As you care for patients throughout the respiratory illness season, keep in mind that respiratory syncytial virus poses a risk for severe infection and even death among older adults. Due to the concurrent circulation of RSV with other respiratory viruses, the 2024-2025 RSV season could be particularly significant for adults 60 and older who have certain medical conditions or other factors associated with increased risk for severe RSV illness. It is important to have a conversation about these risk factors with your patients who are most likely to benefit from RSV vaccination.
This page features guidance from the Advisory Committee on Immunization Practices (ACIP), as well as motivational interviewing strategies for conversations with your patients.
There are three RSV vaccines approved for adults 60 and older in the United States: RSVPreF3 (Arexvy), RSVpreF (AbrysvoTM) and mRNA[1]1345 (mRESVIA). Evidence suggests that RSV incidence increases as patients age and should be considered when determining the risk for severe RSV disease. The three single-dose RSV vaccines appear to provide measurable protection for adults 60 and older for at least two RSV seasons. However, research is still underway about the full efficacy and duration of the RSV vaccines.
Data from 2023-2024 show that Arexy (83%) and Abrysvo (73%) effectively prevented RSV-associated hospitalizations in adults 60 and older. Due to the recency of mRESVIA, data about the effectiveness of that vaccine in preventing RSV-associated hospitalizations in adults 60 and older are currently unavailable.
Following guidance from the ACIP, the American Academy of Family Physicians recommends that all adults 75 and older and those 60-74 who are at increased risk for severe RSV disease should receive a single dose of RSV vaccine. Adults who have previously received RSV vaccine do not currently require another dose.
Click on the drop-downs below to read more specific recommendations.
The RSV vaccine can be administered at the same patient visit when the influenza vaccine is provided during viral respiratory illness season. However, given that RSV vaccines are relatively new, immunogenicity data is limited when coadministering the RSV vaccine with other vaccines. For example, safety data is lacking about coadministering the RSV vaccine for adults 60 and older with other vaccines recommended for this age group, such as COVID-19; pneumococcal; adult tetanus, diphtheria, and pertussis; and recombinant zoster.
When determining the coadministration of other vaccines with an RSV vaccine, please consider the patient’s:
While there is a lack of safety data regarding the coadministration of RSV vaccines with other vaccines, there is also a rise in vaccine hesitancy, particularly for new vaccines. Family physicians should discuss the lack of data, but also the standard clinical practice of coadministering vaccines, which could lead to higher vaccination rates and lower incidence and severity of disease in older adults.6
RSV vaccines should not be administered to a person with a history of a severe allergic reaction, such as anaphylaxis to any vaccine component. Each manufacturer’s insert contains additional information about the U.S. Food and Drug Administration-approved RSV vaccines. The inserts are in the Safety section of the Center for Disease Control and Prevention’s RSV Vaccine Guidance for Older Adults webpage.
Adults with a minor acute illness, such as a cold, can receive RSV vaccination. As a precaution, adults with moderate or severe illness with or without fever should defer vaccination until the patient recovers.
Within 42 days after receiving the Arexvy and Abrysvo RSV vaccinations in clinical trials, a small number of individuals 60 and older developed serious neurologic conditions, such as Guillain-Barré syndrome.7 However, it is unclear if the RSV vaccine caused these events.
Patients can receive the RSV vaccine at any time, but family physicians and other clinicians should provide RSV vaccination as early as the vaccine supply becomes available, preferably before the onset of the respiratory illness season.
Incorporating the RSV vaccine into routine immunization discussions can protect your patients from unnecessary suffering, improve their quality of life and reduce disease and health care utilization. Additionally, widespread vaccination can reduce the strain on health care systems, particularly during peak respiratory illness seasons. It is essential to educate patients on the safety and efficacy of the RSV vaccine and advocate for its inclusion in their preventive health plans to enhance longevity and well-being.
More information for health care professionals about RSV vaccine composition, administration and storage and handling is available from the Centers for Disease Control and Prevention. The AAFP also provides several valuable RSV resources on our Respiratory Syncytial Virus (RSV) Vaccines and Therapeutics webpage, including clinical guidance recommendations, a maternal RSV podcast, publications and free continuing medical education on demand.
The AAFP endorses the following RSV vaccination recommendations from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention
The RSV vaccine is not currently an annual vaccine, so people who have previously received it do not need to get another dose.
A recommendation from a health care professional is the strongest predictor of whether a patient will get vaccinated. This clinical guidance tool from the American Academy of Family Physicians highlights recommended approaches as you encourage your patients 60 and older to get the RSV vaccine. It can help you and your practice team prepare to talk to these patients about the benefits and risks of RSV vaccination, address their questions and help them make an informed decision.
Use a presumptive and positive approach focused on illness prevention.
When you recommend the RSV vaccine to a patient, assume they will receive it that day. Rather than asking if your patient wants to be vaccinated, explain that they are due to get the vaccine and will be vaccinated during their visit. Highlight why they need the RSV vaccine to protect them, with special emphasis on illness prevention. “I see you are here today for your annual exam. Since you haven’t had your RSV vaccine yet, we’ll give you that vaccine today to continue your preventive care.”
Listen carefully and respond with an attitude of curiosity, empathy and collaboration.
Patients who are hesitant about getting the RSV vaccine may be more willing to get vaccinated if you take an empathetic, collaborative approach with them. If a patient does not want to talk about getting the RSV vaccine, respect their preference and leave the door open for a future conversation. Based on your patient’s exhibited emotions and expressed values, you may also want to briefly explore why they do not want to talk about vaccination.
“I hear you saying that you don’t want to receive the RSV vaccine today. I wonder if you would be open to a conversation about this vaccine in the future.”
Practice active listening and use motivational interviewing strategies.
At this point, it is important for you to focus on listening to gain understanding rather than trying to change your patient’s mind. It is unlikely that debating your patient will make them more willing to get vaccinated. Instead, show that you are genuinely curious about their feelings and concerns.
Motivational interviewing is a proven technique to help patients explore their vaccine hesitancy and arrive at a decision that aligns with their values and health goals. Consider using the OARS framework to facilitate a nonjudgmental, patient-centered conversation (Table 1).
| Ask open-ended questions that allow your patient freedom to respond without the fear of giving a wrong answer. | “Can you share with me what concerns you have about getting the RSV vaccine?” “The RSV vaccine can help protect you against serious illness. Have you thought about how that might fit into your long-term health goals?” |
| Affirm your patient’s concerns to show that you empathize with and understand them. | “Thank you for sharing your concerns. There’s a lot of information about vaccines online and on social media, and some of it may not be the most accurate. I appreciate that you want to know more about the RSV vaccine before making a decision.” |
| Reflect to connect so the patient feels heard and understood. | “It sounds like you’re unsure about how effective the RSV vaccine might be. Can you tell me more about that?” “It sounds like you’re weighing the benefits and risks of the RSV vaccine. What benefits do you see, and what worries you the most?” |
| Summarize a path forward while reinforcing your strong recommendation and your goal to prevent illness. | “I care about you and want to help you avoid getting sick. The RSV vaccine significantly reduces your risk of serious illness, and it’s something I strongly recommend for you. My goal is to ensure you have accurate information so you can make an informed decision about this vaccine. I’m wondering if there is a way our team can help you feel more comfortable about getting vaccinated.” |
Continue the conversation after vaccine deferral.
If a patient continues to decline the RSV vaccine after you give a strong recommendation and engage in brief motivational interviewing, document the conversation and the patient’s vaccine deferral. Indicate in future visit notes that the patient is due for an RSV vaccine. You may also consider adding vaccine deferral to the active health issues list in their medical record. This will serve as a cue to talk about vaccination with them at a subsequent visit.
*Find references for data on this page in these PDFs:
1. Opportunities to Increase Respiratory Syncytial Virus Vaccination Among Adults 60 and Older
2. Discussing Respiratory Syncytial Virus Vaccination With Adults 60 and Older