Vaccination against respiratory syncytial virus (RSV) has been a topic of discussion, particularly for adults ages 60 and older. The CDC’s Advisory Committee on Immunization Practices (ACIP) recently reaffirmed that the benefits of RSV vaccination likely outweigh the small risk of Guillain-Barré syndrome (GBS) associated with the vaccine. Dr. Amadea Britton, a member of the CDC’s RSV adult vaccination work group, presented findings that showed a few cases of GBS in clinical trials for FDA-approved RSV prefusion F protein vaccines. However, the connection between RSV vaccination and GBS remains uncertain.
Vaccination Approval and Surveillance Data Analysis
The first-ever RSV vaccine, Arexvy, received FDA approval in May 2023 for adults ages 60 and older. Subsequently, a second RSV vaccine, Abrysvo, was also approved for the same population. Dr. Michael Melgar from the CDC presented an analysis of FDA active surveillance data collected from Medicare beneficiaries aged 65 years and older. The analysis revealed a potential 10 GBS cases per 1 million Arexvy doses administered and 25 GBS cases per million Abrysvo doses. While the historical background rate from 2022 suggested five GBS cases per 1 million, it is important to note the limitations of comparing historical data with current findings.
Dr. Britton emphasized the need for cautious interpretation of the data, particularly in the context of the flu vaccine, where there is a higher risk of GBS from the flu itself. She highlighted the importance of considering the benefits of RSV vaccination alongside any potential risks. Over two RSV seasons, projections indicated that every 1 million doses of the vaccine in older adults could prevent a significant number of outpatient visits, hospitalizations, ICU admissions, and in-hospital deaths. However, despite the clear benefits, the uptake of RSV vaccines among adults aged 60 and older has been relatively low.
Recognizing that older adults with chronic medical conditions are at higher risk for severe RSV disease, Dr. Britton emphasized the importance of vaccination for this vulnerable population. Those with chronic lung diseases, heart failure, compromised immune systems, advanced age, and residents of long-term care facilities stand to benefit the most from RSV vaccination. The CDC’s work group continues to support the recommendation for RSV vaccination based on the available evidence of benefits outweighing risks.
The ongoing assessment of RSV vaccination in older adults highlights the importance of considering both the risks and benefits of immunization. While concerns about GBS warrant careful monitoring, the potential benefits in preventing severe RSV-related outcomes underscore the importance of promoting vaccination among high-risk groups. It is essential to continue evaluating the data and recommendations to ensure the overall health and well-being of older adults in the face of respiratory syncytial virus.
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