RSV Vaccines (Abrysvo Arexvy) - Who Needs Them and the Pharmacist Role

Pharmacy
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Introduction:
Respiratory Syncytial Virus (RSV) has been a major cause of hospitalization and death in infants and older adults for many years, but until recently, we lacked effective vaccines. In 2023, the FDA approved two novel RSV vaccines for adults ≥60 years: GSK’s Arexvy and Pfizer’s Abrysvo, as well as Pfizer’s maternal vaccine to protect newborns. As frontline healthcare providers, pharmacists are ideally suited to screen patients, educate them on the risks of RSV infection, overcome vaccine reluctance, and administer these life-saving vaccines. Familiarity with the subtleties of these vaccines is essential as we enter the RSV season.
Body:
Understanding RSV Burden:
RSV is not just a “bad cold”—it’s serious business:
Older adults (≥60): 60,000-160,000 hospitalizations and 6,000-10,000 deaths annually in the U.S.
Infants: Leading cause of hospitalization in children <1 year old
High-risk groups: COPD, asthma, heart failure, immunocompromised patients
Seasonal pattern: Peaks fall through spring (October-March in most regions)
The RSV Vaccines - What’s Available:

  1. Arexvy (GSK) - Adjuvanted RSV Vaccine:
    Indication: Adults ≥60 years
    Composition: RSVPreF3 protein + AS01E adjuvant (same adjuvant as Shingrix)
    Efficacy: 82.6% reduction in lower respiratory tract disease in first season
    Dosing: Single 0.5 mL IM injection
    Administration: Can be given with Flu vaccine ( Seperate arms) or other vaccine.

  2. side effect- Injection site pain, Fatigue, Myalgia, Headache.

  3. Abrysvo (Pfizer) - Non-Adjuvanted RSV Vaccine:
    Indications:
    Adults ≥60 years
    Pregnant women at 32-36 weeks gestation (maternal immunization)
    Formulation: Bivalent RSVpreF protein (RSV-A and RSV-B)
    Efficacy:
    Adults ≥60 years: 66.7% reduction in lower respiratory tract disease
    Maternal: 81.8% reduction in severe RSV disease in infants through 90 days
    Dosage: Single 0.5 mL IM dose
    Side effects: Relatively mild compared to Arexvy - injection site pain (41%), fatigue (24%), headache (21%)
    Unique feature: Non-adjuvanted and dual-indication

  4. Beyfortus (Nirsevimab) - Monoclonal Antibody (not a vaccine but worth mentioning):
    Indication: All infants <8 months of age entering first RSV season
    Mechanism: Long-acting monoclonal antibody conferring passive immunity
    Efficacy: 70-75% reduction in RSV hospitalization
    Dosage: Single IM injection (50 mg if <5 kg, 100 mg if ≥5 kg)
    Role: Supplements maternal immunization approach
    Who Should Receive RSV Vaccines?
    CDC ACIP Recommendations (Shared Clinical Decision-Making Approach):
    Adults ≥75 years: Strong recommendation
    Adults 60-74 years with risk factors:
    Chronic heart or lung disease (COPD, asthma, CHF)
    Immunocompromised
    Diabetes
    Chronic kidney disease
    Obesity (BMI ≥40)
    Residing in nursing home or long-term care facility
    Severe frailty
    Note: Unlike flu vaccine, RSV vaccine employs “shared clinical decision-making” - not recommended for all ≥60 years.

  5. Role of the Pharmacist - More Than Just Administering Shots:

    1. Patient Identification:
      Look at medication lists for high-risk conditions (inhalers = COPD/asthma, heart failure medications, immunosuppressants)
      Screen for during flu vaccine visits
      Target nursing home patients during facility visits
      Identify pregnant patients during prenatal vitamin counseling
    2. Risk Assessment Discussion:
      Begin with: “Have you heard about the new RSV vaccine? Let me tell you who might benefit…”
      Assess age and risk factors
      Discuss previous RSV infections or frequent respiratory illnesses
      Consider social factors (caregiver for infant, frequent contact with young children)
    3. Education & Counseling:
      What is RSV? “It’s a respiratory virus that can be serious in older adults, causing pneumonia and hospitalization”
      Why now? “You may have had RSV before, but your immune system weakens with age, and if you have lung or heart problems, RSV can be dangerous”
      Efficacy: “This vaccine can reduce your risk of serious RSV infection by about 70-80% in the first season”
      Duration: “We’re still learning how long protection lasts - might need another dose in 1-2 years”
      Side effects: “Expect a sore arm, maybe some fatigue for a day or two - similar to Shingrix but usually milder”
    4. Addressing Vaccine Hesitancy:
      Common concerns:
      “I’ve never heard of RSV” → Educate on disease burden, show hospitalization statistics
      “Is this the COVID vaccine?” → Clarify it’s completely different, protects against RSV specifically
      “Do I really need this if I get the flu shot?” → Explain they’re different viruses, both important
      “Too many vaccines at once” → Reassure coadministration is safe, or offer to schedule separately
      “Is it safe?” → Discuss clinical trial data, FDA approval process, post-market surveillance
      5. Practical Administration Tips:
      Timing: Can give simultaneously with flu/COVID vaccines (different injection sites)
      Documentation: Use CVX code 307 (Abrysvo) or 308 (Arexvy)
      Insurance: Covered under Medicare Part D, most commercial plans - check coverage
      Injection site: Deltoid muscle, standard IM technique
      Post-vaccination: Advise 15-minute observation, warn about potential day-after soreness
      6. Pregnancy-Specific Counseling (Abrysvo only):
      Timing is critical: Must give between 32-36 weeks to protect newborn
      Seasonal consideration: Ideally given September-January when RSV season starts
      Alternative: Explain if they miss window, baby can receive Bey Fortus after birth

MBH/AB

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