RSV Vaccine Side Effects in Older Adults: What’s Normal and What’s Not

RSV Vaccine Side Effects in Older Adults: What’s Normal and What’s Not

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Two RSV vaccines have been approved for use in the U.S. in older adults, Arexvy and Abrysvo, and we’re entering our first respiratory virus season where these shots are available. RSV season usually starts in the fall and peaks in the winter, making now the perfect time to get vaccinated against the virus. But, what are the RSV vaccine side effects in older adults?

Every body is different, but there are some common side effects of the RSV shot to be aware of prior to getting vaccinated. Ahead, experts explain everything you need to know about the RSV vaccine, including if it’s safe, potential side effects, and when to be concerned if you’re having a reaction to the RSV vaccine.

Meet the experts: Amesh A. Adalja, M.D., is a senior scholar at the Johns Hopkins Center for Health Security; Thomas Russo, M.D., is a professor and chief of infectious diseases at the University at Buffalo in New York; William Schaffner, M.D., is an infectious disease specialist and professor at the Vanderbilt University School of Medicine.

What is RSV?

Respiratory syncytial virus, a.k.a. RSV, is a common respiratory virus that usually causes mild, cold-like symptoms, according to the Centers for Disease Control and Prevention(CDC). While most people recover from the virus in a week or two, others can experience serious complications like pneumonia and need to be hospitalized.

“RSV is a ubiquitous respiratory virus that is comparable in severity to influenza in older adults,” says Amesh A. Adalja, M.D., a senior scholar at the Johns Hopkins Center for Health Security.

Each year, RSV infections cause about 177,000 hospitalizations and 14,000 deaths in adults aged 65 and older, per CDC data. It also leads to about 58,000 hospitalizations and 500 deaths in children under the age of 5.

There are currently two types of RSV vaccines approved for use in the U.S.: Two (Arexvy and Abrysvo) are designed for adults aged 60 and up, while one (Abrysvo) is also approved for pregnant women to help protect their newborns from RSV. The vaccines are up to 89% effective at preventing lung infections like pneumonia in the first RSV season after someone is vaccinated, the CDC says.

RSV vaccine side effects in older adults

The CDC lists the following as possible side effects of the RSV vaccine:

  • Pain, redness, and swelling where the shot is given

  • Fatigue

  • Fever

  • Headache

  • Nausea

  • Diarrhea

  • Muscle or joint pain

“Overall, the vaccine seems to be pretty well tolerated,” says Thomas Russo, M.D., a professor and chief of infectious diseases at the University at Buffalo in New York. “For the most part, these side effects are what we expect with most vaccines.”

William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agrees. “Most side effects are ones you would expect,” he says. “A small number of people—as with any vaccine—may feel out of sorts for a little bit.”

Side effects are usually “mild and self-limited,” Dr. Russo says, resolving within 24 to 48 hours in people who experience them.

What is a severe reaction to the RSV vaccine?

The Food and Drug Administration (FDA) has flagged a rare but potential link between the RSV vaccine—particularly Arexvy—and neurological complications. That includes Guillain-Barré syndrome, a rare disorder where the body’s immune system damages nerve cells, leading to muscle weakness and sometimes paralysis.

The FDA notes that, in one of the clinical trials for the vaccine, two of the participants developed acute disseminated encephalomyelitis (ADEM), a rare type of inflammation that affects the brain and spinal cord, seven and 22 days after receiving the RSV and flu vaccine at the same time. One of those study participants died.

In another study, one participant developed Guillain-Barré syndrome nine days after receiving the vaccine.

In one study on Abrysvo, one person developed Guillain-Barré syndrome seven days after they were vaccinated, while another developed Miller Fisher Syndrome, which is a rare form of Guillain-Barré syndrome, eight days after they received the vaccine.

You can develop Guillain-Barré syndrome from other causes, making it tricky to pin it to the vaccines. “Given the small number, it is unclear whether the vaccine caused these events, or whether they occurred due to chance,” Dr. Adalja says.

“Both the FDA and CDC’s advisory committee thought that these cases were probably coincidental, but that’s something that people are keeping an eye on,” Dr. Schaffner says.

Is the RSV vaccine safe?

As a whole, doctors say the vaccine is safe. “The RSV vaccine is very safe based on the clinical trial data,” Dr. Adalja says. “The risk-benefit ratio favors it in the approved groups.”

Dr. Scahffner agrees. “The vaccine is safe,” he says. “I'm going to get it later this week, and my wife has already gotten it.”

Ultimately, Dr. Russo says that choosing to get the RSV vaccine comes down to your individual risk-benefit ratio. “There’s little question that if you’re 60 and older and you have significant underlying cardiac disease, pulmonary disease, or other significant comorbidities, the benefits of vaccination really outweigh any potential risks,” he says. “Those people should get vaccinated. RSV can be as deadly as influenza.”

But, Dr. Russo says, if you’re “perfectly healthy” and over 60, he recommends talking to your healthcare provider about whether you should receive the vaccine. “Certainly in high-risk groups, there’s little question where the benefit exceeds a potential and ill-defined risk," he adds.

Who should not get the RSV vaccine?

The CDC says that you should not get the RSV vaccine if you’ve ever had a severe allergic reaction to any component of the vaccine. (Details on what’s in Arexvy can be found here; A breakdown of Abrysvo’s ingredients is here.)

If you’re interested in the RSV vaccine but unsure if it’s right for you, talk to your doctor for personalized guidance.

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