nearly half had never heard of them.

The CDC recommends RSV vaccines for people over 60 after individual discussions with their health care providers, something called “shared clinical decision making.” Medicare Part D, Medicaid, and most private insurers will cover the entire cost.

The fact that the elderly are vulnerable to RSV is an unfamiliar concept to many people. For decades, the virus was seen primarily as a threat to infants and young children. Most doctors “when they went to medical school were taught that RSV was a pediatric disease,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “It’s Still the Leading Cause of Hospitalization for Babies in the US”

But the FDA estimates that the virus sends 60,000 to 160,000 people over 65 to hospitals each year and causes 6,000 to 10,000 deaths. Other published estimates are even higher.

“It’s a very contagious virus,” Dr Malani said. Although children can get quite sick, more often than not, “a 4-year-old with a runny nose can have RSV and not get very sick; it looks like a common cold,” she said. However, she added: “Grandparents can get pneumonia.”

The risk of serious illness from RSV increases significantly with age. Hospitalization rates rise sharply for those in their 70s and 80s, especially for those with chronic heart and lung conditions such as asthma, heart failure, and chronic obstructive pulmonary disease. Older adults who have diabetes or liver and kidney disease, or a weakened immune system, also face a higher risk. Adults can be infected multiple times and there is no medicine to relieve the disease like there is for the flu and Covid-19.

A study published in The New England Journal of Medicine in 2005 followed patients over four winters and reported that among high-risk patients (average age 70) with heart failure or lung disease who became infected with RSV, 16 percent required hospitalization. In another group of older patients hospitalized with respiratory symptoms (with an average age of 75) and diagnosed with RSV, 15 percent ended up in an intensive care unit.

The new RSV vaccines are very effective. Clinical trial results show that Arexvy, the injection made by GSK, is 94 percent effective against severe disease in older people. Pfizer’s injection, called Abrysvo, is 86 percent effective against severe disease.

So why haven’t vaccines caught on more with their intended recipients?

One reason: A CDC shared decision-making recommendation can lower vaccination rates, Dr. Schaffner said, because “you can’t promote it with the same intensity and confidence as you can with a blanket recommendation” — like one recommending flu shots. vaccines for everyone over 6 months.

In addition, older people already receive multiple public health messages about seasonal vaccinations. “A few years ago, we all recommended one vaccine every winter — the flu,” Dr. Schaffner said. “We still haven’t organized ourselves to be persuasive about getting people to get three seasonal vaccines” for flu, Covid-19 and now RSV (Getting two or three at once is fine, the CDC says.)

When R. Jessica Jones, 76, who lives in Haiku, Hawaii, texted her doctor about seasonal vaccinations, he replied that she should get a Covid-19 booster and a flu shot, but that getting an RSV shot was “ optionally”.

Mrs. Jones, surprised, asked why. He told her he thought the data on their safety and efficacy was “limited” (the FDA disagreed), so she skipped getting one.

“When providers are confused, patients are confused,” said Dr. Maloney of the University of Michigan Health. “If we really want uptake by the population that could be beneficial, we need to provide clear information to doctors and others.”

While some health care providers hope to improve vaccination rates among older Americans, vaccine makers are apparently pleased with the number of people seeking the shots so soon after they shipped them to pharmacies, hospitals and doctors’ offices last summer. Manufacturers are collecting data on the vaccines’ effectiveness and side effects and — a central unanswered question — how often people will need to be revaccinated to maintain protection.

“For a new class of vaccine, this is really fantastic,” said Dr Len Friedland, who leads public health for GSK Vaccines.

“There will always be hiccups,” he said. “But overall everything went very well and we haven’t heard of any issues with patient access.”

Dr. Nathaniel Huppert, co-director of the Cornell Institute for Disease and Disaster Preparedness, was more cautious. Fifteen percent is “much better than zero,” he said, noting that until last summer there was no RSV prevention available, but, he said, “if you want to eradicate RSV, it’s not going to happen at that level of coverage.”

Other manufacturers are developing RSV vaccines, and older Americans may eventually have greater protection as more pregnant women and infants are immunized, as the CDC recommends. “Children have the franchise to spread these respiratory viruses every winter,” said Dr. Schaffner of Vanderbilt University Medical Center.

Over time, “we will probably see less transmission of RSV from children to their grandparents,” Dr. Huppert said. “But we’re not there yet.”

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