By Annette M. Boyle
WASHINGTON, DC — Respiratory syncytial virus 
(RSV) is no longer a disease clinicians associate only 
with sick infants and worried parents in pediatric 
wards. For older veterans served by VAMCs across the 
country, RSV has emerged as a serious and sometimes 
deadly respiratory threat. Fortunately, it is a risk that 
a new generation of vaccines is working to address, 
although questions about durability and optimal 
dosing strategies remain.
Three RSV vaccines are currently approved for 
adults in the United States: Arexvy, a recombinant 
stabilized prefusion F protein vaccine; Abrysvo, a 
bivalent prefusion F protein vaccine; and mRESVIA, 
an mRNA-based vaccine. Each uses a distinct 
platform, and all three have demonstrated meaningful 
protection against RSV-associated lower respiratory 
tract disease (LRTD). Together, they represent a 
significant expansions in adult vaccine options 
in recent years and an important new tool for VA 
clinicians managing medically vulnerable patients.
For VA, the stakes are high. The veteran 
population skews older with a disproportionate burden 
of chronic cardiopulmonary disease, diabetes, and 
immunocompromising conditions, all risk factors 
for severe RSV illness. As the largest integrated 
healthcare systems in the country, the VA has 
positioned itself at the forefront of RSV vaccine 
research and implementation, including a landmark 
durability study that has helped define what clinicians 
can and cannot expect from a single vaccine dose.
Moderna’s mRNA Entry Into the RSV Arena
The vaccine mRESVIA, approved by the Food and 
Drug Administration in May 2024, brought mRNA 
technology to the RSV vaccine space for the first 
time. The vaccine, designated mRNA-1345, encodes 
a stabilized prefusion conformation of RSV’s fusion 
(F) protein delivered via lipid nanoparticles.
Clinical trial data supporting mRESVIA’s approval 
demonstrated vaccine efficacy of 83.7% against RSV-
associated LRTD with two or more symptoms in adults 
60 years of age and older. The mRNA platform offers 
RSV Vaccines Protect  
Veterans Well, But Repeat Jabs 
Might Be Needed
Because of an older population of veteran 
patients, many with numerous co-morbidities, 
the VA recognizes respiratory syncytial virus 
(RSV) as a serious threat.  Three RSV vaccines 
are currently approved for adults in the United 
States; the latest is an mRNA-based vaccine.  
While all three have demonstrated meaningful 
protection against RSV-associated lower 
respiratory tract disease (LRTD), concerns have 
been raised about the durability of some of them 
and whether repeat shots might be required.
	
	
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