Respiratory syncytial virus (RSV) vaccine recommendations for adults: a review of available global, regional, and country level recommendations

Respiratory syncytial virus (RSV) can cause serious disease in older adults (OAs), particularly those with underlying medical conditions. It can lead to acute respiratory illness and lower respiratory tract infections in adults ≥60 years and at increased risk groups. RSV morbidity, mortality, and health care burden are increasingly evident. This review aims to equip clinicians with practical guidance to support consistent implementation of RSV vaccination recommendations. We examined global implementation of RSV vaccination recommendations by extracting guidelines from national immunization technical advisory groups, ministries of health, global and regional recommendations, and local medical societies. We categorized guidance by age, risk factors and comorbidities. We compared differences in indications, age thresholds, and frameworks. Across >24 countries and >50 medical societies, a common recommendation supports RSV vaccination in ≥60 years and immunocompromised individuals. The set cutoff date was November 2025. However, significant heterogeneity exists across countries in age threshold indications and risk-based eligibility, as well as in implementation depending on health system infrastructure and resources. Global guidance converges on prioritizing vaccination for OAs and individuals at high risk of severe disease. By synthesizing worldwide RSV vaccination recommendations, this review offers clinicians an accessible guide to support consistent RSV vaccination. Why was the study done? Respiratory syncytial virus (RSV) used to be perceived as an illness primarily affecting children, but it can also cause serious disease in older adults (OA), especially those with chronic health problems such as cardiorespiratory and metabolic diseases. RSV leads to thousands of hospitalizations and deaths each year among older adults globally. Limited testing and symptoms overlap with flu or coronavirus disease often result in underdiagnosis. This review consolidates global, regional, and national immunization technical advisory groups (NITAG) and medical societies’ recommendations on RSV vaccination to provide clinicians with a clear reference. What did the researchers do and find? We extracted guidance from NITAGs, ministries of health, global, and regional recommendations, and local medical societies across specialties. We then compared recommendations across age indications, risk-based criteria, and comorbidity frameworks to highlight differences. Across 24 countries and over 50 specialty societies, there is broad agreement supporting RSV vaccination for OAs, immunocompromised individuals, and those with significant chronic conditions. Endorsements span cardiology, pulmonology, diabetology, nephrology, oncology, and geriatrics, reflecting widespread recognition of the susceptibility of OAs to RSV‑related severe outcomes and the importance of RSV prevention in this population. However, notable heterogeneity persists regarding age thresholds, definitions of high-risk groups, and other specific recommendations. What do the results mean? Despite variations in recommendations, the overarching message remains consistent: RSV vaccination should be prioritized for people 60 years and older and earlier for those at increased risk. What is the objective influence on the wider field? By bringing together these diverse recommendations into one summary, this review supports evidence-based clinical decision-making and advances efforts to reduce the global burden of RSV in OAs.