NACI issues Canadian guidance for use of RSV vaccines in older adults

The National Advisory Committee on Immunization has released a statement and recommendations on the use of respiratory syncytial virus (RSV) vaccines in older adults.1,2 The new guidance for older adults follows NACI’s May 2024 statement on prevention of RSV disease in infants.3The risk of severe RSV disease increases with age and with certain medical conditions, and can lead to serious complications for older adults, including hospitalization, intensive care unit admission and death.1,2 Two RSV vaccines are approved by Health Canada to protect older adults:Arexvy (GSK) was authorized on August 4, 2023 to protect adults ≥ 60 years of age.4Abrysvo (Pfizer) was authorized on December 21, 2023 to protect adults ≥ 60 years of age. It is also authorized for people who are 32–36 weeks pregnant to protect their infants from RSV.5Following a review of the evidence for use of RSV vaccines (Arexvy and Abrysvo) in adults over 60 years of age, NACI issued the following recommendations based on evidence and NACI expert opinion.1,2NACI recommendations1,2For public health decisions:NACI recommends RSV immunization programs for adults ≥ 75 years of age, particularly for those at increased risk of severe RSV disease (see chronic health conditions, listed below). (Strong recommendation). NACI recommends RSV immunization programs for adults ≥ 60 years of age who are residents of nursing homes and other chronic care facilities. (Strong recommendation)One dose of either Arexvy or Abrysvo can be used.For healthcare providers advising individual patients:NACI recommends that an RSV vaccine may be considered as an individual decision by adults 60–74 years of age in consultation with their healthcare provider. (Discretionary recommendation)Chronic health conditions for which RSV vaccination is particularly importantRSV vaccination is particularly important for individuals with any of the following clinically significant chronic health conditions that increase the risk for severe RSV disease:1,2Cardiac or pulmonary disorders (includes chronic obstructive pulmonary disease, asthma, cystic fibrosis and conditions affecting ability to clear airway secretions)Diabetes mellitus and other metabolic diseases Moderate or severe immunodeficiency (see list of conditions) Chronic renal disease or chronic liver diseaseNeurologic or neurodevelopmental conditions (includes neuromuscular, neurovascular, neurodegenerative [e.g., dementia], neurodevelopmental conditions and seizure disorders, but excludes migraines and psychiatric conditions without neurological conditions)Class 3 obesity (i.e., body mass index of ≥ 40 kg/m2)Other key points1,2RSV vaccines (Arexvy and Abrysvo) work best when given just before or during the RSV season, which typically occurs from November to April. People at highest risk of severe RSV disease should time their vaccination to optimize protection during the RSV season. A single dose of RSV vaccine protects adults for one year (potentially longer), with a good safety profile.It is uncertain whether RSV vaccines provide protection for more than one year, or if the vaccine response can be boosted with another dose later. Healthy individuals who are < 75 years of age may want to discuss deferring vaccination with their healthcare providers to a future time when they may be at greater risk.Adults ≥ 75 years of age, particularly those who have a chronic health condition that puts them at increased risk, are expected to benefit the most from vaccination during the RSV season. Early safety data from US surveillance systems suggest that there may be an increased risk of Guillain-Barré syndrome after RSV vaccination in adults ≥ 60 years of age. However, an association has not yet been confirmed and this issue is being monitored closely. When possible, RSV vaccines should be given at least six weeks before or after nonseasonal vaccines (e.g., shingles vaccine), to help with identifying adverse events related to the new RSV vaccines. This advice may change as more research is completed on same-day administration of RSV vaccines and other adult vaccines.References:National Advisory Committee on Immunization. Summary of NACI statement of July 12, 2024: Statement on the prevention of respiratory syncytial virus disease in older adults. (accessed July 18, 2024).National Advisory Committee on Immunization (NACI). An Advisory Committee Statement (ACS). Statement on the prevention of respiratory syncytial virus (RSV) disease in older adults. July 2024.National Advisory Committee on Immunization (NACI). Statement on the prevention of respiratory syncytial virus (RSV) disease in infants. An Advisory Committee Statement (ACS). (accessed July 18, 2024).GlaxoSmithKline Inc. Arexvy (respiratory syncytial virus vaccine, recombinant, AS01E adjuvanted) product monograph. Mississauga, ON; August 4, 2023. (accessed July 18, 2024).Pfizer Canada. Abrysvo (respiratory syncytial virus stabilized prefusion F subunit vaccine) product monograph. Kirkland, QC; December 21, 2023. (accessed July 18, 2024).

NACI issues Canadian guidance for use of RSV vaccines in older adults

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