November 2025: RSV Prefusion F Vaccine for Prevention of Hospitalization in Older Adults
The issue
A large, real-world randomized trial in Denmark found that the single-dose RSVpreF vaccine substantially reduced hospitalizations for RSV in adults aged 60 and older during the 2024–2025 season, with similar rates of serious adverse events to no vaccine.
What do I need to know?
131,276 older adults were randomized 1:1 to RSVpreF or no vaccine and followed through the winter. Hospitalizations for RSV-related respiratory disease occurred in 3 vaccinated participants versus 18 controls (0.11 vs 0.66 per 1000 participant-years), an 83.3% relative reduction. Hospitalization for RSV-related lower-respiratory disease was 1 vs 12(VE 91.7%). Hospitalization for respiratory disease from any cause was also lower with vaccination (284 vs 335; VE 15.2%). Serious adverse events over six weeks were similar between groups; five SAEs in the vaccine group were judged vaccine-related (e.g., Bell’s palsy, pericarditis), and no cases of Guillain–Barré were observed in the 6-week window.
Potential risk of severe RSV (community-dwelling, age 60+, no major lung/heart disease)
Recommended Actions
Review fall/winter vaccination plans with your clinician; ask specifically about RSVpreF availability for your age group.
Keep flu and Covid boosters current and continue hand hygiene and sick-contact avoidance during RSV season.
Monitor for cough, wheeze, or shortness of breath in winter and seek care early if symptoms escalate.
Imminent risk (age ≥75 or 60–74 with COPD, heart failure, diabetes, or frailty)
Recommended Actions
Prioritize RSV vaccination before peak season, ideally alongside routine immunizations when appropriate.
Ask about expected, usually mild, post-shot effects and what symptoms (e.g., chest pain, persistent neurologic symptoms) should prompt a call.
Make a plan for rapid evaluation if significant respiratory symptoms develop.
Confirmed high-risk situation (recent RSV hospitalization, chronic oxygen use, or immunosuppression)
Recommended Actions
Receive RSVpreF unless contraindicated; arrange close follow-up to reassess breathing status after vaccination.
Ensure pneumococcal and influenza vaccines are current to reduce co-infections and secondary complications.
Create an action plan with your clinician for urgent evaluation if RSV-like symptoms recur.
What can I do?
Ask, “Am I at potential, imminent, or confirmed risk this winter—and should I get the RSV vaccine now?” Bring a list of conditions and medicines to your visit. After vaccination, expect brief soreness or malaise; report unusual persistent symptoms. Caregivers can help arrange appointments and watch for early breathing problems during RSV peaks.
