decision-making with individual patients remains central to RSV vaccination decisions, particularly in the 60-to-74 age group where the risk-benefit calcula- tion is less clear-cut. The ACP guidance also stops short of addressing immunocompromised individuals, the group for whom the VA study found the most pronounced reduction in vaccine protection over time. This gap reflects the broader evidence gap that veteran-focused researchers are now working to fill. Implementation Challenges and VA’s Role Despite the availability of three approved vaccines and clear guidance for the oldest adults, RSV vacci- nation rates among eligible adults remain disappoint- ingly low. By the end of the 2024–2025 respiratory illness season, only 48% of U.S. adults 75 and older and 38% of adults 60 to 74 with a high-risk condition reported receiving an RSV vaccine, according to the JAMA Internal Medicine study authors. VA’s integrated healthcare system offers advantages in reaching this population with electronic health record prompts, centralized pharmacy infrastructure, and the ability to link vaccine administration directly to clinical care. VAMCs serve as important venues for catching unvaccinated older veterans at routine appointments and for closing immunization gaps that primary care in the community often misses. The Cureus comprehensive review underscored that healthcare providers play a crucial role in advo- cating for RSV vaccination and that equitable access to preventive solutions requires active clinical engage- ment. For VA clinicians, that advocacy takes on added weight: the veteran population’s age, sex, and chronic disease burden collectively create one of the highest- risk RSV populations in the country. Safety Monitoring and Ongoing Vigilance RSV vaccines have been associated with rare but seri- ous adverse events that continue to be monitored in post-market surveillance. Guillain-Barré syndrome emerged as a signal in regulatory review of several RSV vaccine candidates. The Cureus review identified vaccine-associated enhanced respiratory disease (VAERD) as an addi- tional safety concern, as was observed in early RSV vaccine candidates tested decades ago. Current vac- cines were designed with this historical lesson in mind, and VAERD has not emerged as a clinical problem with the approved products. Nonetheless, the review authors emphasized that “comprehensive post-market surveillance and ongoing pharmacovigilance are vital to refining vaccine strategies, ensuring safety for high- risk groups.”1 What Comes Next The veteran study authors concluded that veter- ans 60 and older who received a single RSVPreF3 or RSVpreF vaccine dose were better protected against RSV illness over two respiratory illness seasons than unvaccinated individuals, a finding that validates cur- rent vaccination recommendations. But they were equally clear that protection declined over time and varied meaningfully by risk group. “The potential benefits and risks of a second vac- cine dose in certain groups should be examined,” the research team stated. For immunocompromised veter- ans and those 80 and older, the current one-dose para- digm may need reexamination. The development of universal RSV vaccines has emerged as a research priority highlighted in the Cureus review. The mRNA platform with its rapid adaptability has been cited as one of the technologies best positioned to contribute to next-generation RSV vaccine development. Whether the mRNA architec- ture confers any durability advantage over protein- subunit competitors across multiple seasons remains an open question that the VA’s data infrastructure may help answer in the future. In the meantime, VA clinicians face a practical imperative: vaccinate eligible veterans now, document outcomes carefully, and remain alert for updated guid- ance on booster dosing as the evidence base matures. RSV is no longer a disease for which there is no defense. The question now is how to make the protec- tion last. 1Genis D, Riaz W, Hussain A, Oz T. Current and Emerging Strategies for the Prevention of Respiratory Syncytial Virus (RSV) Infections: A Comprehensive Review of Vaccines and Antibody Therapies. Cureus. 2026 Jan 12. PMID: 41685002. doi:10.7759/cureus.101340. 2Bajema KL, Bui DP, Yan L, et al. Durability of Respiratory Syncytial Virus Vaccine Effectiveness Among US Veterans. JAMA Intern Med. 2026 Jan 1;186(1):78–88. doi:10.1001/jamainternmed.2025.6355. 3Qiu X, Xu S, Lu Y, Luo Z, Yan Y, Wang C, Ji J. Development of mRNA vaccines against respiratory syncytial virus (RSV). Cyto- kine Growth Factor Rev. 2022 Dec;68:37-53. doi: 10.1016/j.cytog- fr.2022.10.001. Epub 2022 Oct 13. PMID: 36280532. 4Qaseem A, Obley AJ, Harrod CS, Wilt TJ, Carroll K, Humphrey LL; Population Health and Medical Science Committee of the American College of Physicians. Respiratory Syncytial Virus Vaccines in Adults Who Are Not Pregnant or Immunocompromised: Rapid Practice Points From the American College of Physicians. Ann Intern Med. 2026 Mar 3. doi:10.7326/ANNALS-25-05485. 7 8
View this content as a flipbook by clicking here.