RSV vaccination of older adults: information for healthcare practitioners

Question 1

Background

Accepted Answer

In 2023, having considered a range of issues including disease epidemiology, vaccine efficacy, vaccine safety and cost effectiveness, the Joint Committee on Vaccination and Immunisation (JCVI) recommended that programmes to protect both infants and older adults against respiratory syncytial virus (RSV) infection and disease should be introduced.

From 1 September 2024, RSV vaccine was offered to:

adults turning 75 years old on or after 1 September 2024, who remain eligible until their 80th birthday
adults already aged 75 to 79 years on 1 September 2024 as a catch up cohort
all pregnant women from 28 weeks’ gestation (see RSV vaccination of pregnant women for infant protection Information for healthcare practitioners)

Population-level reductions in RSV admissions have been seen since the introduction of the older adult vaccination programmes in England and Scotland (Surveillance of respiratory syncytial virus: winter 2024 to 2025).

In 2025, the JCVI reviewed the latest available disease epidemiology and programme data, including emerging international evidence of clinical effectiveness and safety – and resultant favourable cost-effectiveness assessment – in those aged 80 years and above, and advised that the programme should be extended to include adults aged 80 years old and over and all adult residents in care homes for older adults. These changes were announced on 2 February 2026 and became effective from 1 April 2026.

In March 2026, following analysis of the burden of disease (hospitalisation and mortality) for individuals with a number of health conditions in adults, the JCVI recommended a further expansion of the programme to two clinical risk groups: individuals aged 65 to 74 years who are immunosuppressed or who have chronic respiratory disease (not including well-controlled asthma). This expansion to the programme becomes effective on 1 September 2026.

About respiratory syncytial virus

Respiratory syncytial virus (RSV) is a common cause of acute respiratory tract infections. For many, these are mild and self-limiting but RSV can cause severe lung infection in infants and older adults, leading to difficulty breathing, hospitalisation and risk to life. The virus is transmitted via respiratory droplets (coughing, sneezing), through close contact with an infected person or contact with contaminated surfaces. Symptoms usually include runny nose, cough and fever.

As previous infection at any age may only confer partial immunity to RSV, individuals may become repeatedly infected with the same or different strains of RSV.

The burden of adult RSV disease is significant, especially in the winter months, though is less well described than in infants. This may be due to a relative lack of recognition as a possible cause of disease, and limited testing. RSV has been estimated to account for 175,000 annual GP episodes in those age 65 years and older in the UK (Fleming and others 2015), and an estimated 5,000 to 7,500 deaths in older adults in England and Wales every winter, the vast majority of which occur in adults over 75 years (2).

Enhanced surveillance in England in the winter prior to the vaccine programme launch found an RSV admission rate of 58 per 100,000 older adults, around half the rate of influenza, with an RSV 30-day mortality among admitted patients equivalent to the mortality risk for influenza (4).

The analysis undertaken by the JCVI and published in March 2026 found that RSV‑related hospitalisation rates per 100,000 for individuals who were immunosuppressed or who had chronic respiratory disease (not including well-controlled asthma) exhibited a hospitalisation rate exceeding individuals aged 75 years and older. Adults aged 65 to 74 years with these conditions have:

the highest hospitalisation rate ratios compared to other potential risk groups of the same age, after adjusting for multiple co‑morbidities
elevated mortality (whereas mortality rates are substantially lower in younger age groups)

A cost-effectiveness analysis found that vaccination for these individuals would likely be a good use of NHS resources when benchmarked against the existing programme for those aged 75 years and over which had already been shown to meet cost-effectiveness criteria.

The Green Book RSV Chapter 27a

The Green Book: respiratory syncytial virus chapter 27a includes detailed information about RSV and RSV vaccination.

Healthcare practitioners should familiarise themselves with the information in the Green Book chapter before offering RSV vaccination.

Aim of the vaccination programme

The aim of the older adults’ RSV programme is to reduce the incidence and severity of RSV disease and hospitalisation as a result of RSV disease in eligible older adults.

Question 2

Eligibility

Accepted Answer

From 1 September 2026, a single dose of the RSV vaccine should be offered to:

everyone aged 75 and over
any adult residing in, or moving into, a care home for older adults
individuals aged 65 to 74 years who are immunosuppressed or have a chronic respiratory disease as defined in the RSV green book chapter

This is a year-round, ongoing programme. There is no upper age limit for receipt of this vaccination.

Individuals currently only require a single dose as part of the older adult programme. The policy may change in future but there is not currently evidence to inform a policy decision. Individuals vaccinated as part of the older adult programme do not require any further dose if they move between groups. For example:

people who had a dose as part of the 65 to 74 risk group programme should not be offered an additional dose on turning 75
people who were vaccinated as part of the 75 to 79 catch-up should not be offered an additional dose as part of the programme extension to 80 years and over
no additional dose is needed if a vaccinated person takes up residence in a care home

Question 3

Individuals aged 75 years and above

Accepted Answer

all adults becoming 75 years of age should be offered a single dose of RSV vaccination on or shortly after their 75th birthday, unless they have already had an NHS dose (for example, as a resident of a care home for older adults or because they are immunosuppressed or have a chronic respiratory disease).
adults already aged 75 years and older who have not yet had a dose remain eligible. This includes individuals born before 1 September 1944 who were not eligible when the programme commenced in September 2024.

Question 4

Care home residents

Accepted Answer

Adults aged 18 to 74 years who are already resident in care homes for older adults who have not previously had a dose of RSV vaccine are eligible.

admission to a care home provides an opportunity to confirm vaccination status (and offer vaccination if the individual is unvaccinated against RSV)
temporary residents have a low probability of being involved in an RSV outbreak during a short stay and as the vaccine takes some time to make immune protection may not necessarily benefit from vaccination; this is primarily a consideration for those age less than 75 years. Temporary residents aged 75 years or above (or 65 to 74 and in an RSV risk group) who have not previously been vaccinated under the NHS RSV programme should receive a dose of RSV vaccine as part of routine eligibility
individuals residing in care homes for older adults who are aged less than 18 years of age are not eligible
social care staff residing in care homes for older adults are not eligible
general practice teams are familiar with their local care homes and will be able to determine which homes this programme applies to

There is no specific definition of a care home for older adults and NHS GP practices are expected to apply their clinical judgement. The age of 65+ years is commonly used as indicative of older age, for example by the Office of National Statistics and the Care Quality Commission, with the latter using this to classify care homes using specific service user bands.

For the purposes of the programme if a person is residing in a care home classified as for older people, for example by CQC service band, then all residents in that care home may be considered eligible regardless of age providing some of them are aged 75 years and above. Conversely, if the care home is registered as an older adults care home but there are no individuals aged 75 years or over living there it would not usually be appropriate to vaccinate everyone, only those who are eligible for another reason, for example people aged 65 to 74 with immunosuppression or chronic respiratory disease. This is because the risk the evidence and rationale behind the decision to extend this programme to residents of older adult care homes relates to those individuals who are resident in them – rather than working solely from the care home’s designation regarding its registration with the local authority or CQC.

The evidence is that it is older adults, particularly those over 80 years (82% of cases) who are resident in a care home for older adults who experience outbreaks with appreciable morbidity and mortality. It is these older adults that we are seeking to protect. Whilst most residents of care homes for older adults are over 80, for operational simplicity adults (of any age) residing in the same facility may be vaccinated too.

It is recognised that a homes’ usage may not always be fully reflected in its CQC registered purpose (such as a home registered as being for older adult but with only younger residents) therefore GPs may also take into consideration the age mix of residents and the prevalence of conditions associated with older age such as dementia.

RSV can cause severe outbreaks in homes for older adults, with increasing severity with age. Most residents of care home for older adults are eligible because of their age. Inclusion of younger residents (aged under 75) of such homes in eligibility recognises the likely medical frailty of such individuals and the potential for less frail younger residents to contribute to transmission in an outbreak.

In the case of a large and complex care home, the GP practice clinical team may apply some clinical judgement in determining if for example, some wings, buildings or floors operate akin to a care home for older adults while others are not, and use that for determining eligibility, considering the impact if an RSV outbreak was to become established in any area. It would also be reasonable in a large, truly mixed function/occupancy, complex care home that some but not all residents less than 75 would have a risk of severe outcomes from RSV infection equivalent to that of a person age 75 or older, based on their underlying medical conditions/clinical frailty, and plan vaccination accordingly.

Question 5

Clinical risk groups

Accepted Answer

From 1 September 2026 the following previously unimmunised individuals aged 65 to 74 years are newly eligible:

Chronic respiratory disease

Those with chronic respiratory disease including:

poorly controlled asthma [note 1]
chronic obstructive pulmonary disease (COPD), including chronic bronchitis and emphysema
chronic obstructive bronchiectasis
cystic fibrosis
interstitial lung fibrosis
pneumoconiosis
bronchopulmonary dysplasia

Immunosuppression [note 2]

Those who are immunosuppressed due to disease or treatment including:

individuals who are receiving immunosuppressive or immunomodulating biological therapy
individuals treated with or likely to be treated with systemic steroids for more than a month at a dose equivalent to prednisolone at 20mg or more per day for adults
anyone with a history of haematological malignancy, including leukaemia, lymphoma, and myeloma
those who require long term immunosuppressive treatment

Immunosuppressed patients may have lower protection from a dose of the vaccine.

Note 1: Poorly controlled asthma is defined as: two or more courses of oral corticosteroids in the preceding 24 months or on maintenance oral corticosteroids or one or more hospital admissions for asthma in the preceding 24 months.

Well-controlled asthma is not an indication.

Note 2: See the Respiratory syncytial virus green book chapter for further information and detail on conditions and treatments.

Question 6

Revaccination

Accepted Answer

There is currently no recommendation for revaccination in the older adults RSV programme. A single dose is expected to give multiple years protection. Additional evidence is needed on the durability of first dose protection and the effectiveness of revaccination to determine any revaccination policy.

Therefore, no one should be offered more than one dose of RSV vaccine as part of the NHS older adult programme. This is different to the maternal programme where an RSV vaccine is recommended in each pregnancy.

Continuing eligibility

As there is no longer an upper age limit, eligible individuals who have not yet taken up the offer of an NHS RSV vaccination remain indefinitely eligible. Opportunities to re-offer the vaccine opportunistically to these individuals include becoming resident in a care home or presenting for their COVID-19 vaccination. They may also receive the vaccine if they request to do so. The vaccine can be administered at any time of the year.

Individuals who have already taken up the offer of vaccination do not require a further dose.

Question 7

Health equity impact of the programme

Accepted Answer

The most recent data shows that overall RSV vaccine coverage for all eligible individuals is 61.9%. There is however, substantial inequalities in coverage across socioeconomic, ethnic and geographical groups.

In all eligible older adults’ cohorts, variation by region was observed with the highest region reporting 66.3% uptake, and the lowest region reporting 48.8% uptake.

Coverage in the most deprived decile was 48.5% and in the least deprived decile was 70.1%, showing marked variation in vaccination uptake and risking exacerbation of existing health inequalities in disadvantaged populations.

Coverage also varies substantially by ethnic group, with the highest coverage reported among White-British (65.3%) and the lowest coverage amongst Asian or Asian British - Pakistani (24.0%) individuals.

RSV vaccine coverage will continue to be monitored across all populations to identify inequalities within underserved groups. Ensuring equitable access to RSV vaccination is critical not only to reduce disease in older adults but also to prevent the widening of existing health inequalities.

Question 8

Optimal timing of vaccination

Accepted Answer

Although vaccination can be given all year round, vaccinating as many eligible individuals as possible before the onset of the main RSV season in the winter will have the greatest impact. This will provide individuals with protection and could reduce transmission of the virus.

For those turning 75 years of age between March and October each year, the vaccine should ideally be given by the end of October before RSV activity increases, otherwise soon after turning 75 if this occurs during the RSV season (November to February).

The RSV programme expansions in 2026 include some groups who are eligible for COVID-19 vaccination (see separate guidance on COVID-19 eligibility). As the timing means that they may arrive in a COVID-19 vaccination campaign window without having yet received an RSV vaccine, co administration with COVID-19 vaccine is encouraged.

There are no contraindications to co-administering the RSV and COVID vaccines and delivering both programmes at the same time will reduce the number of appointments that are required. The COVID-19 campaign also provides another opportunity to re-offer RSV vaccine to eligible individuals who have not previously received it.

There is no minimum interval to be observed between doses of RSV and COVID-19 vaccine if for any reason individuals do not receive both vaccines at the same appointment or visit. Eligible individuals who wish to receive both vaccines but decline the option of co-administration should be offered the outstanding dose as soon as practicable (by the end of the campaign for COVID-19 vaccine, no time limit for RSV vaccine). With the exception of flu vaccination, RSV can be co-administered with other vaccines including those that are routinely offered to older adults. See Administering Abrysvo® at the same time as other vaccines section

Question 9

The recommended RSV vaccine (Abrysvo®)

Accepted Answer

Abrysvo® Pre-F RSV vaccine (Pfizer Limited) is the vaccine to be used for the adult national RSV programme. The vaccine’s full name is Abrysvo® powder and solvent for solution for injection Respiratory syncytial virus vaccine (bivalent, recombinant).

Abrysvo® was licensed in the UK by the Medicines and Healthcare Products Regulatory Agency (MHRA) in November 2023 following clinical trials. The vaccine was trialled in over 17,000 adults over the age of 60 and in over 4,000 pregnant women.

How the vaccine works

The RSV vaccine Abrysvo® is a non-live bivalent recombinant vaccine. This means a small piece of the genetic material (DNA) from the protein of the virus is taken and inserted into a manufactured cell. As these cells grow, the protein is made too. This protein is then purified and put into the vaccine, which, when introduced into the body via intramuscular injection, activates the immune system to produce antibodies against RSV.

It is referred to as bivalent because Abrysvo® contains versions of two proteins found on the surface of the virus, one from a virus in RSV subgroup A and one from subgroup B. The vaccine is sometimes called pre-F because it is based on the prefusion form of the fusion (F) protein which the virus uses to invade human cells.

The vaccine also contains very small amounts of other ingredients, such as stabilisers (which preserve vaccine potency) and emulsifiers (which help the vaccine powder mix with the solvent (which is water for injection)). For the full list of vaccine components and excipients, vaccinators should see below and refer to the Abrysvo® Summary of product characteristics (SPC).

Question 10

Prescription-only medicines

Accepted Answer

All vaccines (including RSV vaccines) are classified as prescription-only medicines (POMs). This means that they are subject to legal restrictions and there needs to be an appropriate legal framework in place before they can be supplied and or administered. Any person who supplies and administers a vaccine must have a legal authority to do so. This legal authority may be in the form of a written patient specific prescription, a Patient Specific Direction (PSD) or a Patient Group Direction (PGD).

The UK Health Security Agency (UKHSA) has developed and published an RSV PGD. This will be available to download from the Immunisation PGD templates collection webpage. The UKHSA immunisation PGD templates require further authorisation before they can be used. They are not legal or valid without signed authorisation.

Question 11

Vaccine ordering

Accepted Answer

Vaccines for the national RSV vaccination programmes in England should be ordered via the ImmForm website. Healthcare practitioners should refer to this website and Vaccine Update (the vaccination newsletter for healthcare practitioners) for current information on vaccine availability.

As both programmes involve a year-round offer and not a seasonal offer of vaccination, vaccines should be ordered regularly throughout the year. To minimise wastage due to fridge failures or expiry, healthcare practitioners are reminded to order no more than 2 weeks’ worth of stock rather than over-ordering or stockpiling vaccines.

Vaccines should be ordered, stored and monitored as described in the Green Book Chapter 3 (Storage, distribution and disposal of vaccines).

Please note, although the same Abrysvo® vaccine will be used for both the older adult and the vaccination of pregnant women, the vaccine supply for these programmes is listed as separate items on ImmForm and the vaccine allocated for each programme should be managed independently where possible. More information can be found on the ImmForm website and in the bipartite letter.

For vaccines required for individuals who are not in the eligible cohort, for example, where a clinician has decided that it is clinically appropriate to vaccinate the individual but they are not within the eligible age cohorts for the national vaccination programme; this would require the GP practice to purchase the vaccine directly from the manufacturer and then reclaim the cost of the vaccine. The exception to this is young children, in whom RSV vaccine is contraindicated. Please see the sections on contraindications and inadvertent administration of Abrysvo® to a young child for more information.

Question 12

Vaccine storage

Accepted Answer

Abrysvo® should be stored in a vaccine refrigerator between 2°C and 8°C. The vaccines should be stored in the original packaging to protect them from light. The vaccine must not be frozen.

After reconstitution Abrysvo® should be administered immediately.

Further information on vaccine storage and stability is available in the Summary of Product Characteristics (SPC), the Patient Group Direction and from the manufacturer.

Question 13

Vaccine composition

Accepted Answer

The RSV vaccine Abrysvo® contains:

trometamol
trometamol hydrochloride
sucrose
mannitol
polysorbate 80
sodium chloride
hydrochloric acid (for pH adjustment)
the solvent is water for injection

There is no animal content in the vaccine. Abrysvo® vaccine has been certified Halal by the Islamic Food and Nutrition Council of America (IFANCA).

The Abrysvo® vaccine contains polysorbate 80. Rarely, people may be allergic to polysorbate 80. However, polysorbate 80 is widely used in medicines and foods and is present in many medicines including some vaccines such as the main injected influenza vaccine for individuals aged 65 years and above. Some individuals may be allergic to polysorbate 80 but as it is present in many foods such as ice-cream and other frozen desserts, it is likely that people will know if they are allergic to it and individuals who have tolerated injections that contain polysorbate 80 are likely to tolerate the Abrysvo® vaccine.

Question 14

Vaccine safety and effectiveness

Accepted Answer

Abrysvo® was licensed in the UK by the MHRA in November 2023 following clinical trials which showed it to be effective and have a good safety profile.

The vaccine was trialled against a placebo in over 17,000 immunocompetent adults aged 60 years and over, 52% of whom had at least one stable chronic underlying condition. At the end of the first RSV season (after vaccination) analysis demonstrated statistically significant vaccine efficacy (VE) for Abrysvo® for reduction of RSV-associated lower respiratory tract illness with 2 or more symptoms of 65.1% and 3 or more symptoms of 88.9%. In the second season, the efficacy against 2 or more symptoms was 55.7% and against 3 or more symptoms was 77.8%. In the first season, one analysis found effectiveness of vaccination against RSV hospitalisation in the UK of 75% whilst another study found, in England, VE to be 88.6% for LRTI admission overall and an estimated 73% against RSV admission in people with immunosuppression.

Abrysvo® is also licensed for use in Europe, USA and in many other parts of the world. Over 3 million doses were administered to adults in the USA during winter 2023 to 2024 and almost 2.5 million doses have been administered to older adults in England (GP data extracted 18 January 2026).

Question 15

Guillain-Barré syndrome

Accepted Answer

A small number of cases of Guillain-Barré syndrome (GBS) have been reported in older adults following vaccination with Abrysvo® in the phase 3 clinical trials and in surveillance studies in the USA and UK. These suggest that RSV vaccines are associated with a small increased risk of GBS in the six weeks following administration in older adults. GBS is a rare and serious condition that affects the nerves. It mainly affects the feet, hands and limbs, causing problems such as numbness, weakness and sharp pain. In severe cases, GBS can cause difficulty moving, walking, breathing and/ or swallowing. GBS is most common following infection, including campylobacter and influenza; cases of GBS that occur following vaccination may occur by chance. GBS is more common in males and older adults.

Between 10 and 25 cases of GBS have been reported for every million doses of Abrysvo® (against an annual background rate of 20 per million in those aged 70 to 79 years [3]. This is one case for every 40,000 to 100,000 doses of vaccine administered in this age group. Overall, the benefits of RSV protection in preventing hospitalisation and death from RSV in the eligible group are highly favourable relative to the risks of serious adverse reactions (Commission on Human Medicines).

The MHRA has advised that healthcare professionals should be alert to the signs and symptoms of GBS, which may start with pins and needles in the hands, arms, feet or legs, to ensure correct diagnosis in order to initiate adequate supportive care and treatment and to rule out other causes. Early treatment can help prevent the most serious syndrome and improve recovery.

Individuals who have a history of GBS should be vaccinated if they are in an eligible group. There is evidence from other vaccines to suggest that having had a prior diagnosis of GBS does not predispose an individual to further episodes of GBS following immunisation.

Question 16

Contraindications and precautions

Accepted Answer

The contraindications to Abrysvo® vaccine are:

confirmed anaphylactic reaction to a previous dose or any component of the vaccine
young children

RSV vaccines should not be given to young children, outside of clinical trials. RSV vaccines are different to monoclonal antibody immunisations which are given to high-risk children.

A recent clinical trial (Moderna’s mRNA-1345) has shown evidence of enhanced disease in children who were immunologically naive (that is that they had never been exposed) to RSV and had received RSV vaccine who then went on to catch seasonally circulating RSV. As safety has not been assessed in clinical trials for these children and due to the possibility of vaccine-associated enhanced disease, RSV vaccine is not recommended in young children.

Immunisation of individuals who are acutely unwell with a fever should be postponed until they have recovered fully. This is to avoid confusing the diagnosis of any acute illness by wrongly attributing any sign or symptoms to the adverse effects of the vaccine. The presence of a minor illness, such as the common cold, is not a contraindication to immunisation.

There are very few individuals who are eligible for vaccination through the programme that cannot receive Abrysvo®. Where there is doubt, rather than withholding vaccination, appropriate advice should be sought from the relevant specialist, or from the local immunisation or health protection team.

For individuals with thrombocytopenia or other bleeding disorders please see the administration advice.

For full details refer to the Green Book RSV Chapter 27a and the Patient Group Direction (PGD).

Question 17

Adverse reactions

Accepted Answer

The adverse reactions reported by Abrysvo® clinical trial participants were the expected side-effects commonly reported after any vaccination, reflecting the initiation of the inflammatory and immune responses that lead to vaccine-induced protection against disease.

For individuals aged 60 years and above, only vaccination site pain was very commonly reported (reported by 11% of those who received the vaccine) following vaccination with Abrysvo®. Commonly reported reactions (affecting more than 1 in 100 but not as many as 1 in 10 of those receiving the vaccine) were vaccination site redness and swelling.

Although headache and myalgia were commonly reported adverse reactions from the clinical trial of younger adults (aged 49 years and under), these were not reported by the 60 years and above age group.

Reporting adverse reactions

Abrysvo® is a relatively newly licensed vaccine in the UK and is subject to additional monitoring under the black triangle (▼) labelling scheme by the MHRA.

All suspected adverse reactions should be reported to the MHRA via the Yellow Card scheme:

Question 18

Vaccine presentation and preparation

Accepted Answer

Each box of Abrysvo® vaccine contains one vial of powder, one pre-filled syringe of solvent, and one vial adaptor with one needle for administration. The vaccine must be reconstituted with the solvent provided. The prepared vaccine is a clear and colourless solution. The expiry dates on the vial of powder, the pre-filled syringe of solvent and the outer box may differ. The expiry date shown on the outer box is the one which should be used.

Clear instructions on how to prepare the vaccine for administration can be found in the SPC and manufacturer’s video. Immunisers are strongly encouraged to look at the SPC and watch the video in its entirety before preparing the vaccine for the first time.

Question 19

Vaccine administration

Accepted Answer

Abrysvo® should be reconstituted according to the manufacturer’s instructions. Once reconstituted, the vaccine should be administered immediately.

Abrysvo® is licensed to be given via the intramuscular (IM) route, preferably into the deltoid muscle in the upper arm.

The needle for administration included in the pack is a 25 gauge, 25mm (‘long orange’) needle. Suitable alternatives can be used if required. For IM injections, the needle needs to be sufficiently long enough to ensure that the vaccine is injected into the muscle. For most adults, the 25mm needle length will be sufficient. In larger adults, a longer length (such as a 38mm) may be required, and an individual assessment should be made. For more information on immunisation procedures, including needle length, please see the Green Book, Chapter 4.

Question 20

Vaccine dosage and schedule

Accepted Answer

Abrysvo® should be administered as a 0.5ml dose after reconstitution using the full volume of the reconstituted vaccine, drawn up into the syringe.

The schedule for Abrysvo® is a single dose of vaccine.

There are no current data to support revaccination of older adults after a first dose.

Individuals who have already taken up the offer of an NHS dose of RSV vaccine do not require a second dose.

Question 21

Individuals who have received a bone marrow transplant

Accepted Answer

For individuals eligible for the RSV vaccine who receive a bone marrow transplant, any protective antibodies from exposure or vaccination prior to transplantation are likely to be lost and it is unclear whether the recipient acquires the donor’s immunity. All such individuals should be considered for re-immunisation after treatment is finished. Specialist advice may be required and should be sought from the treating clinician.

Question 22

Vaccination for individuals with bleeding disorders

Accepted Answer

Individuals with bleeding disorders may be vaccinated intramuscularly if, in the opinion of a doctor familiar with the individual’s bleeding risk, vaccines or similar small volume IM injections can be administered with reasonable safety by this route. If the individual receives medication or treatment to reduce bleeding, for example treatment for haemophilia, IM vaccination can be scheduled shortly after such medication or treatment is administered.

Individuals on stable anticoagulation therapy, including individuals on warfarin who are up to date with their scheduled international normalised ratio (INR) blood testing and whose latest INR was below the upper threshold of their therapeutic range, can receive IM vaccination. A fine needle (equal to 23 gauge or finer calibre such as 25 gauge) should be used for the vaccination, followed by firm pressure applied to the site (without rubbing) for at least 2 minutes.

If in any doubt, consult with the clinician responsible for prescribing or monitoring the individual’s anticoagulant therapy. On occasion the treating clinician may conclude, in discussion with the individual, that the benefit of protection against RSV disease could outweigh the increased risk of a transient local reaction with intramuscular immunisation. Subcutaneous administration is off-label, and a PSD would be required.

The individual or their carer should be informed about the risk of haematoma from the injection.

Question 23

Recommendations for the use of Abrysvo® vaccine

Accepted Answer

Individuals who present early and before they become eligible for RSV vaccine

Individuals who present early and outside the eligible criteria for the RSV vaccine national immunisation programme should be advised when they will become eligible.

It should be explained to them that the JCVI have advised the vaccine should be offered only to those who are 75 years of age and older, and to adults (aged 18 years and above) living in a care home for older adults, The expiry dates on the vial of powder, the pre-filled syringe of solvent and the outer box may differ. The expiry date shown on the outer box is the one which should be used, based on evidence which shows that the risk from RSV in these groups. These decisions are based on a combination of factors including the risk of the disease and the effectiveness of the vaccine in different age groups, vaccine supply and the capacity of the NHS to deliver the programme alongside other important healthcare priorities.

Individuals living in the community who are not aged 65 to 74 years with immunosuppression or chronic respiratory disease should be encouraged to attend for vaccination on or shortly after their 75th birthday.

Individuals currently residing in care homes for older adults should be offered a vaccine as soon as practicable from 1 April 2026. Adults newly entering older adult care homes after that date should have their vaccine status checked and offer the vaccine if they are unvaccinated (these individuals will be either aged less than 75 years and so were not previously eligible or aged 75 years and above but have not yet taken up the offered of NHS vaccination).

Previously unvaccinated temporary residents aged 75 years and above are recommended to be vaccinated based on their age eligibility, the same applies if they are age 65 to 74 in one of the two clinical risk groups. Temporary residents under 75 years of age with planned short stays (for example respite care or intermediate care while domiciliary care arrangements are made) are at low risk of being in an outbreak during a short stay and may not benefit from vaccination due to the time required for an immune response, and should not ordinarily be considered for immunisation as part of the national programme based on a short stay in an older adults care home.

Vaccination of individuals who have previously received a private RSV vaccine

The RSV vaccine programme offer is a single, one-off dose of vaccine from the 75th birthday or on taking up residence in a care home for older adults if this happens before 75 or for those aged 65 to 74 years who are immunosuppressed or have chronic respiratory disease (excluding well-controlled asthma).

Both Arexvy® (manufactured by GSK) and Abrysvo® vaccines are approved for use in individuals over the age of 60 and marketed in the UK, Europe and the USA. Moderna’s mRESVIA® (mRNA-1345) RSV vaccine is approved and marketed from 60 years in the USA. All three vaccines also have international regulatory approvals for younger adults with raised risk from RSV. Therefore, some individuals may have received an RSV vaccine privately or in another country prior to becoming eligible in the UK national programme.

Current trial data shows protection from Abrysvo® and Arexvy® lasts for at least 24 months. There is some evidence for Arexvy® that revaccination of older adults at 12 months following the first dose does not confer additional protection. Therefore, revaccination may result in typical vaccine side effects for no clinical benefit. At this time, evidence does not support further vaccination if an individual has previously received an NHS RSV vaccine for any reason. Individuals who received the RSV vaccine in clinical trials will continue to be followed up to establish how long protection lasts. The protective effect for mRESVIA® appears to wane more quickly.

Eligible NHS patients do not lose their NHS eligibility for RSV vaccination if they have received an RSV vaccine privately (outside of the national programme). However, the need for revaccination and the appropriate timing of any revaccination is not established. If an individual chooses to receive their NHS dose, until further data emerges, it is recommended that the minimum acceptable interval for older adults is 24 months from a non-NHS dose of Abrysvo® or Arexvy® and 12 months from a dose of mRESVIA® following a discussion of the risks and benefits with the patient.

Individuals diagnosed with confirmed or suspected RSV

Vaccination of individuals who may be infected or asymptomatic or incubating RSV infection is unlikely to have a detrimental effect on the illness but individuals currently unwell with a febrile illness should not attend for vaccination until they have recovered to avoid confusing disease symptoms with vaccine side effects. Eligible individuals should be vaccinated as soon as they are clinically recovered. Previous infection with RSV at any age will only confer partial immunity to RSV and individuals may therefore be infected repeatedly with RSV. It is very rare for anyone to reach adulthood without having had multiple RSV infections. There are no safety concerns from vaccinating individuals with any past history of RSV infection (recent or historic), or with detectable RSV antibody.

Vaccination offers the best protection against RSV infection.

Question 24

Vaccination of individuals not included in the eligible cohorts

Accepted Answer

Clinical recommendation

When providing advice to government, the JCVI reviews the current evidence with regard to benefit and cost-effectiveness. On the rare occasion when a clinician, following an assessment, determines that an individual who is not eligible for the national RSV vaccination programme should receive an NHS RSV vaccination, the vaccine should be procured from the manufacturer. GP surgeries can reclaim the cost of the vaccine from the NHS. Vaccines supplied to practices free of charge via ImmForm cannot be used for this purpose.

The exception to this is young children, in whom RSV vaccine is contraindicated. Please see the sections on contraindications and inadvertent administration of Abrysvo® to a young child for more information.

Private vaccination

GPs are not permitted to offer RSV vaccination privately to individuals registered at their practice.

GPs, community pharmacists and all other providers of a private vaccination service must order RSV vaccine directly from the manufacturer. They cannot use stock centrally procured for the national programme.

Individuals who are not eligible to receive RSV vaccine as part of the national programme, but who wish to pay for the vaccine privately, should be advised to discuss their request with a private provider and be made aware that they will be liable for the full cost of the vaccine and any additional administration charges that the private provider may apply.

The exception to this is young children, in whom RSV vaccine is contraindicated. Please see the sections on contraindications and inadvertent administration of Abrysvo® to a young child for more information.

Question 25

Administering Abrysvo® at the same time as other vaccines

Accepted Answer

Advice for co-administration is different for different vaccines. Read the following sections for specific scenarios. This information applies to older adults only. For advice on co-administration of vaccines of pregnant women, see RSV vaccination of pregnant women: healthcare practitioner guidance.

Where more than one vaccine can be administered at the same time, the vaccines should be given at a separate site, preferably in a different limb. If more than one vaccine is given in the same limb, they should be given at least 2.5cm apart. The sites at which each vaccine is given should be noted in the individual’s health records. When co-administered, any reactions experienced are expected to be the same as those experienced when receiving the vaccines separately.

A training slide set for the co-administration of vaccines routinely offered to older adults is available to download.

Seasonal influenza vaccine and RSV vaccines

There is some data which shows that in older adults, administering Abrysvo® at the same time as seasonal influenza vaccine may reduce the immune response to the RSV vaccine. There is also data that suggests that the response to the influenza A(H3N2) component of seasonal influenza vaccine (the influenza subtype which most severely affects older adults) may be diminished when RSV and seasonal influenza vaccine are co-administered to older adults.

The clinical significance of any reduced response is unknown, but influenza immune response is known to correlate with protection against infection, and there is emerging data that RSV immune response also correlates with clinical protection. It is therefore recommended that these vaccines should not routinely be scheduled to be given at the same appointment or on the same day. No specific interval is required between administering the vaccines.

If it is thought that the individual is unlikely to return for a second appointment or immediate protection is necessary, Abrysvo® can be administered at the same time as the influenza vaccine.

RSV vaccines with COVID-19, pneumococcal, shingles and other vaccines

Abrysvo® can be safely given with other* inactivated vaccines including those routinely administered to older individuals eligible for the RSV programme, such as the Shingrix shingles vaccine, the COVID-19 vaccines and the pneumococcal vaccine.

Abrysvo® can be given at any interval before or after these vaccines or other inactivated or non-live vaccines.

While is it not common that live vaccines are indicated in older adults, Abrysvo® is a non-live vaccine and can be given at the same time as any live vaccines that may be required.

The previous recommendation to not schedule co-administration of RSV and COVID-19 vaccines no longer applies, following the assessment of new evidence by JCVI See the above section Administering Abrysvo® at the same time as other vaccines for further information on flu vaccine co-administration.

Question 26

Inadvertent vaccine administration errors

Accepted Answer

Healthcare practitioners should report all inadvertent vaccine administration errors via their local governance systems so that appropriate action can be taken, lessons can be learnt, and the risk of future errors minimised.

Inadvertent administration to someone who is not yet eligible

If an adult who is not resident in an older adult care home has received a dose of RSV vaccine before the age of 75 in error, they should be offered a dose when they reach the eligible age (or when they first take up residence in a care home for older adults if they are aged less than 75 years of age when they do so). It is recommended this is given with an interval of not less than 24 months since their previous dose to maximise any potential benefit from receiving a second dose as current trial data shows protection from these vaccines lasts for at least 24 months. In these circumstances, the RSV PGD cannot be used – a PSD would be required.

Abrysvo® vaccines are licensed for active immunisation for the prevention of lower respiratory tract disease caused by RSV in individuals aged 60 years of age and older and individuals aged 18 to 59 years of age who are at increased risk for lower respiratory tract disease caused by RSV. There are no specific safety concerns arising from a dose that is given to an adult before the eligible age. Adults who inadvertently receive RSV vaccination before they become eligible should be reassured (including mention of use within the licensed indication, if applicable) and, if appropriate, advised of the possible adverse reactions that are typical of other vaccinations (see section on Adverse reactions commonly associated with the administration of Abrysvo®).

A dose that is given in error before a person reaches the age eligibility criteria means that vaccination has been given before the individual has reached the age associated with greatest risk. Although protection after vaccination is expected to last for at least 2 years and there is currently no data to indicate that second doses are required, individuals who have received a dose too early in error should be afforded the same opportunity for protection as those who are vaccinated at the correct time.

Inadvertent administration of Abrysvo® to a young child

RSV vaccines should not be given to young children, outside of clinical trials. These RSV vaccines are different from monoclonal antibody immunisations which are given to high-risk children.

A recent clinical trial (Moderna’s mRNA-1345) has shown evidence of enhanced disease in children who were immunologically naive (that is that they had never been exposed) to RSV and had received RSV vaccine who then went on to catch seasonally circulating RSV. Investigations are underway to understand the biological basis of this, but it may be due to a misdirected or imbalanced immune response when the virus is encountered. As safety has not been assessed in clinical trials for these children, and due to the possibility of vaccine-associated enhanced disease, RSV vaccine is not recommended in young children.

Although clinicians can recommend vaccines outside of the routine immunisation schedule, and off-label medication use is common in paediatrics, RSV vaccine should not be purposefully administered to young children. The scientific evidence against administering RSV vaccines to young children has become much stronger meaning RSV vaccine should not be used for RSV protection in young children.

If RSV vaccine has been inadvertently administered or purposefully prescribed for a young child this should be managed as a Serious Untoward Incident (SUI) and an appropriate investigation carried out. Immediate side effects of inadvertent RSV vaccination in a young child are expected to be consistent with post-vaccination reactions common to routine infant vaccines recommended in the national schedule and the side effects of RSV vaccination in adults. Parents/guardians should be alerted of the possibility that that the vaccinated infant or young child may be at increased risk of severe RSV bronchiolitis. General advice for parents on the signs and symptoms of bronchiolitis and when to seek help should be provided, in line with current NHS website advice.

Additional dose given in error

In the event of an additional dose being inadvertently administered, the individual should be monitored and advised an extra dose is expected to have adverse reactions consistent with those of having a single dose. Symptomatic treatment such as paracetamol can be taken if required. A study in which a second dose of vaccine was administered to participants aged 65 to 85 years showed that the percentage of participants reporting local and systemic reactions after revaccination was similar to the number following initial vaccination and no new safety concerns were identified.

Incomplete dose given

If an incomplete dose of Abrysvo® has been given inadvertently, this dose should be discounted. If the individual is still in the clinic, administer a replacement full dose immediately. If the replacement dose cannot be given on the same day, administer it as soon as possible after the invalid (incomplete or partial) dose was given in order to provide protection at the earliest opportunity.

Administration of an expired vaccine

All vaccines have an expiry date that is determined by the manufacturer and is clearly documented on the vaccine packaging. Vaccines that have been stored appropriately within the cold chain environment (and as per national recommendations) can be used up until the last day of the month indicated on the expiration date.

Vaccines that have expired should not be administered to patients. Whilst it is unlikely that a vaccine will cease to become effective on the day of expiration, given its prolonged time in storage, the potency of the vaccine is likely to have declined naturally over time. For this reason, where a vaccine has been given outside of its expiry date, the vaccine will usually need to be repeated. However, contact the vaccine’s manufacturer if this occurs, as they may be able to provide additional information about the shelf-life of their vaccine. If the vaccine needs to be repeated, it should ideally be repeated on the same day. If it cannot be administered on the same day, RSV vaccine should be repeated as soon as possible after the expired dose was given. In these circumstances, the RSV PGD cannot be used and so a PSD would be required.

Question 27

Reconstitution errors

Accepted Answer

Inadvertent administration of solvent only

Where individuals have inadvertently received the solvent only, they should be revaccinated with the correctly reconstituted vaccine. If the individual is still in the clinic, administer a replacement dose immediately. If the replacement dose cannot be given on the same day (for example because the individual has left before the error has been realised), they should be recalled and the dose administered as soon as possible. The solvent is water for injection and contains no active ingredient, meaning that the individual would not receive any protection.

If only the solvent is injected without reconstituting it with the powder containing the active ingredients, the individual should be reassured that it is not harmful but will not offer them any protection. They should be offered a correctly reconstituted vaccine as soon as possible after the error is realised.

What to do if the vaccine has been shaken

The SPC recommends that the vaccine is swirled and not shaken during reconstitution. If it is shaken in error, this is not expected to affect the potency or effectiveness of the vaccine. If the vaccine has already been given, it does not need to be repeated. If the vaccine has not yet been given, it can still be used and should not be discarded.

What to do if the luer lock adaptor has not been used

The technique for preparing the vaccine, as set out in the video and SPC, should be followed. For vials supplied with a luer lock adapter, if this has been detached following reconstitution, or was not used in the preparation of the vaccine, providing the preparation technique has not introduced microbial contamination (that is, appropriate infection control procedures have been followed) and the syringe contains a full reconstituted dose, it is possible to attach a needle to the luer slip tip and safely administer a full dose of the vaccine.

Question 28

Document history

Accepted Answer

Version number	Change details	Date
01.00	New information document	July 2024
02.00	Updated Guillain-Barré syndrome data and updated contraindication	February 2025
03.00	Updated Guillain-Barré syndrome data/text and changed co-administration section (RSV vaccine may now be co-administered with COVID-19 vaccines) to align with amended Green Book RSV chapter	July 2025
03.50	Updated catch up cohort section with interim guidance for the 80+ age group expansion	August 2025
04.00	Updated to reflect expansion of the older adult RSV vaccination programme to include adults living in an older adult care home and individuals aged 80 years and older	March 2026
05.00	Updated to reflect inclusion of individuals aged 65 to 74 years who are immunosuppressed or have chronic respiratory disease from 1 September 2026	July 2026

Question 29

Resources

Accepted Answer

Posters and leaflets for the older adults RSV programme are available to view and download.

To order RSV stickers, social media graphics, posters or patient leaflets to be delivered to you, please visit Find public health resources and register for a health professional account. Searching for RSV should identify patient resources available. Digital resources such as the social media graphics and BSL videos are download only.

Healthcare practitioner resources to support the RSV programme including the Green Book RSV chapter, Information for Healthcare Practitioners document and a training slide set for both programmes are available on the RSV immunisation collection site. The PGD is also available on the UKHSA PGD templates collection page ready for local authorisation.

Pfizer, (the product manufacturer) has a preparation video and resources about the Abrysvo® vaccine available on the Pfizer health professionals’ website.

For additional information about RSV disease see Respiratory syncytial virus (RSV): symptoms, transmission, prevention, treatment.

Question 30

References

Accepted Answer

1. Fleming DM and others. Modelling estimates of the burden of respiratory syncytial virus infection in adults and the elderly in the United Kingdom. BMC Infectious Diseases 2015: volume 15, page 443

2. Hardelid P, Pebody R and Andrews N. Mortality caused by influenza and respiratory syncytial virus by age group In England and Wales 1999 to 2010. Influenza and Other Respiratory Viruses 2013: volume 1, issue 7, pages 35 to 45

3. Sejvar JJ, Baughman AL, Wise M and Morgan OW. Population Incidence of Guillain-Barré Syndrome: A Systematic Review and Meta-Analysis Neuroepidemiology 2011: volume 36, pages 123-33

4. Symes R, Keddie SH, Walker J and others. Estimating the disease burden of respiratory syncytial virus (RSV) in older adults in England during the 2023/24 season: a new national hospital-based surveillance system Journal of Infection 2025: volume 91, issue 3, page 106,570

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Healthcare practitioner resources alignment with the UKHSA Immunisation Equity Strategy