why new rsv vaccine recommendations are essential for seniors and long-term care facilities
8 minute read
rsv vaccines can significantly reduce the risk of severe disease in older populations.
getty images
stay up to date on this topic
on july 16, 2024, the national advisory committee on immunization (naci) released new recommendations regarding rsv vaccines for use in high-risk populations, including older adults aged 60 and older, especially for those living in long-term care facilities.
the recommendations were built on the mounting evidence that the vaccine works to reduce the risk of contracting rsv, as well as the risk of having a significant and severe rsv infection that could potentially lead to death in older adult populations.
in 2019 alone, there were roughly 470,000 hospitalizations and 33,000 deaths attributed to rsv in people over the age of 60 living in high-income countries.
currently, ontario is the only province that has begun offering the vaccine under the publicly-funded system, and many in the industry hope the others will follow suit before the height of the upcoming flu season this fall.
laura tamblyn watts, ceo of canada’s national seniors’ advocacy organization (canage), understands the importance of adult vaccinations and hopes that the remaining provinces will follow ontario’s example.
“i hope they approve (the public funding of rsv vaccinations) very quickly because we are moving into our fall season,” she said.
the fall season, while notoriously known for its uptick in flu cases, also drives an increase in the spread of other infectious pathogens, including rsv.
what is rsv?
respiratory syncytial virus, or rsv, is a viral infection that drives lower respiratory illness. it most notably affects young children and infants, with nearly 100 per cent of infants contracting the virus before the age of two.
however, while generally considered a children’s disease because of the high prevalence rates, it does affect other populations as well, including older adults.
advertisement
when people develop rsv, they can experience symptoms that resemble a cold, such as a runny nose, cough, fever, wheezing, fatigue, and loss of appetite. this type of infection is typically mild but can be much more severe in vulnerable populations. if someone who is more at risk for severe infection contracts rsv, they can experience life-threatening symptoms and the worsening of current chronic health conditions.
“so many people don’t realize that if you get rsv, you could die,” tamblyn watts said. “if you don’t die, as an older person, your chances of recovering your full wellbeing is significantly restricted.”
rsv isn’t a new virus and has been around for quite some time. however, since it does increase during flu season, it’s often taken a back seat to other more notable viral infections. because of that, its impact on vulnerable older adult populations has been somewhat minimized.
dr. zain chagla, associate professor and co-medical director of infection control and head of infectious diseases service at st. joseph’s healthcare in hamilton, ontario, has vast experience working with infectious diseases and knows firsthand how underrecognized rsv has been.
“we didn’t test for it as much, and that may be due to the fact that we didn’t have anything to offer people,” he said. “it was one of the other viruses where we didn’t have vaccines. you didn’t have therapeutics.”
he continued, “there is almost a bit of apathy that comes from it in the context that if you don’t have anything to offer, other than measuring the burden, you really are just dealing with it year to year. you’re not necessarily modifying the risk. you’re not necessarily changing people’s behaviours and reducing the burden on individuals.”
to put it plainly, if there was nothing to be done, the diagnosis of rsv became purposeless.
advertisement
rsv and its impact on older populations
as people age, their immune systems begin to lose its power. when that happens, the system cannot fight off infections, such as rsv, as much. older adults are also more likely to have chronic health conditions that can drive worsened outcomes if a viral infection is contracted.
“in older individuals, people with comorbidities, people who are compromised or live in institutions such as long-term care, it can have a pretty devastating impact,” said dr. chagla.
in terms of the flu, it is widely known that vulnerable populations should get their flu shot each year. for the most part, these vaccinations provided by the government do their job to reduce the risk of severe complications, death and added burden on the healthcare system.
that said, the attention given to rsv should be amplified, especially when compared to the flu, for one simple reason.
“people who end up hospitalized with rsv actually may have a worse prognosis than influenza, so they may be more likely to need oxygen. they may be more likely to need intensive care,” said dr. chagla. “unfortunately, they may be more likely to die of that disease as part of their hospitalization.”
contracting rsv as an older adult can be hard on the entire body, and even for people who recover from the illness, their overall well-being may never be the same.
this lack of recovery following infection can lead older adults to require even more care if they did so beforehand, a new set of care needs, or may be required to move into a care facility if it wreaks enough havoc on the body.
“a percentage of them (older adults who get rsv) may require assisted living care as part of their long-term prognosis after these infections,” said dr. chagla. “it causes a lot of bronchospasm or spasticity in the airways, and so that may lead to people to not come back with the same lung function. you can’t breathe as well. it means that you can’t mobilize as well, and if you can’t mobilize as well, it means there’s a higher risk of falls. there’s a higher risk of poor nutrition.”
advertisement
after contracting the viral infection, older adults can lose functional dependence because of this domino effect, especially for people who are already close to being “pushed over the edge.”
rsv impact on healthcare systems
rsv is a “vaccine-preventable illness.” that means that while a vaccine will not make someone completely immune to the effects of rsv, it will reduce the risk of contracting the infection and the severity of the illness if someone does happen to get it.
unfortunately, access to these vaccines across the country is limited, with only ontario offering them under the ontario health insurance plan (ohip). without adequate access to these types of vaccines, those individuals who could be protected may develop more severe illnesses and require hospitalizations or other care that puts an added strain on the healthcare system, especially during the fall season when respiratory illnesses make their high-level comeback.
“this is where we see really short-sighted policy decisions happen in action,” said tamblyn watts. “we know how overburdened our healthcare systems are. we know how overburdened doctors and nurses are, and we know how many hospitals are at full capacity or even over full capacity.”
dr. chagla, who works in a clinical capacity, as well as research, has seen the impact that rsv has on the healthcare systems as well. his hope is that vaccines available to canadians will be used effectively.
“hopefully, as we move into a new era of rsv prevention and potentially rsv therapeutics, they’re really does become that light on (the fact that) this is actually a serious disease and has a big impact on individuals and the health system at large,” he said.
when it comes to publicly funding the vaccine, the small amount of government money allotted to healthcare must make room because, ultimately, paying for the vaccine is far less expensive than waiting for the hospitals to fill up with those who have contracted the infection.
advertisement
“it’s incredibly inexpensive compared to this overburdened healthcare system,” said tamblyn watts. “it is the single cheapest and most effective thing that we can do to help our healthcare system.”
how vaccinations can help
vaccinations have been a tremendous modern medicine intervention used to prevent a wide range of infectious diseases. smallpox, for example, was eradicated using vaccines.
in the case of rsv, the goal and efficacy of the vaccine may not entirely eradicate the disease, but according to data, it can significantly improve outcomes as well as the transmission of rsv in older adult populations and others who are most at risk.
the newly approved rsv vaccines, which have been decades in the making, along with the recent naci recommendations, are making pushes toward the protection of vulnerable people at risk of severe rsv. clinical trials also show these vaccines are highly effective with minimal side effects.
“we see in the ballpark of 70 to 80 per cent reductions in moderate to severe disease in these individuals (older populations),” dr. chagla said. “we even see data of 18 months to two years suggesting those effects last longer than the year they’re vaccinated. the effect lingers into the second year.”
along with long-term coverage and reduced illness severity, the rsv vaccines can also help prevent an overburdened healthcare system. decreasing the threat of severe infections also results in less need for healthcare and hospitalizations.
according to dr. chagla, people who are 60 or older should speak to their primary care provider about the vaccine and strongly consider getting it.
“anyone over the age of 60 should consider it, particularly if they’re over the age of 75, if they have comorbidities, if they live in an institution, they should really consider it,” he said. “we do know other places where there are higher community burdens, so people in poor housing states where ventilation is poor, certain communities, and racialized communities may also be at risk.”
advertisement
pushing for change from all provinces
the naci recommendations outline a new need for rsv vaccinations across the country for those over 60. they are as follows:
- older adults aged 60 to 74 years should consult with their healthcare provider and consider a vaccine
- those 75 and older who are at an increased risk of severe rsv are strongly recommended to get the vaccine
- those older than 60 who live in chronic care facilities or long-term care are strongly recommended to get the vaccine
the only province that has jumped on board with the vaccines is ontario, which began publicly funding them last year after assessing the evidence for rsv vaccination. the rest, however, waited for the naci recommendations that were released this past july and are just now in talks to implement new publicly funded rsv vaccination programs.
“there’s absolutely no excuse for provinces and territories not to do that (offer vaccinations),” said tamblyn watts.
as of writing, all other provinces are still working on getting the vaccines publicly funded, and the speed at which they do so is entirely up in the air. because of that, advocacy work and a harder push from advocacy groups and people at risk of rsv are needed to ensure that rsv vaccines are prioritized as they should be.
“we need to be excited that it happens, and we need to make sure that we’re investing in it,” said tamblyn watts. “and that’s only going to happen with the advocacy of people because otherwise, the government has lots of priorities. we need to make sure that they keep vaccines as a key priority.”
share story
