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Commentary on RSV Prevention
The Case for RSV Vaccination in Older Adults

Released: September 15, 2023

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Key Takeaways
  • Educating patients about new and emerging RSV vaccines is imperative to protecting at-risk groups.
  • There are many proactive and practical actions pharmacists can take to facilitate the uptake of RSV vaccinations and address vaccine hesitancy across care settings.

With the recent availability of 2 respiratory syncytial virus (RSV) vaccines for older adults, it is imperative for pharmacists in all settings to plan to incorporate them into their daily practice. Consider the following case example for pharmacists on the frontlines of implementation in community pharmacy.

As the pharmacist in a bustling community pharmacy, you have proactively generated a report of patients you see who would qualify for an RSV vaccination. As a strategy to inform patients of their candidacy and the availability of RSV vaccines, you have labeled prescription bags awaiting pickup.

 A patient approaches the counter to inquire about the notification on his bag. He would like to know more about his risk for RSV and why it is important for him to get a vaccine. He also expresses some confusion about vaccines that have been recommended to him. He asks, “Why do I have to get so many vaccines? There are vaccines for flu, pneumonia, shingles, COVID-19, and now this one? How do I know what to get and when?”

Here are my thoughts on how to provide the most accurate information for this patient and the importance of working with him to craft an individualized plan to keep him healthy.

Educating Older Adults on RSV
In general, we know that respiratory illnesses are a concern for older adults because, as we age, we experience immunosenescence, a reduction in the ability to respond to infections and respiratory pathogens. Older adults with a history of chronic respiratory conditions (eg, asthma, chronic obstructive pulmonary disease) and cardiovascular conditions (eg, hypertension, heart failure) are more at risk of contracting RSV. In addition, patients who have received hematopoietic stem cell transplantation or are taking immunosuppressive medications for cancer treatment, solid organ transplantation, or other conditions also have compromised immunity and thus increased susceptibility to RSV.

Although symptoms of RSV can be mild—including rhinorrhea, coughing, sneezing, wheezing, and presence of a fever—older adults can be at risk of more severe symptoms and health outcomes from the infection. RSV in older adults has been associated with similar hospital admissions and mortality rates compared with influenza, with potentially longer hospital durations and increased admissions in critical care units.

It is hypothesized that seasonal outbreaks of RSV derive from the evolution of local strains that infect susceptible people in the area. RSV infections seemed to dissipate during the COVID-19 pandemic in part because of masking precautions that blocked RSV transmission through droplets. Once people started to unmask, transmission increased, and more cases of RSV were seen.

Ultimately, many respiratory infections are preventable. Newly available vaccinations against RSV now offer us that tool for adults aged 60 years and older.

Practice Strategies to Increase RSV Vaccine Uptake
In June 2023, the Advisory Committee on Immunization Practices recommended that adults aged 60 years and older could receive a single dose of an RSV vaccine using shared clinical decision-making, stating that “RSV vaccines have demonstrated moderate to high efficacy in preventing RSV-associated lower respiratory tract disease and have the potential to prevent substantial morbidity and mortality among older adults; postmarketing surveillance [of safety and efficacy] will direct future guidance.” While awaiting results of this postmarketing surveillance, the CDC advises targeting older adults who are at highest risk for severe RSV disease and would likely benefit from RSV vaccination. Therefore, providing patients with the facts about RSV and prevention strategies equips them to make informed decisions for themselves and their families.

For a more proactive and individualized approach, healthcare professionals can work to actively identify patients who would qualify for and benefit the most from an RSV vaccine. A strategy would be to run a report within your pharmacy or clinical setting that might include patients aged 60 years and older who are prescribed medications for hypertension, diabetes, or heart failure. Once you have that list, you can compare it with the immunization registry at your facility or with the state registry. In the United States, each state has an immunization registry to track coverage rates and determine vaccination requirements. In this way, you can determine these patients’ vaccination needs and reach out to eligible patients by leaving notes on prescription bags or calling to educate them about RSV prevention options. As pharmacists, it is important to explain to patients why we think they need that vaccine, when it is appropriate for them to get it, if they can receive it at the same time as another vaccination, and additional vaccines they may need in the future.

For example, if a patient is 64 years of age, you should let them know that they will need the pneumococcal vaccine when they turn 65. Doing a bit of due diligence to identify at-risk groups and notifying them before they are due for a vaccine can help tremendously. This is similar to the process we use with flu and COVID-19 vaccines; we start reminding people pretty early, as well as when a new formulation is likely to be approved by the FDA. The average adult visits a pharmacy 35 times per year, so each of those encounters is a touch point where we can remind people about their vaccination needs.

Discussing the RSV Vaccine
It is important to mindfully consider how to talk with patients about vaccines. I have 2 main recommendations. First, research and implement motivational interviewing strategies. Bruce Berger, PhD, has worked with pharmacists to show how motivational interviewing affects patient care and adherence and how it relates to vaccine hesitancy from a public health standpoint.

My second recommendation is to engage with local programs to learn about vaccination strategies. For example, the University of California San Diego has a vaccine hesitancy course that I have found helpful. The program recommends first asking permission from the patient before providing information about vaccinations. Then, it provides some foundational information about understanding the misinformation or disinformation that patients may receive from a source they consider trustworthy. They advise that, rather than discounting the patient’s source, we should provide patients with evidence-based information and science-based resources. Immunize.org, the Immunization Action Coalition’s website, has excellent information on how to talk to patients about vaccinations in a way that facilitates patient education.

Reducing Healthcare Disparities
Unfortunately, there is inherent racism within our healthcare system. The language that we use as healthcare professionals is very important. The American Medical Association published a document discussing the language we use when we refer to individuals who we feel are either at risk or could benefit from the services that we provide. What I have learned from this document is that people themselves are not risk factors. Rather, the effects of systematic actions have created their risk.

These issues are not one-size-fits-all; a patient’s lived experience needs to be taken into consideration when determining what is best and whether they decide to get vaccinated. Because of a long-standing history of unfavorable experiences within the medical system, including discrimination from implicit and overt biases, patients from marginalized groups may be understandably hesitant when interacting with the healthcare system. We know some people may choose to never get vaccinated, but our responsibility is to provide unbiased information to everyone so that they can make an informed decision.

Join Us
To learn more about key issues related to RSV infection in adults, including the underrecognized vast burden of disease, risk factors for illness and severity, and the emerging field of RSV vaccines for older adults, join me and my colleague Mary Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP, for an upcoming live webinar.

Your Thoughts?
Do you have a plan to actively educate your patients about the benefits of RSV vaccinations in your practice? Join the discussion by posting a comment.