About the RSV Vaccine
Respiratory syncytial virus (RSV) can lead to serious lung illness, particularly in elderly individuals and those with compromised immune systems. With newly released extended eligibility requirements, the Canadian Immunization Guide now advises older persons to receive a single dose of the RSV vaccine. The risks for severe RSV infection are older age, those with chronic disease, immune compromised, those in nursing homes and immune suppressive drugs.
Why It Matters for People With Lupus
Because lupus and many of its treatments can compromise immune defenses, people with SLE are at higher risk of complications from respiratory viral infections, including RSV. The RSV vaccine reduces the severity of RSV illness including hospitalization. Despite a lack of specific data in SLE, general guidelines for immunization in immunocompromised hosts apply. Even partial protection is advantageous.
In SLE higher risk patients who could benefit from the RSV vaccination are older people, those living in a nursing home, those with lung disease (such as emphysema/COPD, recurrent pneumonia, bronchiectasis, interstitial lung disease, damaged lungs from blood clots, pulmonary hypertension, and ‘shrinking lungs’ from diaphragm weakness) and those on strong immune suppression.
Recommendations and Dosing
75 years of age and older
The National Advisory Committee on Immunization (NACI) now advises a single dose of the RSV vaccine (RSVPreF3, RSVpreF, or mRNA-1345), particularly for those who are more susceptible to severe RSV disease (e.g., those with chronic diseases).
60 years of age or older
Adults aged 60 or older who live in long-term care or chronic care institutions are recommended to get the RSV vaccine.
50 to 74 years of age
For adults 50 to 74 years of age, RSV vaccination is considered a shared clinical decision with their healthcare provider.
Either RSVPreF3 or mRNA-1345 may be used for those aged 60–74, and RSVPreF3 alone may be used for those 50–59.
Timing and Practical Considerations
The optimal vaccine timing is right before or right at the beginning of the RSV season, usually the fall and winter months. This is the timing of flu shots and COVID boosters also.
The duration of protection and benefit of boosting are still unknown; no booster doses are now advised beyond the initial dosage. This could change as more knowledge following patients who are vaccinated over time is acquired.
Safety and Lupus Considerations
1. Because the currently used RSV vaccines in Canada are non-live, they are safer for immunocompromised patients than live vaccines would be.
2. Common side effects are mild and short-lived (pain at the injection site, fatigue, headache).
3. For people who recently had RSV, vaccination may be given once clinically recovered; there is no fixed waiting period.
4. For recent organ transplant recipients (e.g., kidney transplant), NACI suggests waiting 3–6 months post-transplant.
5. Vaccination should be postponed for severe acute illness, though mild illnesses (e.g., common cold) are acceptable for vaccination.
Conclusion
RSV infection can be quite dangerous for lupus patients, particularly if they are elderly or on immunosuppressive drugs. The use of non-live vaccinations means RSV vaccination is generally safe for immunocompromised people, and the revised Canadian guidelines now make it available to more adults. Protection against severe respiratory disease and hospitalization is a significant benefit, even though moderate side effects are possible.
Always discuss RSV vaccination with your healthcare practitioner to find the optimal time and strategy for you, as timing with lupus drugs or disease activity can alter your reaction.
Authors: Daniel Tingey and Doctor Janet Pope
Note: Please consult your healthcare provider or local health authorities for up-to-date vaccine recommendations.