In an ASHP Midyear 2023 Clinical Meeting & Exhibition midday symposium titled “Pharmacists’ Role in the Prevention of Respiratory Syncytial Virus in Older Adults,” Kelly Gebo, MD, MPH, and Shmuel Shoham, MD, explained the impact of respiratory syncytial virus (RSV) and the clinical symptoms it presents in the older adult population and how to integrate tactics to educate these adults on RSV prevention.

Every year in the United States, RSV leads to approximately 177,000 hospitalizations and 14,000 deaths among adults aged older than 65 years. Among those hospitalized, 10% to 31% require intensive care, and 3% to 17% require mechanical ventilation. These rates were significantly higher among adults with chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), and coronary artery disease (CAD) compared with those without these conditions. Dr. Gebo speculated that historically, mortality due to RSV may have been attributed to influenza. She added, “Some of the influenza-like illnesses that we saw that people died of previously were probably due to RSV.”

Using data from Shanghai, China, Dr. Gebo explained how RSV trended downward during the COVID-19 pandemic due to the use of masks and isolation; however, the disease has been trending significantly upward in 2022 and 2023. This recent uptick was mostly isolated to the southern United States; however, it has trended towards the northern states.

Dr. Gebo emphasized the need for additional testing for RSV. She stated that there was a significant amount of “undertesting and probably underdiagnosis” for RSV historically. She added that testing would reduce unneeded antibiotic therapy and would allow patients to begin palivizumab prophylaxis. In addition to clinic testing for RSV/flu/COVID-19, she added that there are FDA-approved at-home polymerase chain reaction (PCR) testing kits. These PCR tests are more widely available, have a high accuracy, and are available to test concomitantly with SARS-CoV-2 and influenza.

Dr. Shoham noted that the Advisory Committee on Immunization Practices recommends that adults aged 60 years and older should receive the vaccine. He noted that Pfizer’s RSVPreF (Abrysvo) and GSK’s RSVpreF3 (Arexvy) vaccines are both available to help prevent lower respiratory tract disease caused by RSV.

Dr. Shoham added that individuals with these conditions should prioritize receiving the RSV vaccine:

• Lung disease (COPD and asthma)
• Cardiovascular diseases (CHF and CAD)
• Moderate or severe immune compromise
• Diabetes mellitus
• Neurologic or neuromuscular conditions
• Kidney, liver, or hematologic disorders
• Other underlying conditions that a healthcare provider determines might increase the risk for severe respiratory disease. 


Other factors associated with an increased risk of contracting RSV include frailty, advanced age, and having a residence in a nursing home or other long-term care facility.

Dr. Gebo concluded the session by adding that pharmacists and healthcare providers can help provide older patients with education about RSV prevention, including vaccines for those in whom they are appropriate, as well as helping overcome barriers to RSV prevention for older adults and reducing healthcare disparities in RSV prevention, “especially helping in populations trying to achieve health equity,” she added.

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