BACKGROUND: Respiratory syncytial virus (RSV) causes respiratory disease with a high disease burden in older adults and people with comorbid conditions.
PURPOSE: To analyze the efficacy, comparative effectiveness, and harm of RSV vaccines in nonpregnant adults who are not immunocompromised.
DATA SOURCES: Ovid Medline, Embase, and ClinicalTrials.gov between January 2023 and October 2025; a recently published Cochrane review to identify studies published before 2023.
STUDY SELECTION: Two independent reviewers screened all references on the abstract and full-text levels.
DATA EXTRACTION: Two independent reviewers assessed the risk of bias (RoB). One reviewer extracted data and assessed the certainty of evidence (CoE); a second reviewer verified extractions and assessments. For studies carried forward from the Cochrane review, reported data and RoB assessments were used.
DATA SYNTHESIS: The review included 7 randomized controlled trials and 1 nonrandomized study. In older adults (=60 years), RSV protein subunit vaccines probably reduce RSV-related hospitalizations (vaccine efficacy [VE], 83.3% [95% CI, 42.9% to 96.9%]; moderate CoE) and severe RSV illness (VE, 94.1% [CI, 62.4% to 99.9%]; moderate CoE) but have no effect on all-cause mortality (risk ratio [RR], 1.07 [CI, 0.68 to 1.68]; high CoE). They probably do not differ from placebo or no vaccination in serious adverse events (SAEs) (RR, 0.96 [CI, 0.75 to 1.23]; moderate CoE). Messenger RNA (mRNA) vaccines for RSV showed no difference in the incidence of SAEs compared with placebo in older adults (RR, 1.09 [CI, 0.83 to 1.45]; high CoE).
LIMITATION: Evidence on RSV vaccines in younger adults and on the efficacy of mRNA vaccines remains insufficient.
CONCLUSION: Protein subunit vaccines for RSV decrease the risk for hospitalization and severe illness in older adults.
PRIMARY FUNDING SOURCE: American College of Physicians. (PROSPERO: CRD420251145237).
| Discipline Area | Score |
|---|---|
| Family Medicine (FM)/General Practice (GP) |  |
| General Internal Medicine-Primary Care(US) | |
| Public Health | |
| Geriatrics | Coming Soon... |
| Infectious Disease | Coming Soon... |
A 94.1% reduction in severe RSV illness and 83.3% reduction in hospitalization without many SAEs is significantly relevant to geriatricians. We have seen enough of the cascade decline in functions and other complications related to hospitalization.
