top of page
vmc-icon_1.png

VMC

Note: This is not medical advice. Our blog posts are for general information purposes only and do not replace medical advice, diagnosis, or treatment. The content is based on careful research and scientific sources, but should not be interpreted as medical advice. Please always consult a doctor with any health-related questions. This article was created with AI assistance and editorially reviewed by the author listed.

(NEWS) RSV vaccination for adults 50+: New evidence 2025/2026 shows 58-75% protection – Germany & USA compared

The respiratory syncytial virus (RSV) vaccine is no longer just a new topic, but has become an established part of preventative care for older adults. But how effective are the vaccines in real-world situations? The latest data from 2025 and 2026 now provide clear answers: A recent JAMA study shows a 58% protective effect against hospitalization over two seasons, while large healthcare data in the JAMA Network Open even demonstrates an effectiveness of around 75% against acute RSV infections. A Lancet analysis also confirms the high level of protection (77–81%). While in Germany the Standing Committee on Vaccination (STIKO) and the Federal Joint Committee (G-BA) recommend vaccination for everyone aged 75 and older, as well as for at-risk groups from age 60, the US authorities (CDC) define the at-risk groups more broadly, starting at age 50. But who benefits the most? And what about rare side effects?

 

Evidence update (as of February 27, 2026) – Why the data is more up-to-date than it seems

 

It may seem confusing at first glance that studies from 2023 are still frequently cited. The reason is simple: RSV vaccines for adults have only been widely available since the 2023/2024 season. Therefore, genuine "real-world" data from patient care could only be collected starting that season.


  • 2023: Approval of the first vaccines (Arexvy, Abrysvo).

  • 2023/24 season: The first season in which broad real-world vaccination data was generated.

  • Season 2024/25: The second season provided data on the durability of the protection.

  • 2025/2026: The first major syntheses, meta-analyses and systematic reviews evaluating these data sets are now available.

  • This means that the body of research is now (as of February 2026) more robust than ever before, as it is based on millions of administered doses.

 

Real-world effectiveness 2025/2026 – What the latest studies show

 

(A) Protection against hospitalization (hard endpoints)

A study published in October 2025 in the prestigious journal JAMA provides particularly high-quality data. It is a test-negative design study conducted over two seasons in 26 clinics across 20 US states.


  • Overall protection: The vaccine efficacy (VE) against RSV-associated hospitalization was 58% (95% CI 45–68%) over the entire observation period.

  • First season: In the vaccination season itself, the protection was significantly higher at 69%.

  • Second season: In the following season (prior-season vaccination), the protection rate was still at 48%.

  • This suggests a certain decrease in protection (waning) in the second year, but the protection remains clinically relevant.

  • The study confirms that vaccination effectively prevents severe cases.

  • Particularly important: Robust protection was also observed in older adults (≥75 years).

 

(B) Big Healthcare Data (EHR Analyses)

Another important publication appeared in 2025 in JAMA Network Open. This involved analyzing electronic health records (EHRs) from the huge Epic Cosmos network, providing a database of over 787,000 patients.


  • High efficacy: The analysis showed a vaccine effectiveness (VE) of approximately 75% (95% CI 73.6–76.4%) against RSV-associated acute respiratory diseases (emergency room visits, doctor visits, hospitalization).

  • Immunosuppressed individuals: People with weakened immune systems also benefited significantly. The VE (vegetative efficacy) ranged between 67% and 73%, depending on the age group.

  • Transplant recipients: In patients with organ transplants, the level of protection varied more (29–69%).

  • Special feature: The lowest efficacy (approx. 29-44%) was observed in stem cell transplant recipients, highlighting the particular vulnerability of this group.

  • These data confirm the effectiveness under "real-world" conditions outside of clinical trials.

  • The large number of cases allows for valid statements even for subgroups.

 

(C) 2026 syntheses (meta-analyses/systematic reviews)

Summary studies for the year 2026 are now also available, which complete the overall picture.


  • A systematic review in The Lancet Regional Health Europe (2026) summarizes data on vaccination uptake, efficacy and safety and confirms the positive benefit-risk profiles.

  • A paper in Clinical Infectious Diseases (2026) examines the worldwide effectiveness regarding emergency room visits and hospitalizations.

  • The Lancet publication from 2024 (for the 23/24 season) already showed a VE of 77–81% against hospitalizations and emergency room visits.

  • The consistency of this data across different study types strengthens confidence in the vaccination recommendation.

 

Security – Post-Marketing Data 2024/2025

 

After approval, the safety of vaccines is closely monitored during widespread use (post-marketing). The following findings emerged for 2024/25:


  • Guillain-Barré syndrome (GBS): A very rare signal for GBS was observed.

  • Arexvy (GSK): Here, approximately 5.2 additional cases per 1 million administered doses were calculated.

  • Abrysvo (Pfizer): Here the rate was slightly higher at approximately 18.2 additional cases per 1 million doses.

  • Assessment: The risk is extremely low and must be weighed against the significantly higher risk of serious RSV complications (pneumonia, death).

  • ITP (Immune Thrombocytopenia): An initial suspicion of ITP was not confirmed in the large-scale analyses.

  • Transparency: The US FDA has updated the package inserts to inform about the rare GBS risk.

 

Recommendations & Implementation – Germany vs USA

 

Germany (RKI/STIKO & G-BA)

In Germany, there are clear rules that are recommended by the Standing Committee on Vaccination (STIKO) and implemented into mandatory benefits by the Federal Joint Committee (G-BA).


  • Standard vaccination: Recommended for all persons aged 75 and over.

  • Indication vaccination: Recommended for people aged 60 to 74 years if they have serious underlying health conditions or live in care facilities.

  • Timing: Ideally in September or October, i.e., before the start of the RSV season.

  • Dosage: Currently, a single dose is recommended. An annual booster is not currently planned.

  • Costs: The aforementioned groups are entitled to reimbursement of costs by statutory health insurance funds (G-BA decision).

  • Combination: Simultaneous administration with flu or COVID-19 vaccines is possible (in different limbs).

  • Sources: RKI STIKO FAQ, G-BA guideline.

 

USA (CDC)

The US Centers for Disease Control and Prevention (CDC) has broadened its recommendations somewhat, particularly regarding risk groups.


  • Age group ≥75: Recommended for all adults aged 75 and over.

  • Age group 50–74: Recommended for all individuals at increased risk of severe illness. This risk definition is broader than in Germany.

  • Dosage: Here too, a single dose is required, not an annual vaccination.

  • Timing: The recommended period is August to October.

  • Vaccines: Three approved vaccines are used: Arexvy, Abrysvo and mResvia.

  • Combination: Co-administration is permitted, although it should be noted that antibody titers may be somewhat lower (clinical relevance unclear).

  • Sources: CDC Adults Vaccination Recommendations.

 

For whom is the RSV vaccination particularly suitable?

 

Based on current evidence, certain groups benefit massively from vaccination.


  • Everyone aged 75 and over: Defined as the standard group in both Germany and the USA, as the risk of severe cases increases exponentially with age.

  • 50–74 years with risk factors: These include chronic heart or lung diseases (COPD, heart failure), diabetes mellitus with complications or renal insufficiency.

  • Residents of nursing homes: Due to close living conditions and often existing frailty, they are particularly at risk.

  • Immunosuppressed individuals: Despite slightly lower efficacy, vaccination offers substantial protection (67–73%).

  • Exception: In stem cell transplant recipients, the protection is significantly reduced to 29–44%, but possibly still better than no protection.

  • Responder rate: The data show that approximately 75–80% of those vaccinated respond well to the vaccine and develop protection.

 

Dosage & practical application

 

The practical implementation of the vaccination is straightforward.


  • Administration: This is a single dose of 0.5 ml, injected intramuscularly (in) into the upper arm muscle.

  • Available vaccines:

    • Arexvy (GSK): Protein-based vaccine with an adjuvant.

    • Abrysvo (Pfizer): Protein-based vaccine (bivalent).

    • mResvia (Moderna): mRNA vaccine (approved since 2024).

  • Onset of effect: Full protection from the vaccine is achieved approximately 14 days after injection.

  • Duration of protection: Clinical studies show protection for at least 2 years. However, real-world data indicate a certain waning of protection after the first year.

  • Tolerability: The side effects are mostly mild and typical for vaccinations (see below).

 

Comparison of vaccines

 

The question often arises: Which vaccine is the best?


  • Efficacy: There are currently no direct comparative studies (head-to-head). Data from individual studies suggest that the efficacy of all three products is in a similar range.

  • GBS risk: Post-marketing data show slight numerical differences (Arexvy 5.2/1M vs. Abrysvo 18.2/1M), but both risks are very low. Sufficient long-term data for mResvia is not yet available.

  • Co-administration: For Arexvy, simultaneous administration with influenza vaccines is the best studied option.

  • Handling: In practice, it is relevant that mResvia comes as a pre-filled syringe, while the others have to be reconstituted.

  • Conclusion: The STIKO currently does not favor any of the vaccines; all are considered suitable.

 

Side effects & contraindications

 

As with any medical procedure, transparency about possible side effects is crucial.


  • Common (>10%): pain at the injection site, fatigue, headache, and muscle pain (myalgia). These reactions indicate that the immune system is working.

  • Rare: Guillain-Barré syndrome (GBS) is a rare neurological disorder. The risk is minimally increased (see above), but it exists.

  • Contraindications: Anyone with a known severe allergy to components of the vaccine must not be vaccinated.

  • Precautions:

    • Pregnancy: The STIKO (Standing Committee on Vaccination) does not currently recommend RSV vaccination as a standard treatment for pregnant women, even though Abrysvo is approved for this purpose. The evidence is still being reviewed.

    • Acute infections: Vaccination should be postponed if there is a high fever.

  • Interactions: When using Abrysvo, a minimum interval of 2 weeks should be observed between Abrysvo and Tdap vaccinations (tetanus, diphtheria, pertussis) to ensure an optimal immune response.

 

What remains unclear? – Limitations of the current evidence

 

Despite the good data situation, there are still open questions that are being researched.


  • Long-term protection: How good is the protection after more than 2 years? Will we need a booster at some point? That's still unclear.

  • Optimal booster strategy: If a booster is needed – when and with what? Data is still lacking on this.

  • Severe immunosuppression: For patients with very severe immunosuppression (e.g., after stem cell transplantation), the effectiveness has not yet been satisfactorily clarified or optimized.

  • Direct comparison: Large head-to-head studies that directly test the vaccines against each other are lacking.

  • mRNA long-term data: Since mResvia was approved later, there is less real-world long-term data available than for protein-based vaccines.

 

⚠️ Important notice:

This information is for general informational purposes only and does not constitute medical advice. RSV vaccination should be discussed with your doctor, especially if you have pre-existing medical conditions or are immunocompromised. The efficacy data mentioned refers to study populations and may vary from person to person. If you have questions about your individual vaccination needs, please consult a healthcare professional.

 

Sources

 

  • Self WH, et al. RSV Vaccine Effectiveness Against Hospitalization Among US Adults Aged ≥60 Years During 2 Seasons. JAMA. 2025;334(16):1442-1451. DOI: 10.1001/jama.2025.15896

  • Fry SE, Terebuh P, Kaelber DC, Xu R, Davis PB. Effectiveness and Safety of Respiratory Syncytial Virus Vaccine for US Adults Aged 60 Years or Older. JAMA Network Open. 2025;8(5):e258322. DOI: 10.1001/jamanetworkopen.2025.8322

  • Payne AB, et al. Respiratory syncytial virus (RSV) vaccine effectiveness against RSV-associated hospitalizations 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):1471-1482. DOI: 10.1016/S0140-6736(24)01738-0


Further links:


bottom of page