IDSA guidelines recommend RSV vaccination for immunocompromised adults, and advise individualized timing plus shared decisions now.
Why RSV Vaccination Matters
Immunocompromised people can experience disproportionately severe outcomes from Respiratory Syncytial Virus infection, yet direct evidence to guide prevention has been limited. To support clinician and patient conversations ahead of the 2025 to 2026 respiratory virus season, a multidisciplinary expert panel developed rapid recommendations focused on benefits, harms, and practical implementation across diverse immunosuppressed subgroups.
The panel’s evidence review assessed comparative effectiveness and safety data published between August 2024 and July 2025, using GRADE to rate certainty and recommendation strength. Although the evidence base remains narrower than in immunocompetent populations, available data indicate meaningful protection against severe disease with a low likelihood of serious harm.
IDSA RSV Vaccination Recommendations
Based on two test negative case control studies in immunocompromised adults, RSV vaccination was associated with a 70% reduction in RSV-associated hospitalization (95% CI: 66–73%). Indirect evidence drawn from older adult populations also suggested strong protection against critical illness, with estimated effectiveness of 81% (95% CI: 52–92%).
Given this balance of benefits and harms, the panel issued a strong recommendation for age-appropriate RSV vaccination in adults and adolescents with compromised immunity. For immunocompromised patients under 18 years, the guidance emphasizes shared decision making, reflecting greater uncertainty in pediatric and adolescent subgroups.
Timing, Safety, and Coadministration
Timing should be individualized across immunocompromised subgroups, with attention to treatment cycles, transplant status, and B-cell–depleting therapies. Safety signals were reassuring overall, with serious adverse events comparable between vaccinated and unvaccinated groups across three randomized trials. Guillain–Barré syndrome was rare, with an estimated 11 excess cases per million doses.
The guidance also notes that eligible household members should remain up to date with RSV vaccination to reduce exposure risk, and that coadministration with influenza and COVID-19 vaccines is acceptable.
Evidence Gaps for Future Seasons
Key research priorities include defining correlates of protection, understanding durability of immunity in specific immunosuppressed groups, clarifying subgroup safety profiles, and determining whether booster doses have a role.
Reference
Chen ST et al. IDSA 2025 Guidelines on the use of vaccines for the prevention of seasonal RSV infections in immunocompromised patients. Clinical Infectious Diseases. 2026;doi:10.1093/cid/ciag117.
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