What age for older adults is RSV vaccine recommended
Executive summary
The Centers for Disease Control and Prevention currently recommends a single dose of an RSV vaccine for all adults age 75 years and older, and for adults ages 50–74 who are at increased risk for severe RSV disease; earlier guidance and professional groups also noted recommendations for older age bands (including 60+) as the policy evolved [1] [2] [3]. The recommendation is not for annual dosing at present, and public-health authorities continue to monitor vaccine effectiveness and rare safety signals such as Guillain–Barré syndrome (GBS) as new data accumulate [1] [2].
1. The simple, current age rule: 75 and up is routine
For routine, age-based protection, CDC’s public guidance is clear: offer a single dose of any FDA-licensed RSV vaccine to all adults aged 75 years and older — this is the baseline recommendation regardless of other health status [1] [2]. Multiple public-facing CDC pages and allied organizations echo this threshold, while clinical guidance clarifies the recommendation applies to a single dose that is not currently considered an annual vaccine [1] [4] [2].
2. What about younger older adults — the 50–74 band and the 60–74 nuance
Adults ages 50–74 are not universally recommended for RSV vaccination solely on age; instead CDC recommends vaccination for those in that age range who have conditions or circumstances that increase their risk of severe RSV disease (for example chronic lung, heart, kidney disease, immunocompromise, or congregate living), while earlier ACIP guidance used shared clinical decision-making for adults 60 and older before the 75-plus routine threshold was set [2] [3] [5]. Health systems and specialty groups therefore counsel clinicians to assess individual risk in the 50–74 group rather than apply a blanket age cutoff [5] [6].
3. Why 75? Balancing rising risk with evolving data and rare safety signals
ACIP and CDC moved to an unequivocal age-based recommendation at 75 in part because the risk of severe RSV outcomes rises sharply with advancing age and because real-world and trial data showed meaningful prevention of hospitalizations among older adults; at the same time, regulators and ACIP flagged a possible small increase in GBS risk that influenced a more cautious, age-targeted approach [2] [1]. FDA estimated GBS excess risk on the order of roughly 10 additional cases per million vaccinated adults 60 or older for some vaccines — a rare event that ACIP judged to be outweighed by reductions in hospitalization and death among the oldest adults [2].
4. Effectiveness, vaccine choices, and practical notes for clinicians
Real‑world data from the first post‑licensure season showed substantial protection against RSV emergency department visits and hospitalizations in older adults with Arexvy and Abrysvo, with reported effectiveness in the 70–80% range for several outcomes in adults age 60 and older; Moderna’s mResvia likewise demonstrated strong trial efficacy in those 60+ [1]. Three vaccines (Pfizer’s Abrysvo, GSK’s Arexvy, Moderna’s mResvia) are licensed for adults in various age and risk groups, any of which can be used in eligible individuals, and current CDC guidance recommends a single dose rather than annual repeat dosing at this time [1] [4] [7].
5. Areas of debate, practical implications, and monitoring ahead
Debate persists about the lower age boundary for routine use — earlier ACIP statements and some clinical organizations framed recommendations starting at 60 with shared decision-making, and some reporting has highlighted incremental expansions to include certain high‑risk adults 50+ depending on health conditions; these nuances reflect both evolving evidence and an intention to tailor protection to those most likely to benefit [3] [8]. Public-health authorities (CDC, FDA, ACIP) and professional societies emphasize ongoing surveillance for effectiveness and rare adverse events and note vaccine availability, insurance coverage, and coadministration with other adult vaccines remain operational questions that will shape real-world uptake [2] [4] [9].