Tuesday, October 10, 2023

RSV - should I get vaccinated?

Respiratory syncytial virus (RSV) has traditionally been thought of as a disease of infants. As many as 80,000 babies under 5 are hospitalized annually in the U.S. with RSV, mostly in the winter, and some 300 die. Until very recently there was little that could be done to prevent RSV.

A monoclonal antibody has recently been approved that was 80% effective at reducing hospitalizations in infants, but it costs $495/dose.

Also new are two RSV vaccines for adults that were shown quite effective, and this availability has focused attention on RSV in older adults.

The “usual” winter respiratory virus about which we have worried for years is influenza. There is quite a bit of variability in influenza from year to year, with estimates of 140,000 to 700,000 flu hospitalizations and 12,000 to 52,000 deaths annually over the past decade. Flu vaccine efficacy has been quite variable but vaccination is universally recommended.

For the past 3 years, Covid has pushed flu out of the headlines, and it is unfortunately still with us.

Estimates for RSV for the same 10-year period are that 60,000 to 160,000 older adults are hospitalized each winter with RSV and 6,000-10,000 die. A CDC analysis of a large sample of adults over 60 found that while RSV was much less common as a cause of hospitalization than flu or COVID, patients with RSV tended to be sicker.

The two recently approved vaccines both reduced the rate of RSV illness requiring medical attention by about 85%. The advisory committee recommended the vaccine for pregnant women to protect their newborns and for adults 60 and older.

Like all new vaccines, there are unanswered questions. There seemed to be a small but real increase in neurologic side effects (notably Guillain-Barré, a temporary paralysis) in vaccine recipients and possibly a small increase in atrial fibrillation. For the frail elderly, the benefits clearly outweigh the risks. For healthier seniors it is less clear.

Cost may be an issue. The vaccine costs $200-$300. It is covered under Part D of Medicare, not Part B like flu or Covid shots. Not all private insurances cover it.

If you are older with heart or lung disease, I would definitely recommend it. If your general health is excellent, the decision is a personal weighing of risks and benefits.

By the way – masks reduce the spread of all respiratory illnesses. And if you are sick and coughing, do everyone a favor and stay home until you are better!

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