Respiratory syncytial virus (RSV) vaccination is now recommended for every U.S. adult age 75 and older and for adults ages 50 to 74 who have a higher risk of severe RSV, according to current Centers for Disease Control and Prevention (CDC) guidance. The recommendation is based on clinical trials and post-licensure evidence showing that vaccination can substantially reduce RSV-related emergency visits and hospitalizations in older adults.
Adults 75 and older are recommended to receive one dose
RSV is often discussed as an infant infection, but it also causes substantial disease in older adults. CDC estimates that RSV leads to 110,000 to 180,000 hospitalizations each year among U.S. adults age 50 and older, with risk rising with age and underlying illness.
For adults age 75 and older, the recommendation is straightforward: CDC recommends a single dose of an RSV vaccine if the person has not been vaccinated previously. The recommendation does not depend on having a chronic medical condition.
That differs from the approach in younger adults. For adults ages 50 to 74, vaccination is risk-based rather than universal.
Adults ages 50 to 74 are eligible when their medical risk is higher
CDC lists several conditions that raise the risk of severe RSV in adults ages 50 to 74. These include chronic heart disease, chronic lung disease, end-stage kidney disease, certain forms of diabetes with end-organ complications or intensive treatment, chronic liver or hematologic disease, moderate or severe immune compromise, and neurologic or neuromuscular disease that impairs airway clearance.
Severe obesity, defined by CDC as a body mass index of at least 40 kg/m2, also appears on the risk list. So do residence in a nursing home and frailty or other clinical circumstances that a health care professional judges to increase the risk of severe respiratory infection.
The recommendation for adults ages 50 to 59 is newer. The Advisory Committee on Immunization Practices (ACIP) recommended vaccination for higher-risk adults in that age group in 2025, extending the earlier risk-based recommendation that had applied to ages 60 to 74.
Three different vaccines are available, but CDC does not rank them
Eligible adults currently have three RSV vaccine options: GSK’s Arexvy, Pfizer’s Abrysvo, and Moderna’s mResvia. CDC does not recommend one over another for adults age 50 and older.
The vaccines use different technologies. Arexvy is an adjuvanted recombinant protein vaccine built around the RSV prefusion F antigen. Abrysvo is a bivalent prefusion F protein vaccine designed against RSV A and RSV B. mResvia uses lipid-encapsulated messenger RNA (mRNA) that instructs cells to make a stabilized RSV prefusion F protein, applying the same broad vaccine platform described in our explainer on how mRNA vaccines work.
Those platform differences do not translate into a CDC preference. Availability, age eligibility, contraindications, prior vaccination history, and individual clinical circumstances are more important than trying to choose a product based on cross-trial efficacy percentages.
FDA approval and CDC recommendation are not the same thing
One source of confusion in 2026 is that FDA labeling has expanded faster than CDC’s population recommendation. As of September 2026, FDA labeling for Arexvy, Abrysvo, and mResvia includes adults ages 18 to 59 who are at increased risk of RSV lower respiratory tract disease.
CDC’s current routine adult recommendation is narrower: all adults age 75 and older, plus higher-risk adults ages 50 to 74. That distinction matters because FDA approval establishes that a vaccine may be marketed for a labeled population, while ACIP and CDC recommendations determine which groups are advised to receive it as part of the national immunization schedule.
CDC’s adult guidance page was last updated in February 2026, before the March 2026 FDA expansion of Arexvy to high-risk adults ages 18 to 49. The agency continues to review evidence for younger high-risk adults.
Real-world data show strong protection against hospitalization in older adults
Post-licensure studies from the first U.S. RSV vaccination season found substantial protection against severe disease. In a CDC-led test-negative study published in The Lancet, 28,271 hospitalizations among immunocompetent adults age 60 and older were included in the hospitalization analysis. Estimated vaccine effectiveness against RSV-associated hospitalization was 80% (95% confidence interval, 71% to 85%).
The same study estimated 81% effectiveness against RSV-associated critical illness, defined as intensive care unit admission or death, and 77% effectiveness against RSV-associated emergency department encounters. Among adults with immunocompromising conditions, estimated effectiveness against hospitalization was 73%.
CDC’s product-specific summaries for the 2023 to 2024 season estimate that Arexvy was about 83% effective against RSV-associated hospitalization and Abrysvo about 73% effective in adults age 60 and older. These estimates should not be read as a head-to-head comparison because the products were not randomized against each other.
For mResvia, CDC notes that real-world hospitalization effectiveness is not yet available. Its phase 2/3 trial showed about 80% efficacy against symptomatic RSV during the first four months after vaccination, with lower estimates over longer follow-up. That is a different endpoint from hospitalization and cannot be directly compared with the observational effectiveness estimates for Arexvy and Abrysvo.
Protection can wane, but a repeat dose is not currently recommended
RSV vaccination differs from influenza vaccination in one important way: it is not currently an annual shot. CDC recommends a single dose for eligible adults who have not previously received one.
Protection does decline over time in both trial and real-world datasets, but the evidence has not yet established the best interval for revaccination. CDC and ACIP are continuing to evaluate whether additional doses will eventually be useful.
For now, an adult who received an RSV vaccine in a previous season should not receive another dose simply because a new RSV season has started.
Late summer and early fall are the preferred vaccination window
Eligible adults can receive an RSV vaccine at any time of year, but CDC says the greatest benefit is expected when vaccination occurs shortly before RSV begins circulating widely. In most of the continental United States, that means August through October.
RSV vaccines can be given at the same visit as other adult vaccines. CDC notes that coadministration may increase common short-term side effects such as injection-site pain, fever, headache, or muscle aches, and that data on immune responses when RSV vaccines are given with other respiratory vaccines remain limited.
This adult schedule is separate from the prevention strategy used for infants. Infants may be protected through maternal RSV vaccination or long-acting antibodies such as nirsevimab or clesrovimab, which we cover in our guide to RSV prevention for infants in 2026 and our comparison of nirsevimab and clesrovimab.
Guillain-Barré syndrome remains a rare safety signal under surveillance
Most reported reactions to RSV vaccines are short-lived, including pain at the injection site, fatigue, headache, and muscle pain. A rarer safety question involves Guillain-Barré syndrome (GBS), an immune-mediated neurologic disorder.
In January 2025, FDA required warnings in the prescribing information for Arexvy and Abrysvo after a postmarketing observational study suggested an increased risk of GBS during the 42 days after vaccination. FDA estimated about 7 excess GBS cases per million Arexvy doses and 9 excess cases per million Abrysvo doses among adults age 65 and older in that analysis. FDA also stated that the available evidence was insufficient to establish a causal relationship.
CDC continues to conclude that the benefits of RSV vaccination outweigh the potential GBS risk for adults age 75 and older and for higher-risk adults ages 50 to 74. Safety monitoring is ongoing, and the risk-benefit calculation is one reason the recommendation is targeted toward groups most likely to develop severe RSV.
The evidence is strongest in older adults, with important gaps remaining
The adult RSV vaccine evidence base is strongest for people age 60 and older because that is where the pivotal efficacy trials and the first large post-licensure effectiveness studies were concentrated. Evidence in high-risk adults younger than 60 relies more heavily on immunogenicity bridging, safety data, and newer studies.
There is also no established revaccination schedule. Protection appears to persist beyond one season but wanes over time, and the optimal timing of a second dose remains unresolved. Comparative evidence among Arexvy, Abrysvo, and mResvia is also limited because there are no large randomized head-to-head trials designed to determine whether one product is clinically superior.
For an eligible adult deciding whether to be vaccinated in 2026, the main question is therefore not which RSV vaccine is “best.” It is whether the person falls into a group for whom CDC recommends vaccination, whether a dose has already been given, and whether vaccination can be timed before the period of highest RSV circulation.
References
- Centers for Disease Control and Prevention. RSV Vaccine Guidance for Adults. Updated February 24, 2026. CDC guidance.
- Payne AB, et al. Respiratory syncytial virus vaccine effectiveness against RSV-associated hospitalisations and emergency department encounters among adults aged 60 years and older in the USA, October 2023 to March 2024: a test-negative design analysis. Lancet. 2024;404(10462):1547-1559. DOI: 10.1016/S0140-6736(24)01738-0
- U.S. Food and Drug Administration. FDA Requires Guillain-Barré Syndrome (GBS) Warning in the Prescribing Information for RSV Vaccines Abrysvo and Arexvy. January 7, 2025. FDA safety communication.