Respiratory syncytial virus (RSV) is a common respiratory virus that can be serious for older adults, particularly those aged 60 and older. The CDC’s Advisory Committee on Immunization Practices (ACIP) has emphasized the benefits of vaccination against RSV in this age group, despite the small risk of vaccine-related Guillain-Barré syndrome (GBS).
Evaluating the Risk of GBS
During the ACIP’s meeting, Dr. Amadea Britton highlighted the occurrence of Guillain-Barré syndrome in clinical trials for FDA-approved RSV vaccines for older adults. While there were a few cases of GBS reported, it is unclear whether they were directly linked to the vaccination or simply chance events. The ACIP’s initial recommendation for RSV vaccination in 2023 acknowledged the potential risks but concluded that the benefits outweighed them.
The FDA approved the first RSV vaccine, Arexvy, in May 2023, followed by the approval of a second vaccine, Abrysvo, for adults aged 60 and older. Dr. Michael Melgar presented data from FDA active surveillance, which indicated a potential increase in GBS cases post-vaccination. However, the historical background rate of GBS may not be an accurate comparison due to various factors.
Benefits of RSV Vaccination
Despite the potential risks, the benefits of RSV vaccination in older adults are substantial. According to projections, every 1 million doses of the vaccine could prevent numerous outpatient visits, hospitalizations, ICU admissions, and in-hospital deaths over two RSV seasons. However, the uptake of the RSV vaccines has been low, with only a small percentage of adults aged 60 and older receiving the vaccine.
The CDC emphasizes that older adults with chronic medical conditions, advanced age, or living in long-term care facilities are at higher risk for severe RSV disease and would benefit most from vaccination. Shared decision-making should be incorporated into discussions about the risk-benefit ratio of RSV vaccination for individual patients.
While there may be a small risk of GBS associated with RSV vaccination in adults aged 60 and older, the benefits of vaccination outweigh the potential risks. It is essential for healthcare providers to educate patients about the importance of RSV vaccination, especially for those at higher risk of severe disease. Continuous monitoring and surveillance of vaccine-related adverse events are crucial to ensuring the safety and efficacy of RSV vaccines in older adults.
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