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RSV Vaccination in Pharmacy Practice
Practical Strategies to Integrate RSV Vaccination Into Pharmacy Practice

Released: April 15, 2024

Expiration: April 14, 2025

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Key Takeaways
  • RSV vaccines should be considered in patients at high risk for severe RSV disease, such as older adults (60 years of age and older), particularly those with comorbidities.
  • Coadministration of the RSV, COVID-19, and influenza vaccines is permitted and may improve uptake for each vaccine.
  • Pharmacists are often the most accessible healthcare professionals and have a major role in overcoming barriers to RSV vaccination. 

The following is a recap of key questions from pharmacists and pharmacy technicians during a program featuring Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, AAHIVP, and Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP, discussing respiratory syncytial virus (RSV) vaccine recommendations in older adults and strategies to integrate RSV vaccines into practice.

Can you give the RSV vaccine at the same time as the COVID-19 and influenza vaccines?
Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP:
2023-2024 is a milestone year because this is the first respiratory season where healthcare professionals (HCPs) have had 3 vaccines available for some of the most common viral respiratory illnesses: influenza, COVID-19, and RSV. Per the CDC guidance, all 3 vaccines can be administered simultaneously.

Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, AAHIVP:
I have found that presenting all 3 vaccines (influenza, COVID-19, and RSV) at one time can be something people really like. Providing a strong recommendation for receiving them together helps motivate people to say, “You know what, I’m going to knock these out and get protected against all 3 viruses.”

Will there be updated RSV vaccines in upcoming seasons like we see for COVID-19 and influenza?

Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP:
My understanding is that we are not likely to see updated RSV vaccines—at least not an annually updated RSV vaccine like with influenza. This is because RSV, as a virus, does not mutate in the same way that influenza does.

In addition, there are differences between influenza and RSV in terms of the viral surface protein that is targeted with immunizations. All of the approved RSV vaccines—even the vaccine that is undergoing phase III studies—have a similar mechanism of action using a version of the RSV fusion glycoprotein stabilized in its prefusion form to generate neutralizing antibodies. The F protein is a common surface antigen that has a critical role in RSV infecting and penetrating our cells. It is highly conserved across the RSV viral subtypes and therefore unlikely to mutate much from year to year.

Will patients need to be vaccinated against RSV annually? Are there any preliminary data on the length of protection or the need for a booster vaccine?

Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP:
There is evidence that these vaccines retain their efficacy across at least 2 RSV seasons, but it is too soon to tell the durability of protection.

Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, AAHIVP:
I will add that the data are rapidly evolving, and there are ongoing clinical trials to determine how long immunity from these vaccines persists. HCPs should continue to remain updated should there be any changes.

Which patients are at highest risk for severe RSV disease and poor outcomes?

Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP:
Infants, young children, and older adults (eg, 60 years of age and older) are at an increased risk of severe RSV.

Adults who are at highest risk of severe RSV disease and poor outcomes such as hospitalization include individuals who have underlying chronic pulmonary diseases (eg, chronic obstructive pulmonary disease), as well as patients with nonpulmonary comorbidities, such as chronic cardiovascular diseases (eg, heart failure or coronary artery disease), immunocompromising conditions, hematologic or neurologic conditions, and diabetes or kidney disease.

Older adults dwelling in long-term care facilities or congregate living environments are also at an increased risk of severe RSV, as are those experiencing the frailty syndrome of aging.

I would consider a blanket recommendation to discuss the RSV vaccine with all adults aged 60 years and older and prioritize and strongly advocate for vaccine administration in individuals with risk factors for severe RSV disease.

What practical measures can be implemented to help the public from being infected by RSV?

Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP:
This infection is caused by a virus with particles that are shed and shared in much the same way as other respiratory viral illnesses. I think the measures that were advised for COVID-19 prevention—namely hand hygiene, masking, and isolation, if possible—are all good prevention strategies. However, RSV, unlike COVID-19, remains active on nonporous surfaces for up to 6 hours, so disinfecting high-contact surfaces is key to preventing the spread of this virus. For example, people should be meticulous in terms of hygiene on shared surfaces, such as countertops, railings, and door handles.

How do you know if a patient has RSV vs other respiratory viruses? Are there testing kits available to identify RSV?

Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, AAHIVP:
HCPs have virus-specific assays to distinguish whether an infection is influenza, COVID-19, or RSV. There are panels that can detect either one of these viruses. Although there are no at-home tests for RSV, patients can go to an urgent care or other ambulatory care settings to be tested for RSV. Also, I think it can be helpful for patients to test for COVID-19 at home to rule it out and determine if they should see their primary care physician or go to the urgent care for more specific testing.

What do you recommend for community pharmacies that do not have the staffing and resources for patients to get RSV vaccines?

Mary Barna Bridgeman, PharmD, BCPS, BCGP, FASCP, FCCP, FNAP:
There are phenomenal data in the CDC’s weekly RSV vaccination dashboard, RSVVaxView. I was so proud and even a bit startled to see how many millions of RSV vaccine doses are being distributed in pharmacies compared with physicians’ offices. It is clear from these numbers that the major destination for these vaccines has been pharmacies, and this highlights how pharmacists are often the most accessible HCPs for many people.

It is critical to recognize our impact and influence as pharmacists and pharmacy providers—we are key to overcoming barriers to RSV vaccination and uptake.

There are certainly challenges with staffing and resources in the contemporary community pharmacy environment, but I think we can integrate these vaccines into the workflow, even with limited resources.

First, I think pharmacists should consider how technicians or pharmacist extenders (eg, students and residents) can be integrated into their workflow, within the scope of state rules related to technicians and technician immunization, to potentially offset the expectations of the pharmacist.

I also think that pharmacists can consider ways to offer these services outside of the usual workflow, using pop-up clinics or working with the local health department.

Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, AAHIVP:
I completely agree. Allowing pharmacy students and technicians to engage with patients can be motivating for them, even if it is as simple as identifying individuals who will most benefit from receiving the vaccine and/or initiating the conversation to consider the vaccine. I think this also can build the pharmacy team rapport, emphasizing we are all in this together.

How does the recommendation to use shared clinical decision-making (SCDM) affect health disparities and vaccine uptake?

Jacinda (JAM) Abdul-Mutakabbir, PharmD, MPH, AAHIVP:
This is something I think about often because I think SCDM has a significant impact on health disparities and vaccine uptake. HCPs have to consider opportunities where patients may engage in SCDM. Many times, it comes down to determining what patients need to participate in the conversation.

One major factor is knowledge—not only of how the virus affects them and their individual risk factors, but also vaccine awareness. Many individuals only hear about these vaccines from a primary care provider. This leads to disparities among communities where many individuals do not have primary care provider, resulting in fewer opportunities to engage with patients on vaccines. I think that this may be an opportunity for pharmacists to educate patients and thereby mitigate these barriers.

Your Thoughts?
In your practice setting, what strategies have you implemented to improve RSV vaccine uptake? Join the discussion by posting a comment.