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CDC Panel Stops Short of Blanket Recommendation of RSV Vaccine

June 22, 2023 — Adults age 60 and older may get either of two new vaccines to protect against respiratory syncytial virus (RSV), a CDC panel of independent experts said Wednesday. 

The Advisory Committee on Immunization Practices (ACIP) stopped short of recommending the vaccines for everyone age 65 and above, which was the original question the committee was to consider. The experts amended that question, changing it to whether the panel should recommend the vaccine for those 65 and above if the person and their doctor agreed. They committee voted 9 to 5 in favor.

Next, the panel also voted to recommend that adults 60 to 64 may get the vaccine, deciding by using the same shared decision making with their health care provider. That vote was 13 in favor with one member not voting. 

Next, the CDC will evaluate the recommendations and make its own decision. It is not bound to follow the panel’s recommendations, but typically does so.

RSV Vaccines

RSV leads to 6,000 to 10,000 deaths a year in the U.S. among those age 65 and older and 60,000 to 160,000 hospitalizations in that group. Seniors and infants are among the most vulnerable to the lower respiratory infection, marked by runny nose, wheezing, sneezing, decreased appetite, and fever. 

The FDA in May approved two vaccines — GSK’s Arexvy and Pfizer’s Abrysvo — for adults age 60 and above.

The vote recommending shared decision making about the vaccine, instead of a routine vaccination recommended for all, “is a weaker recommendation,” said William Schaffner, MD, an infectious disease specialist at Vanderbilt University Medical Center in Nashville and medical director of the National Foundation for Infectious Diseases. Schaffner is a non-voting member of ACIP. He attended the Tuesday meeting.

He said the experts voiced concern about a number of issues, including what some saw as a lack of sufficient data from trials on the most vulnerable groups, such as nursing home residents. 

Experts also wanted more information about the duration of protection and exactly when a second dose might be needed. At the meeting, a GSK official said its vaccine was 84.6% effective after one and a half seasons, down from 94.1% after one season. A Pfizer official said its vaccine decreased the risk of RSV with three or more symptoms by 78.6% after a season and a half, down from 88.9% after one season.

The panel also wanted more data on whether the RSV vaccines could be administered at the same time as other vaccines recommended for adults.

Both companies gave a range of cost estimates. Pfizer expects its vaccine to cost $180 to $270 but said it could not guarantee that range. GSK said it expects a price of $200 to $295. Under the Inflation Reduction Act, recommended vaccines are covered under Medicare for those with Part D plans, which 51 million of 65 million Medicare patients have. Commercial insurance is likely to cover the vaccines if the CDC recommends them. 

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