Be Ready to Dispense RSV Vaccines for Older Adults

Abrysvo and Arexvy will be the first vaccines to prevent respiratory syncytial virus (RSV) in adults 60 years and older.

RSV is a common virus that generally causes mild cold-like symptoms...and typically circulates from October through March.

But RSV may cause serious lower respiratory tract infections...especially in infants and older adults.

In fact, RSV causes up to 160,000 hospitalizations and 10,000 deaths annually in patients over age 65. These stats are similar to many flu seasons.

Be aware that Abrysvo or Arexvy is a single 0.5 mL IM dose.

Help identify patients who may be eligible for RSV vaccination.

For example, offer an RSV vaccine to patients 60 and older...along with other immunizations they may need (fluCOVID-19pneumococcal, etc). All can be administered at the same visit.

Keep patient profiles current with medical conditions. The risk of severe RSV infection is higher in patients with diabetes or chronic heart or lung conditions (COPD, etc).

Get your pharmacist involved to discuss benefits and risks...and to help patients make individual decisions about RSV vaccination.

For example, evidence in patients 60 and older suggests that getting a single dose of either RSV vaccine makes it about 85% less likely to need a healthcare visit due to RSV infection.

But it’s too soon to say how well either product prevents RSV hospitalization or death...or whether vaccination is needed annually.

Your pharmacist can also explain that these vaccines aren’t live...and can’t cause RSV. Plus they’re generally well tolerated.

Arexvy costs $280/dose...Abrysvo is $295/dose. But expect Medicare Part D to cover no co-pay. And many payers will cover RSV vaccines for age 60 to 64...since CDC recommends them.

Be familiar with how to dispense Abrysvo or Arexvy properly. Either option requires reconstitution...but are prepped differently.

Abrysvo is a single-dose “kit” that contains a vial of vaccine powder...a syringe of sterile water diluent...and a vial adapter.

On the other hand, each dose of Arexvy consists of 2 vials...the vaccine powder and an adjuvant suspension.

Store both products in the fridge in their original packages before reconstitution.

And keep in mind that a dose of either RSV vaccine is only good for 4 hours once mixed. Don’t prep a dose until its needed.

Stay tuned for additional updates. FDA has approved Abrysvo for use during pregnancy to prevent severe RSV in infants...but CDC will need to vote on an official recommendation.

And nirsevimab-alip (Beyfortus) will be a new monoclonal antibody to prevent RSV in infants and some toddlers.

See our resource, The Basics of Immunization and Vaccines, for help with billing, storing, dispensing, etc.

Key References

  • Melgar M, Britton A, Roper LE, et al. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices - United States, 2023. MMWR Morb Mortal Wkly Rep. 2023 Jul 21;72(29):793-801.
  • CDC. Respiratory Syncytial Virus Infection (RSV). Older Adults. July 14, 2023. (Accessed August 3, 2023).
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