Toby Gould was one of the first to adopt it. In September, Mr. Gould, 78, went to a pharmacy in Hyannis, Massachusetts, to receive one of the new vaccines against the respiratory syncytial virus, known as RSV. He has asthma, which would increase his risk of serious illness if he were to become infected.
Carol Kerton, 64, knew RSV could be dangerous: Her 3-year-old granddaughter had such a severe case that she was taken to the emergency room. Ms. Kerton was vaccinated in September at a local supermarket in Daytona Beach, Florida.
Sam Delson, 63, received the RSV vaccine last month in Sacramento. His doctor recommended it, he said, “because I’m over 60 and my immune system is somewhat weakened” after a long battle with cancer.
These are exceptions. So far only about 15 percent Americans over 60 have received one of two new RSV vaccines, approved by the Food and Drug Administration in May as the first-ever vaccines against the disease. Just 16 percent more said they definitely planned to do so, according to the Centers for Disease Control and Prevention.
In contrast, more than 62% of adults over 65 received the recommended flu vaccine this fall, and a third received the updated Covid-19 vaccine.
“It’s a new vaccine, and people are trying to figure out whether they need it or not,” said Dr. Preeti Malani, a geriatrician and infectious disease specialist at University of Michigan Health.
That’s if they know about RSV vaccines. HAS national survey This summer, people aged 60 to 80 found that almost half had not heard of it.
THE CDC recommends RSV vaccines for people over 60, after having one-on-one discussions with their health care providers, called “shared clinical decision-making.” Medicare Part D, Medicaid, and most private insurers will cover the entire cost.
The fact that older adults are vulnerable to RSV is an unfamiliar concept to many people. For decades, the virus was primarily seen as a threat to infants and young children. Most doctors, “when they were in medical school, were taught that RSV was a pediatric disease,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “It is still the leading cause of hospitalization among infants in the United States”
But the FDA Estimates that the virus sends 60,000 to 160,000 people over 65 to hospital each year and causes 6,000 to 10,000 deaths. Other published estimates are even higher.
“It’s a very contagious virus,” Dr. Malani said. Although children can get very sick, most often, “a 4-year-old with a runny nose could have RSV and not get very sick; it looks like a common cold,” she said. However, she added: “Grandparents could get pneumonia. »
The risk of becoming seriously ill from RSV increases significantly with age. Hospitalization rates rise sharply among people in their 70s and 80s, especially among people with chronic heart and lung conditions like asthma, heart failure and chronic obstructive pulmonary disease. Older people with diabetes, liver or kidney disease, or weakened immune systems are also at higher risk. Adults can be infected repeatedly and there is no medication that alleviates the illness, as is the case with the flu and Covid-19.
A study published in the New England Journal of Medicine in 2005 followed patients over four winters and reported that among high-risk patients (their average age was 70) with heart failure or lung disease and having contracted RSV, 16 percent required hospitalization. In another cohort of older patients hospitalized for respiratory symptoms (with an average age of 75) and diagnosed with RSV, 15 percent ended up in intensive care.
The new RSV vaccines are very effective. Clinical trial results showed that Arexvy, the vaccine manufactured by GSK, was 94% effective against serious illnesses in the elderly. Pfizer’s vaccine, called Abrysvo, was 86% effective against severe disease.
So why haven’t vaccines been more successful in the intended containers?
One reason: A shared decision-making recommendation from the CDC may lower vaccination rates, Dr. Schaffner said, because “you can’t promote it with as much intensity and assertiveness as with a blanket recommendation” — like that recommending flu vaccines. everyone over 6 months old.
Additionally, older adults now receive many public health messages regarding seasonal vaccinations. “A few years ago, we all recommended one vaccine every winter: the flu vaccine,” Dr. Schaffner said. “We have not yet organized ourselves to convince people to accept three seasonal vaccines”, against the flu, Covid-19 and now RSV (receiving two or three at the same time is good, says the CDC .)
When R. Jessica Jones, 76, who lives in Haiku, Hawaii, texted her doctor about seasonal vaccinations, he replied that she should get the Covid-19 booster and a flu shot, but that getting vaccinated against RSV was “optional”.
Mrs. Jones, surprised, asked why. He told her he thought the data on their safety and effectiveness was “limited” (the FDA disagreed), so she didn’t get any.
“When providers are confused, patients are confused,” said Dr. Malani, of University of Michigan Health. “If we really want to reach the population that could benefit, we need to provide clear information to doctors and others. »
While some health care providers hope to improve the vaccination rate of older Americans, vaccine makers are apparently pleased with the number of people seeking shots so quickly after shipping them to pharmacies, hospitals and doctor’s offices last summer. Manufacturers are collecting data on the effectiveness and side effects of vaccines and — a central unanswered question — how often people will need to be revaccinated to maintain protection.
“For a new class of vaccines, this is really fantastic,” said Dr. Len Friedland, who leads public health at GSK Vaccines.
“There will always be hiccups,” he said. “But generally everything has gone very well and we don’t hear about any issues with patient access.”
Dr. Nathaniel Hupert, co-director of the Cornell Institute for Disease and Disaster Preparedness, was more cautious. Fifteen percent is “much better than zero,” he said, noting that until last summer there was no prevention against RSV. But, he added, “if you want to eradicate RSV, it’s not going to happen with this level of coverage.”
Other manufacturers have RSV vaccines in development, and older Americans may eventually benefit from better protection as more pregnant women and babies are vaccinated, as the CDC recommends. “Children have the frank distribution of these respiratory viruses every winter,” said Dr. Schaffner, of Vanderbilt University Medical Center.
Over time, “we will likely see less transmission of RSV from children to their grandparents,” Dr. Hupert said. “But we are not there yet.”
