Toby Gould was an early adopter. In September, Gould, 78, went to a pharmacy in Hyannis, Massachusetts, to receive one of the new vaccines against respiratory syncytial virus, known as RSV. He has asthma, which would increase his risk of getting seriously ill if he had to. be infected.
Carol Kerton, 64, knew RSV could be dangerous: Her 3-year-old granddaughter had a case so severe that she was taken to an 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 am over 60 years old and have a somewhat weakened immune system” after a long fight against cancer.
They are the exceptions. Until now, only about 15 percent of Americans over age 60 have received one of two new RSV vaccines, which the Food and Drug Administration approved in May and are the first vaccines against the disease. Only 16 percent more said they definitely planned to do so, according to the Centers for Disease Control and Prevention.
By contrast, more than 62 percent of adults over 65 received the recommended flu vaccine this fall, and one-third received the updated Covid-19 vaccine.
“It’s a new vaccine and people are trying to determine whether they need it or not,” said Dr. Preeti Malani, a geriatrician and infectious disease specialist at University of Michigan Health.
That is if they know anything about RSV vaccines. TO National survey This summer, people aged 60 to 80 discovered that almost half had never heard of them.
He CDC recommends RSV vaccines for people over age 60, after having individual conversations with their health care providers, something called “shared clinical decision making.” Medicare Part D, Medicaid, and most private insurers will cover the full cost.
The fact that older people are vulnerable to RSV is an unknown concept to many people. For decades, the virus was primarily considered a threat to infants and young children. Most doctors, “when they went to medical school, were taught that RSV was a pediatric disease,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center. “It remains the leading cause of childhood hospitalization in the US.”
But FDA estimates that the virus sends between 60,000 and 160,000 people over 65 to hospitals each year and causes between 6,000 and 10,000 deaths. Other published estimates are even higher.
“It’s a very contagious virus,” Dr. Malani said. Although children can get quite sick, more often “a 4-year-old with a runny nose could have RSV and not get seriously ill; It looks like a normal cold,” he said. However, he added: “Grandparents could get pneumonia.”
The risk of becoming seriously ill from RSV increases markedly with age. Hospitalization rates increase dramatically among people in their 70s and 80s, especially among those with chronic heart and lung diseases such as asthma, heart failure, and chronic obstructive pulmonary disease. Older adults who have diabetes or liver and kidney disease, or weakened immune systems, also face a higher risk. Adults can be infected repeatedly and there is no medication that improves the disease, as is the case with the flu and Covid-19.
A study published in The New England Journal of Medicine in 2005 followed patients for four winters and reported that, among high-risk patients (their average age was 70 years) with heart failure or lung disease who contracted RSV, 16 percent required hospitalization. In another cohort of older patients hospitalized with respiratory symptoms (average age 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 injection manufactured by GSK, was 94 percent effective against serious diseases in older adults. Pfizer’s shot, called Abrysvo, was 86 percent effective against severe illness.
So why haven’t the vaccines seen more acceptance among their intended recipients?
One reason: A CDC recommendation for shared decision-making may reduce vaccination rates, Dr. Schaffner said, because “you can’t promote it as strongly and as safely as with a blanket recommendation,” such as one that recommends vaccines. against the flu for everyone. all those over 6 months.
Additionally, seniors now receive multiple public health messages about seasonal vaccines. “A few years ago, we all recommended one vaccine every winter: the flu,” Dr. Schaffner said. “We haven’t yet organized ourselves to be persuasive and get people to accept three seasonal vaccines,” for influenza, Covid-19, and now RSV (getting two or three at a time is fine, the CDC says).
When R. Jessica Jones, 76, who lives in Haiku, Hawaii, texted her doctor about seasonal vaccines, he responded that she should get the Covid-19 booster and a flu shot, but that receiving the RSV vaccine was “optional.”
Mrs. Jones, surprised, asked why. He told her that she thought the data on her safety and effectiveness were “limited” (the FDA disagreed), so she skipped one.
“When providers are confused, patients are confused,” said Dr. Malani of University of Michigan Health. “If we really want the population to benefit, we must provide clear information to doctors and others.”
While some health care providers hope to improve the vaccination rate among older Americans, vaccine makers are apparently delighted by the number of people seeking out the shots so soon after shipping them to pharmacies, hospitals and doctors’ offices last summer. Manufacturers are collecting data on the vaccines’ effectiveness and side effects 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, director of public health at GSK Vaccines.
“There will always be setbacks,” he said. “But overall it has gone very well and we don’t know of any access problems for patients.”
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 RSV prevention available. But, he said, “if we want to eradicate RSV, that won’t happen with this level of coverage.”
Other manufacturers have RSV vaccines in development, and older Americans may have greater protection as more pregnant women and babies are vaccinated, as the CDC recommends. “Children have the franchise of distributing these respiratory viruses every winter,” said Dr. Schaffner of Vanderbilt University Medical Center.
Over time, “we will probably see less transmission of RSV from children to their grandparents,” Dr. Hupert said. “But we’re not there yet.”
