Independent report

Vaccination in adults at higher risk of respiratory syncytial virus (RSV) disease: JCVI advice, 18 March 2026

Published 9 April 2026

Introduction

The aim of the respiratory syncytial virus (RSV) immunisation programme is to protect those at higher risk of serious disease and mortality from RSV infection. As data has emerged on the effectiveness of RSV vaccines and the burden of RSV disease in the UK population, the Joint Committee on Vaccination and Immunisation (JCVI) has continued to update its advice on target groups for vaccination. Following advice for universal vaccination in older adults aged 75 years and over, JCVI has begun a review of data on the disease burden in adults with underlying health conditions. This statement outlines the findings from initial considerations on RSV vaccination in those with underlying health conditions and advice on clinical risk groups for RSV.

Advice

JCVI advises that, in addition to the current programme, adults aged 65 to 74 years with the following underlying health conditions should be offered RSV vaccination:

• chronic respiratory disease, including those with:
  • poorly controlled asthma
  • chronic obstructive pulmonary disease (COPD)
  • bronchiectasis
  • cystic fibrosis
  • interstitial lung fibrosis
  • pneumoconiosis
  • bronchopulmonary dysplasia
• immunosuppression due to disease or treatment

JCVI is continuing to review data on the potential impact and cost-effectiveness of RSV vaccination in adults with other underlying health conditions. Further advice may be developed following consideration of additional evidence.

Background

In June 2023 JCVI advised a programme for RSV vaccination in older adults. The RSV vaccination programme began in England in September 2024, with an offer of immunisation to those 75 to 79 years of age.

Following consideration of additional data on the use of vaccine in older adults, JCVI issued further advice in July 2025 to extend the programme to those aged 80 years and older and all residents in a care home for older adults. The government accepted this advice and the programme extension is anticipated to commence from 1 April 2026.

Developing an understanding of the incidence and disease burden in adults with underlying health conditions, stratified by age, was deemed the next focus for consideration.

Evidence review

In September 2025 the RSV sub-committee reviewed preliminary analyses by the UK Health Security Agency (UKHSA), investigating the burden of RSV in those with underlying health conditions. The sub-committee agreed that the initial aim was to assess the disease burden in those with underlying health conditions, by age, and to compare this with the burden observed in those aged 75 years and over (the cohort advised by JCVI in June 2023). This would allow a comparative assessment using existing cost-effectiveness estimates.

The RSV sub-committee met again in January 2026 to review updated UKHSA analyses, and JCVI met in February 2026 to review the analyses and consider the proposed advice of the RSV sub-committee.

Risk group analysis

UKHSA conducted an analysis on hospitalisation rates and mortality associated with RSV among adults aged 18 to 74 years in England using linked national data sets, including:

• laboratory‑confirmed RSV cases from the Second Generation Surveillance System (SGSS) and DataMart
• hospital admissions data from Hospital Episode Statistics (HES)
• mortality within 28 days of a positive RSV test
• clinical risk group information from NHS England’s ‘Cohorting as a Service’ (CaaS)

This data was linked to denominators from the national Immunisation Information System (IIS).

Age-stratified burden of disease was estimated for a number of health conditions, including:

• chronic respiratory disease
• chronic heart and vascular disease
• chronic liver disease
• diabetes
• morbid obesity
• asplenia
• chronic neurological disease
• severe mental illness

For chronic respiratory disease, analyses were undertaken with both a wider and a narrower definition, either including or excluding well-controlled asthma. For chronic neurological disease data limitations were noted, with the analysis focusing on those with more severe neurological conditions.

Findings

RSV‑related hospitalisation rates per 100,000 indicated that in those aged 65 to 74, 50 to 64 and 18 to 49 years, individuals who were immunosuppressed or who had chronic respiratory disease (not including well-controlled asthma) exhibited a hospitalisation burden meeting or exceeding the benchmark set by individuals aged 75 years and older. Adults aged 65 to 74 years with immunosuppression or chronic respiratory disease (not including well-controlled asthma) had the highest rate ratios after adjusting for multiple co‑morbidities.

Mortality was concentrated in older adults. In those aged 65 to 74 years, elevated mortality was most evident in those with immunosuppression and chronic respiratory disease (not including well-controlled asthma). Mortality rates were substantially lower in younger age groups.

Preliminary analyses from UKHSA calculated a combined ‘monetary benefit’ derived from RSV hospitalisation and mortality rates applying standard hospitalisation costs and quality-adjusted life years (QALYs) loss values to estimate the overall potential benefit from a health economics perspective across risk groups. An analysis combining adults aged 65 to 74 years with either immunosuppression or chronic respiratory disease (not including well-controlled asthma) demonstrated a monetary benefit exceeding that estimated in those aged 75 years and over.

Modelling and cost-effectiveness

JCVI must take cost-effectiveness into account when advising on new programmes for the NHS or changes to existing programmes once implemented. The rules that JCVI follows include a requirement to assess the certainty around the cost-effectiveness analysis, to ensure that the government can be sure that this represents a good use of NHS resources.

JCVI reviewed preliminary modelling and cost-effectiveness work conducted by UKHSA. The model included symptomatic disease, general practice care, emergency care, hospitalisations, intensive care and mortality, with vaccine effectiveness derived from trial data and protection capped at 2 seasons. Given limitations in data on the burden of disease in the UK, 2 alternative scenarios representing different levels of under‑ascertainment were applied.

Mortality prevention accounted for most of the health benefits in terms of QALYs gained from vaccination. The analysis estimated that a programme that included adults aged 65 to 74 years with immunosuppression or chronic respiratory disease (not including well-controlled asthma) was likely to be at least as cost-effective as a programme for those aged 75 years and over. The large divergence in mortality estimates in the available data led to substantial uncertainty in the cost‑effectiveness estimates.

In both modelled burden scenarios, extending vaccination to individuals below 65 years of age was generally much less likely to be cost‑effective under plausible price assumptions.

Considerations

Most of the health‑economic benefit from vaccination in adults is from averted mortality, and as such the cost‑effective threshold price is highly sensitive to the mortality estimates used. Therefore, more work is required to reduce uncertainty in the burden estimates and improve confidence in the cost-effectiveness assessments.

Current analyses indicate that vaccination of adults aged 65 to 74 years with immunosuppression or with chronic respiratory disease (not including well-controlled asthma) is likely to have an equal or greater impact than the existing programme for those aged 75 years and over.

JCVI advised that the adult RSV vaccination programme be extended to those aged 65 to 74 years with immunosuppression or chronic respiratory disease (not including well-controlled asthma), using case definitions in line with the analyses conducted.

JCVI agreed that given the uncertainties in the burden estimates, further work should be undertaken to better define the benefits and cost-effectiveness in younger adults with underlying health conditions, particularly those aged 50 to 64 years with immunosuppression or chronic respiratory disease. Further advice will be developed as additional data becomes available.

Safety

The Medicines and Healthcare products Regulatory Agency (MHRA) confirmed there were no new safety signals for adults with respect to RSV vaccines other than those already known. The risk of Guillain-Barré syndrome remained principally age‑related and there was no evidence of a higher risk in those with underlying health conditions beyond that conferred by age. Ongoing observational studies will continue to inform on long‑term safety.

The risk-benefit balance of vaccination was considered clearly in favour of vaccination in the groups advised.

Further work

JCVI will continue to keep its advice under review as further evidence accrues, including the work on the impact and cost-effectiveness of vaccination in specific clinical risk groups.

JCVI welcomes evidence submissions from interested parties to support its considerations, with a particular focus on data setting out the burden of disease in adults with underlying health conditions. These can be sent to the JCVI secretariat at jcvi@ukhsa.gov.uk.

References

Joint Committee on Vaccination and Immunisation. Minutes of the meeting of the RSV sub-committee on 19 January 2026. Available on the Joint Committee on Vaccination and Immunisation group page.

Joint Committee on Vaccination and Immunisation. Minutes of the meeting on 4 February 2026. Available on the Joint Committee on Vaccination and Immunisation group page.

Osei-Yeboah R and others. Respiratory syncytial virus-associated hospitalization in adults with comorbidities in 2 European countries: a modeling study. Journal of Infectious Diseases. 1 March 2024; volume 229 (supplement 1): pages S70 to S77. doi: 10.1093/infdis/jiad510. PMID: 37970679

Symes R, Keddie SH, Walker J and others. (2025) 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. (Pre-print). medRxiv: 19 April 2025. doi: 10.1101/2025.04.17.25325639