Preventing Respiratory Syncytial Virus (RSV): Immunization Updates

RSV prevention is more important than ever, and pharmacy teams are on the front lines. In this episode, TRC Healthcare Associate Editor, Vickie Danaher, PharmD, reviews who should receive RSV vaccines, recent changes to age and risk-based recommendations, and how monoclonal antibodies protect infants and high-risk children. 

You’ll also hear practical tips on the best time to vaccinate patients, co-administration with other vaccines, product nuances, and safety considerations to help confidently guide patients through RSV prevention this season.

This is an excerpt from our October 2025 Pharmacy Essential Updates continuing education webinar series.

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CE Information:

TRC Healthcare offers CE credit for this podcast for pharmacist subscribers at our platinum level or higher and pharmacy technician subscribers. Log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses. None of the speakers have anything to disclose.

Claim Credit

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Clinical Resources from Pharmacist’s Letter, Pharmacy Technician’s Letter, and Prescriber Insights: 

• Article: Stay Current on RSV Immunization Guidance
• Chart: RSV Vaccines
• Chart: Preventing RSV
• Chart: RSV Monoclonal Antibodies

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Chapters

• 0:04 Introduction
• 0:43 CE Information
• 1:07 Overview
• 1:43 What is RSV?
• 4:46 Recommendations for RSV Vaccine in Older Adults
• 12:59 Protecting Newborns and Infants Against RSV
• 16:25 RSV Vaccine Nuances
• 19:07 Conclusion

Transcript

This transcript is automatically generated. 

00:00:04 Narrator

Welcome to Clinical Capsules from TRC Healthcare, your go-to podcast for fast, evidence-based insights. 

00:00:11 Narrator

On this episode, Associate Editor and Clinical Pharmacist Vickie Danaher shares practical strategies for preventing RSV, 

00:00:18 Narrator

including recommendations for vaccines and monoclonal antibodies, guidance for pregnant patients, and more in an excerpt from our popular Pharmacy Essential Updates webinar series.  

00:00:29 Narrator

TRC has been a trusted resource for healthcare professionals for over 40 years—and now we’re bringing that expertise straight to your ears every 2nd and 4th Tuesday, in bite-sized, actionable episodes…right here on Clinical Capsules.

00:00:43 Narrator

This podcast offers Continuing Education credit for pharmacists and pharmacy technicians. 

00:00:48 Narrator

Please log in to your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.

00:00:55 Narrator

None of the speakers have anything to disclose. 

00:00:58 Narrator

With that, Let's get started…

00:01:07 Vickie Danaher

We're talking about this today because we, as pharmacists and pharmacy technicians, play a key role in ensuring patients are educated about RSV, its associated risks, and its preventative strategies, including immunization.

00:01:21 Vickie Danaher

We’ll need to be ready to effectively engage with patients about RSV prevention, as well as recommend and administer RSV vaccines that are now available for certain populations.

00:01:32 Vickie Danaher

There's also been some recent changes regarding who RSV immunizations are recommended for, as well as changes to the RSV products themselves, including a new monoclonal antibody for infants.

00:01:44 Vickie Danaher

But before we delve into all that, let's start with the basics and discuss what respiratory syncytial virus is and why it's a big deal.

00:01:52 Vickie Danaher

And this will help give us some talking points that we can share with patients about why preventative strategies against RSV may be needed.

00:02:01 Vickie Danaher

So we can educate that RSV is a common virus that's usually spread through respiratory droplets, such as when someone coughs or sneezes, or by touching surfaces contaminated with the virus and then touching the eyes, nose or mouth.

00:02:15 Vickie Danaher

RSV typically circulates from October through March, and it's possible to get infected multiple times.

00:02:23 Vickie Danaher

Now, generally, RSV causes mild cold like symptoms like runny nose and congestion, but it may also cause serious or even life threatening lower respiratory tract infections, especially in infants and older adults.

00:02:37 Vickie Danaher

In fact, RSV is the most common cause of hospitalizations in infants, and older adults who get very sick from RSV may need to be hospitalized and have a high risk of complications such as intubation.

00:02:51 Vickie Danaher

And just to give you a more specific idea of the burden of RSV infection, CDC estimates that for 2024-2025 alone, there were up to 6.5 million outpatient visits due to RSV.

00:03:05 Vickie Danaher

Up to 350,000 RSV related hospitalizations and up to 23,000 RSV related deaths.

00:03:14 Vickie Danaher

So to help prevent the spread of RSV, we can continue to remind patients to practice good hygiene, such as covering coughs and sneezes and washing or sanitizing hands often.

00:03:24 Vickie Danaher

But we also want to emphasize the importance of RSV immunization.

00:03:29 Vickie Danaher

And to protect against RSV there are two different types of immunization strategies, either vaccines or monoclonal antibodies.

00:03:39 Vickie Danaher

So let's talk about the vaccines at a high level first.

00:03:43 Vickie Danaher

There are currently three RSV vaccines that we can administer in our pharmacies: Abrysvo, Arexvy, or mResvia.

00:03:52 Vickie Danaher

And these vaccines are used in older adults or given to pregnant patients to prevent RSV in the newborn.

00:03:59 Vickie Danaher

These vaccines provide active immunity, they stimulate the body's immune response against RSV.

00:04:05 Vickie Danaher

So the patient's immune system produces antibodies, and it usually takes about several weeks to build immunity.

00:04:12 Vickie Danaher

On the other hand, the monoclonal antibodies are nirsevimab or Beyfortus and clesrovimab or Enflonsia, and these are given to infants and high-risk children.

00:04:26 Vickie Danaher

Monoclonal antibodies provide direct immediate protection against RSV since they’re pre-made antibodies, and they're considered passive immunizations, not vaccines, as they don't activate the body's own immune response.

00:04:41 Vickie Danaher

We're going to talk much more in depth about these products later, but now that we have this background, let's dig deeper into which patient should be vaccinated against RSV.

00:04:51 Vickie Danaher

And to get us thinking about that, we have a patient case.

00:04:54 Vickie Danaher

So our patients today are Howard and Linda, who are just picking up some routine prescriptions at your pharmacy.

00:05:01 Vickie Danaher

They tell you that some of their friends were talking about RSV vaccines, and they want to know if they need one.

00:05:08 Vickie Danaher

So what do you say to Howard and Linda, and what would you want to know about each of them to help determine if they should get an RSV vaccine?

00:05:18 Vickie Danaher

So in thinking about RSV vaccines for older adults, we'll need to know things like the patient's age and medical conditions and whether they've had an RSV vaccine before.

00:05:29 Vickie Danaher

We want to recommend RSV vaccination for all unvaccinated patients age seventy-five and older.

00:05:35 Vickie Danaher

And that's because our oldest patients are at the highest risk for severe illness from RSV.

00:05:41 Vickie Danaher

So really, when we see a patient seventy-five years or older, that should be an automatic prompt to start a discussion about RSV vaccination.

00:05:49 Vickie Danaher

Another group of patients that should get RSV vaccine are those who are fifty to seventy-four years old and who have a risk factor or condition that increases the chance of severe RSV.

00:06:02 Vickie Danaher

And this is a recent change.

00:06:04 Vickie Danaher

Vaccination used to be recommended starting at age sixty for these high-risk patients, but now that age has been lowered to fifty.

00:06:14 Vickie Danaher

So we want to watch out for patients age fifty to seventy-four years old who have conditions such as heart disease or kidney disease, lung disease like asthma or COPD…

00:06:23 Vickie Danaher

…diabetes with organ damage like neuropathy or retinopathy, or who are taking insulin or an Sglt2 inhibitor like dapagliflozin.

00:06:35 Vickie Danaher

Those with severe obesity are also at high risk, as well as those who are immunocompromised due to medical conditions or medications.

00:06:43 Vickie Danaher

And this group also includes older patients who are frail or residing in a nursing home or long-term care facility.

00:06:51 Vickie Danaher

All of these patients are recommended for RSV vaccination again, since they are at the highest risk for severe complications from RSV infection.

00:07:00 Vickie Danaher

So for our pharmacy technicians, one area where you can especially make a big impact is by keeping patient profiles current with medical conditions and medications, since these factors are what's going to help determine if a patient fifty to seventy-four should get an RSV vaccine.

00:07:15 Vickie Danaher

On the other hand, explained that RSV vaccination is not recommended for patients age fifty to seventy-four without risk factors since these patients aren't as likely to benefit.

00:07:26 Vickie Danaher

And then thinking about even younger patients point out that CDC does not yet recommend routine RSV vaccine for adults under age fifty.

00:07:35 Vickie Danaher

Even though two of the RSV vaccines, Abrysvo and mResvia, are FDA approved for people aged eighteen to forty nine who are at high risk.

00:07:46 Vickie Danaher

The CDC immunization workgroup say that there's currently insufficient evidence to make a recommendation for these patients, and are awaiting additional data to review.

00:07:56 Vickie Danaher

So this is something you should expect to hear more on as the evidence emerges.

00:08:01 Vickie Danaher

Let's pause here for a minute to revisit our patient case with Howard and Linda.

00:08:06 Vickie Danaher

After talking with them more, and in reviewing their patient profiles, we learned that both Howard and Linda have never gotten an RSV vaccine before.

00:08:14 Vickie Danaher

Howard is sixty-five and he's otherwise healthy.

00:08:18 Vickie Danaher

And then Linda is seventy-five and she has asthma.

00:08:23 Vickie Danaher

So what should be recommended for each of these patients regarding RSV vaccination?

00:08:31 Vickie Danaher

So again Howard is aged sixty-five.

00:08:34 Vickie Danaher

So for patients aged fifty to seventy-four we need to check whether there's any risk factors that put him at higher risk of severe RSV complications.

00:08:43 Vickie Danaher

So he's otherwise healthy, he's at a healthy weight, he lives at home and so forth.

00:08:48 Vickie Danaher

So no, Howard would not be a candidate for RSV vaccine.

00:08:54 Vickie Danaher

Moving on to Linda, she's seventy-five years old, so based on her age alone, that's a yes that we do want to recommend RSV vaccine for her.

00:09:03 Vickie Danaher

And then on top of that, she does have asthma, which puts her at even higher risk.

00:09:09 Vickie Danaher

So now that we know Linda should get an RSV vaccine, let's discuss the RSV vaccine products and how they stack up.

00:09:17 Vickie Danaher

Like I mentioned earlier, there's three vaccines available to protect against RSV: Abrysvo, Arexvy, and mResvia.

00:09:26 Vickie Danaher

All of these vaccines are FDA approved for adults age sixty or older and younger patients at high risk.

00:09:32 Vickie Danaher

And any option is a single 0.5 ML dose administered into the muscle.

00:09:38 Vickie Danaher

But the vaccines do work a little differently.

00:09:41 Vickie Danaher

Abrysvo and Arexvy are both recombinant subunit vaccines, but Abrysvo is bivalent to optimize protection against RSV A and RSV B strains.

00:09:53 Vickie Danaher

And Arexvy has an adjuvant added to help induce the immune response.

00:09:59 Vickie Danaher

On the other hand, mResvia is an mRNA vaccine that teaches the body to make a protein that's found on RSV, which causes the immune system to build antibodies against it for protection.

00:10:11 Vickie Danaher

Point out that CDC has no preference for one RSV vaccine over another in older patients.

00:10:18 Vickie Danaher

So for patients age fifty years and up who are eligible for an RSV vaccine give a single 0.5 ML IM dose of any product… Abrysvo, Arexvy or mResvia.

00:10:31 Vickie Danaher

Keep in mind that RSV vaccine can be given to older adults year-round but explain the best time to get RSV vaccine is in late summer and early fall, just before RSV usually starts to spread in the community.

00:10:43 Vickie Danaher

So in most areas of the US, this corresponds to vaccination between August and October.

00:10:50 Vickie Danaher

Point out that currently only one lifetime dose is recommended, so patients who already received an RSV vaccine previously don't need one again this season.

00:11:00 Vickie Danaher

Data suggests that one dose of RSV vaccine provides protection for at least two years, and it's too soon to say when or if another dose will be needed.

00:11:11 Vickie Danaher

In terms of efficacy, we can educate that for any RSV vaccine, studies show moderate to high efficacy of one dose for preventing RSV associated lower respiratory tract infections.

00:11:23 Vickie Danaher

And data from the first season of use of RSV vaccines in 2023-2024 indicate that vaccination with Arexvy or Abrysvo provided protection against hospitalization, critical illness, including ICU admission and death, and emergency department visits among people aged sixty and older.

00:11:43 Vickie Danaher

But since mResvia was first used during the 2024-2025 season, that real world effectiveness data are not yet available.

00:11:52 Vickie Danaher

In regard to safety, clarify that RSV vaccines aren't live and they can't cause RSV, and overall most patients tolerate these vaccines well.

00:12:02 Vickie Danaher

The side effects are similar to what we usually expect with vaccines such as fatigue or pain, redness and swelling where the injection is given.

00:12:10 Vickie Danaher

It's also important to be aware that a very small number of cases of Guillain-Barré syndrome have been reported after RSV vaccination, and there's now a warning about this in the labeling for Arexvy and Abrysvo, but explain the risk is rare.

00:12:24 Vickie Danaher

For both vaccines FDA estimates there's about eight additional cases per one million doses given, and the benefits of RSV vaccination still outweigh potential risks.

00:12:35 Vickie Danaher

For example, vaccination of a million people would prevent thousands more hospitalizations and hundreds more deaths than the small number of Guillain-Barré cases that vaccination might trigger.

00:12:47 Vickie Danaher

Anticipate that Medicare Part D and many other payers will cover RSV vaccines for eligible patients, and the cost is pretty similar among all three products about three hundred dollars per dose.

00:12:59 Vickie Danaher

Okay, now that we've talked about RSV immunization and older adults, let's discuss the immunization recommendations for protecting babies and infants against RSV.

00:13:08 Vickie Danaher

So for our next patient case, we have Jasmine, who's thirty years old and thirty-four weeks pregnant with her second child.

00:13:17 Vickie Danaher

Jasmine received an RSV vaccine in her last pregnancy when she was about thirty-four weeks pregnant, and she wants to know if she needs to be vaccinated again to protect this baby.

00:13:27 Vickie Danaher

So what do you think about this?

00:13:30 Vickie Danaher

So like I mentioned earlier, there's two immunization strategies to prevent RSV in infants.

00:13:35 Vickie Danaher

And that's either maternal RSV vaccination in pregnancy or in RSV monoclonal antibody for the infant after delivery.

00:13:46 Vickie Danaher

In terms of RSV vaccination in pregnancy advise that Abrysvo is the only RSV vaccine that is FDA approved for use in pregnancy.

00:13:56 Vickie Danaher

It's recommended for pregnant patients thirty-two through thirty-six weeks gestation, and CDC recommends Abrysvo for seasonal use, usually September through January.

00:14:10 Vickie Danaher

Explain that currently only one lifetime dose is recommended due to lack of data, so patients who get an RSV vaccine during one pregnancy do not need a repeat dose with subsequent pregnancies.

00:14:23 Vickie Danaher

However, RSV vaccination during one pregnancy is not expected to protect infants in future pregnancies.

00:14:30 Vickie Danaher

Therefore, a patient who is currently pregnant and received RSV vaccine before the current pregnancy should be counseled that their infant should be immunized with an RSV monoclonal antibody for protection against RSV disease after birth.

00:14:44 Vickie Danaher

Be aware that most infants will not need both maternal immunization and a monoclonal antibody.

00:14:51 Vickie Danaher

So if the mom was vaccinated against RSV this season in the current pregnancy, share that their newborn won't need a monoclonal antibody after delivery.

00:15:02 Vickie Danaher

On the other hand, if the mom was unvaccinated against RSV at the time of delivery or the mom received RSV vaccine but then delivered within two weeks after vaccination…

00:15:14 Vickie Danaher

…or if the mom received RSV vaccine in a previous pregnancy, explained that an RSV monoclonal antibody is recommended for the baby.

00:15:25 Vickie Danaher

In this case, recommend a single dose of Nirsevimab or clesrovimab, which are given intramuscularly to the baby, usually in the hospital or prescriber office.

00:15:36 Vickie Danaher

The dose is given to infants younger than eight months of age, but preferably within one week after birth, to those who are born during or who are entering their first RSV season again, which is typically October through March.

00:15:52 Vickie Danaher

Also, keep in mind that a second dose of nirsevimab may be needed for some infants at eight to nineteen months old, who are at increased risk of severe RSV disease during their second RSV season.

00:16:06 Vickie Danaher

So going back to our patient case with Jasmine, point out that since she received an RSV vaccine in her last pregnancy, she is not a candidate for RSV vaccination in this pregnancy.

00:16:18 Vickie Danaher

Instead, a monoclonal antibody is recommended for the baby after delivery.

00:16:26 Vickie Danaher

All right. Now we in the community pharmacy generally won't be stacking or dispensing the RSV monoclonal antibodies, but we definitely will continue to be a prime place for patients to get RSV vaccines.

00:16:37 Vickie Danaher

So let's wrap up this topic with some key vaccine nuances to be aware of, to limit vaccine errors and other problems.

00:16:45 Vickie Danaher

And one key difference we want to take note of is how these products are presented and prepared.

00:16:50 Vickie Danaher

For example, Abrysvo and Arexvy both require reconstitution, but they're prepped differently.

00:16:58 Vickie Danaher

With Abrysvo this season, we should expect to only get the dual chamber act-o-vial version that mixes drug and diluent when activated.

00:17:06 Vickie Danaher

The vial and diluent syringe kits are being phased out. 

00:17:11 Vickie Danaher

With Arexvy, each dose consists of two vials, the vaccine powder and an adjuvant suspension that must be reconstituted prior to administration.

00:17:23 Vickie Danaher

On the other hand, mResvia comes as pre-filled syringes and does not require reconstitution.

00:17:31 Vickie Danaher

Also remind everyone working in the pharmacy about proper storage.

00:17:35 Vickie Danaher

Abrysvo or Arexvy should be stored in the fridge, but mResvia must be stored in the freezer.

00:17:42 Vickie Danaher

Limit confusion by ideally stocking the fewest vaccine options needed to cover your patient population.

00:17:48 Vickie Danaher

For example, consider prioritizing Abrysvo if you serve both pregnant and older adults, since it can be used for both groups of patients.

00:17:57 Vickie Danaher

Pay close attention to preparation and stability info.

00:18:00 Vickie Danaher

For instance, when thawing mResvia the amount of time required for thawing ranges from forty to one hundred and sixty minutes before use, depending on whether it's being thawed in the fridge or at room temperature, as well as the package size.

00:18:15 Vickie Danaher

And with Abrysvo or Arexvy, don't reconstitute a dose until it's needed, since it's only good for four hours once mixed.

00:18:24 Vickie Danaher

And then questions are always bound to come up about vaccine co-administration.

00:18:28 Vickie Danaher

So explain that RSV vaccine may be given at the same visit as any other immunizations patients may be getting, such as flu, Covid-19 or Tdap.

00:18:39 Vickie Danaher

Okay, so I know this is a lot to try to keep straight, especially with all the other vaccines we're giving and everything else that we're doing in our pharmacies, especially this time of year.

00:18:47 Vickie Danaher

So we've got you covered with multiple resources, including our charts on preventing RSV, RSV vaccines, and RSV monoclonal antibodies.

00:18:56 Vickie Danaher

These give side by side comparisons of all the products used to prevent RSV infection, as well as more details about the recommendations that we talked about today.

00:19:07 Narrator

We hope you enjoyed and gained practical insights from listening to this episode! 

00:19:11 Narrator

Now that you’ve listened, pharmacists and pharmacy technicians can receive CE credit. Just log into your Pharmacist’s Letter or Pharmacy Technician’s Letter account and look for the title of this podcast in the list of available CE courses.

00:19:24 Narrator

We’ve linked the resources we mentioned—and more on today’s topic—right in the show notes. Those links will take you straight to our websites, where you’ll find even more concise, evidence-based charts, articles, and tools.

00:19:38 Narrator

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00:19:56 Narrator

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00:20:04 Narrator

Thanks for listening… stay sharp, stay current—and we’ll catch you next time on Clinical Capsules!