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Screening Β· Β§140
RSV Vaccine for Adults
RSV isn't just a kids' disease. Every winter it hospitalizes 60,000 to 160,000 older Americans and kills 6,000 to 10,000 Hansen 2022. There's now a one-time shot that cuts your odds of an RSV hospitalization by about three-quarters, free for nearly everyone on Medicare or ACA insurance. The twist most people miss: a healthy 65-year-old is no longer on the recommended list. The rules are stratified by age and risk, and which bucket you're in is the whole decision.
Do Β· Once Evidence Moderate Chapter Screening

Which bucket you're in decides everything. The current rules sort adults three ways 1:

  • 75 or older: recommended, full stop, however healthy you are. One shot.
  • 50 to 74: recommended only if you carry a risk condition.
  • No qualifying risk and under 75: not routinely recommended, though some choose it after a doctor conversation.

The risk conditions that move you into the yes column: chronic heart or lung disease (COPD, heart failure, asthma), diabetes with kidney, eye, or nerve damage, serious kidney or liver disease, a BMI of 40 or higher, a weakened immune system, sickle cell disease, frailty, or living in long-term care.

The shot works, and the real-world data backs the trials. Three big trials found it prevented roughly two-thirds to over four-fifths of RSV lower respiratory illness in the first season, with protection against the most severe outcomes running higher still 234. Tracking actual hospitalizations across a full season, vaccinated adults 60 and up were about 75 to 80 percent less likely to land in the hospital for RSV 5. Protection against milder illness fades by year two; protection against severe disease holds up. It's one lifetime dose, no booster.

If you're in a yes bucket, here's the move. Time it so peak protection lands before RSV season, which runs November through March.

You're covered within two to four weeks of the shot.

What it costs you. The typical reaction is a sore arm and maybe a day of feeling tired or achy, like the Shingrix shot. The price tag is usually zero: Medicare Part D and ACA-compliant private plans cover it with no copay. Uninsured cash price runs about $280 to $320.

The fine print β€” when to skip it, and what people get wrong

Skip it if you've had a severe allergic reaction to a prior RSV shot. Vaccinated adults had about seven to nine extra Guillain-BarrΓ© cases per million doses; the CDC kept the recommendation because far more hospitalizations and deaths are prevented 1.

Pregnant: get Abrysvo only, in a set window, to protect the baby; Arexvy and mResvia aren't for you. "I had RSV, so I'm immune" is false; immunity fades and adults catch it repeatedly. Healthy 65-year-olds aren't on the routine list; the floor moved to 75.

References
  1. 1Britton A, Roper LE, Kotton CN, et al. (2024). Use of Respiratory Syncytial Virus Vaccines in Adults Aged β‰₯60 Years: Updated Recommendations of the Advisory Committee on Immunization Practices β€” United States, 2024. MMWR Morbidity and Mortality Weekly Report. link
  2. 2Papi A, Ison MG, Langley JM, et al. (2023). Respiratory Syncytial Virus Prefusion F Protein Vaccine in Older Adults. New England Journal of Medicine. link
  3. 3Walsh EE, PΓ©rez Marc G, Zareba AM, et al. (2023). Efficacy and Safety of a Bivalent RSV Prefusion F Vaccine in Older Adults. New England Journal of Medicine. link
  4. 4Wilson E, Goswami J, Baqui AH, et al. (2023). Efficacy and Safety of an mRNA-Based RSV PreF Vaccine in Older Adults. New England Journal of Medicine. link
  5. 5Surie D, Yuengling KA, DeCuir J, et al. (2024). Early Estimate of Respiratory Syncytial Virus Vaccine Effectiveness Against RSV-Associated Hospitalization Among Adults Aged β‰₯60 Years β€” IVY Network, United States. MMWR Morbidity and Mortality Weekly Report. link
Related in the handbook (3)
Related
  • β€” RSV is one of the shots on the adult schedule, with its own age and risk gate before you qualify.
  • β€” COPD is exactly the kind of lung condition that both raises your RSV risk and qualifies you for the vaccine earlier.
  • β€” Not sure if you're old enough or sick enough to need the RSV shot yet? This walks the eligibility line.
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