Centers for Disease Control and Prevention

Summary of Proposed Clinical Considerations for RSV 

Vaccines

June 21, 2023

ACIP Older Adult RSV Vaccine Session

Amadea Britton, MD

Michael Melgar, MD
Overview of clinical considerations

▪ Shared clinical decision-making based on risk assessment among 

adults aged 60–64 years

▪ Timing of RSV vaccination for the 2023–2024 RSV season

▪ Coadministration of RSV vaccines with other vaccines

▪ Persons with immunocompromising conditions

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Clinical consideration: Shared clinical decision-making 

based on risk assessment among adults aged 60–64 years

The decision about whether or not to vaccinate 

an individual may be informed by:

• Best available evidence of who may 

benefit

• An individual’s characteristics, values, and 

preferences

• Health care provider’s clinical discretion

• Characteristics of the vaccine being 

considered

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Source: CDC. ACIP Shared Clinical Decision-Making Recommendations. Website: https://www.cdc.gov/vaccines/acip/acip-scdm-faqs.html. 

Last updated February 10, 2020. Accessed June 13, 2023. 

For shared clinical 

decision-making 

recommendations 

there is no default.
If shared clinical decision-making is recommended adults who may 

be at higher risk of RSV disease include persons with:

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Immune 

compromise

Endocrine disorders 

such as diabetes

Hematologic 

disorders

Chronic cardiovascular 

diseases such as congestive 

heart failure and coronary 

artery disease

Residents of nursing 

homes and other longterm care facilities

Neurologic disorders

Chronic lung diseases 

such as COPD and 

asthma

Kidney and liver 

disorders

Other underlying conditions or 

factors that the provider 

determines might increase the 

risk of severe respiratory illness
If shared clinical decision-making is recommended adults who may 

be at higher risk of RSV disease include persons with:

5

Immune 

compromise

Endocrine disorders 

such as diabetes

Hematologic 

disorders

Chronic cardiovascular 

diseases such as congestive 

heart failure and coronary 

artery disease

Residents of nursing 

homes and other longterm care facilities

Neurologic disorders

Chronic lung diseases 

such as COPD and 

asthma

Kidney and liver 

disorders

Other underlying conditions

or factors that the provider 

determines might increase the 

risk of severe respiratory illness
Clinical consideration: Timing of RSV vaccination for 

the 2023–2024 RSV season

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RSV vaccination is currently approved and recommended as a 

single dose.

Optimally, vaccination of eligible adults should occur before 

the onset of increased RSV activity in the community. 

The timing of the onset, peak, and decline of RSV activity 

varies each year, and RSV seasonality during the COVID-19 

pandemic deviated from prior seasons.
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RSV Hospitalizations in adults aged ≥65 years by season:

RSV-NET 2017–2023

COVID-19 pandemic affected RSV

seasonality in 2020-21, 2021-22,

and 2022-23

RSV-NET: unpublished data. Surveillance for 2017-18 through 2019-20 seasons were conducted from October – April; for 2020-21 and 2021-22 surveillance was conducted continuously from 

October – September. Data shown for 2022-23 season is from October – December 2022. 

0

50

100

150

200

250

300

Weekly RSV hospitalizations

40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38

MMWR Week

2017-18 2018-19 2019-20 2020-21 2021-22 2022-23

January
Clinical consideration: Timing of RSV vaccination for 

the 2023–2024 RSV season

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Given this 

variability the 

ideal time to start 

vaccinating 

cannot be 

predicted in 

advance of the 

2023-2024 RSV 

season.

Providers should 

therefore offer 

RSV vaccination 

as soon as 

vaccine supply 

becomes 

available.

Providers should 

continue to offer 

RSV vaccination 

throughout the 

RSV season to 

eligible adults 

who remain 

unvaccinated.

There are 

insufficient data 

at this time to 

determine the 

need for 

revaccination.
Clinical consideration: Coadministration of RSV 

vaccines with other vaccines

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In accordance with General Best Practice Guidelines for 

Immunization, coadministration of RSV vaccines with other 

adult vaccines is acceptable.*

*ACIP Timing and Spacing Guidelines for Immunization | CDC

This includes giving RSV vaccines simultaneously with 

seasonal influenza vaccines, COVID-19 vaccines, 

pneumococcal vaccines, Td/Tdap, and recombinant zoster 

vaccine (Shingrix).
Data on immunogenicity of coadministration of RSV 

vaccines with other vaccines

• There are currently limited data available on immunogenicity of 

coadministration of RSV vaccines and other vaccines.

• In general, coadministration of RSV and seasonal influenza 

vaccines met non-inferiority criteria for immunogenicity.*

• However, RSV and influenza antibody titers were generally 

somewhat lower with coadministration.

• Additional studies on immunogenicity of coadministration of RSV 

with other adult vaccines are in process.

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* Pre-specified non-inferiority criteria for immune responses were met across trials, with the exception of the FluA/Darwin H3N2 strain 

after simultaneous administration of RSVPreF3 vaccine (Arexvy by GSK) and adjuvanted quadrivalent inactivated influenza vaccine. 
Reactogenicity and safety of coadministration of RSV 

vaccines with other vaccines

• Coadministration of multiple vaccines at the same visit may increase reactogenicity.

• Only coadministration of RSV and influenza vaccines have clinical trial data available. 

Evidence is mixed on whether there may be increased reactogenicity with 

coadministration of RSV and influenza vaccines.

• Data are lacking on coadministration of other vaccines that might be recommended 

for people in this age group, such as COVID-19 vaccines, pneumococcal vaccines, 

Td/Tdap, and the recombinant zoster vaccine (Shingrix by GSK) which contains the 

same adjuvant as RSVPreF3 vaccine (Arexvy by GSK).

• Post-licensure safety monitoring of coadministration of RSV vaccines with other 

vaccines will further inform coadministration guidance.

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Clinical consideration: RSV vaccines and persons with 

immunocompromising conditions

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Persons with 

immunocompromising conditions 

are recommended to receive the 

RSV vaccine under shared clinical 

decision-making given the 

potential for significant benefit.

Adults with immunocompromising 

conditions are at risk of severe RSVassociated disease and death.

They may benefit from RSV vaccination 

but were not included in the clinical 

trials so efficacy in this population is 

unknown.

These individuals, including those 

receiving immunosuppressive therapy, 

may have a diminished immune 

response to RSV vaccination.
For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the 

official position of the Centers for Disease Control and Prevention.

Acknowledgements: 

Michael Melgar

Lauren Roper

Hannah Rosenblum

Melinda Wharton

Tara Anderson 

Lisa Grohskopf

David Shay

Tom Shimabukuro

Karen Broder

Mila Prill

Anne Hause

Fiona Havers

Meredith McMorrow

Jefferson Jones

Katherine Fleming-Dutra

Andrew Kroger

Manisha Patel

Sarah Meyer 

Neil Murthy

Patricia Wodi

Sara Oliver