Ask the Pharmacist – RSV vaccine

Q. Last year there was an uptick in respiratory syncytial virus (RSV) and many of my adult friends were getting the new RSV vaccine, Arexvy. Should I be considering getting this vaccine and is it a yearly vaccine like the influenza and likely the Covid vaccines?

A. RSV is a common virus that affects the respiratory system primarily amongst infants, young children and older adults. Though last year showed an increase in the number of RSV cases that led to hospitalizations and death, we do not yet know the predictions for this fall and winter seasons. That being said, it is believed that RSV will continue to be problematic for many years to come.

Some of the more common symptoms associated with RSV are cough, runny nose, fever, wheezing, reduced appetite, lethargy, irritability. You may notice these symptoms are very similar to other common seasonal conditions like the common cold, influenza or COVID-19. For most people, their symptoms may be mild and last just a few days. However, as is the case with many illnesses, some people may not cope as well with RSV. Seek medical attention if your notice someone with RSV has difficulty breathing, repeated vomiting, signs of dehydration or very sleepy and difficult to wake.

To help combat the rise in RSV infections, the Ontario government has included specific age groups in their eligibility for a government funded RSV vaccine this season. This will include;

· All children up to 12 months of age
· Children up 24 months of age AND are high risk of severe illness
· High-risk older adults
>Residents of long-term care home, elder homes, retirement homes
>Individuals receiving hemodialysis or peritoneal dialysis
> Individuals who have received solid organ or hematopoietic stem transplants
>Individuals experiencing homelessness
>Individuals who identify as First Nations, Inuit, or Métis

For anyone who does not fit into the above profile to receive a government funded RSV vaccine, you have the option to pay for the vaccine yourself or enquire if your private insurance will help pay for it.

Currently there are two RSV vaccines available that are available on the market, Abrysvo and Arexvy. Both have been approved by Health Canada for adults aged 60 and over and have similar efficacy and side effect profiles and therefore one product is not preferred over the other. However, before everyone runs to their health care practitioner to get a prescription for one or the other RSV vaccines, let’s review the latest recommendations from Health Canada regarding these vaccines.

Anyone who is 75 years of age and older is recommended to get the RSV vaccine, especially those with other underlying conditions that increase their risk of severe RSV. Classic examples of such underlying conditions are those with heart, lung, liver or kidney disease, those living with diabetes, those with a BMI of 40 kg/m2 or those who are immunocompromised. As well, anyone living in a long-term care home should also be receiving the RSV vaccine if they have not already received it (as stated above, these individuals would qualify for the government funded vaccine).

For those that are between 60 and 74 years of age, only those people that live in a nursing home or another form of communal living such as retirement homes or group homes should receive the RSV vaccine (reminder, they would be eligible for government funded vaccine). At this point, those people in this age bracket that do not have any risk factors are likely not going to benefit from an RSV vaccine and thus it is not recommended.

Since both RSV vaccines are approved only for those 60 and over, anyone not in this age bracket are not recommended to get in line for this vaccine.

Some people may have opted to receive the RSV vaccine within the last year. For those who previously received a dose, it is not recommended to bare your arm for another dose for this upcoming season. At this point, it is understood that the vaccine will work beyond one season, however studies are ongoing as

it is still unknown how long the immunity will last or if getting another dose will extend your immunity.

As for when the best timing would be for receiving the RSV vaccine, it is recommended to get it just before or during an RSV season. Usually this falls within the months of November to April.

For the last year, it has been recommended to give the RSV vaccine 2 weeks apart from any other vaccine. This has been updated to 6 weeks before or after other nonseasonal vaccines only such as shingles in order to help sort out which vaccine might be responsible for specific side effects, specifically, a very rare reports of Guillain-Barré syndrome that is continuing to be investigated. However, RSV vaccines may be given at the same time as other seasonal vaccines such as influenza or COVID-19 vaccines.

In summary, if you have already received an RSV vaccine, you do not need to concern yourself about getting another one this upcoming season. If you have not yet received your RSV vaccine, and you are 75 years of age or older, it is recommended to go ahead and get your RSV vaccine. If you are younger than 75 years of age and have medical conditions that would increase your risk of having severe RSV or you are a resident in a communal living home, then you should be considering getting your RSV vaccine if you have not yet had one.

For more information on this or any other health related topic, contact your pharmacist.