Respiratory Syncytial Virus, or RSV, has long been a major public health concern — especially for infants and older adults. While the virus typically causes mild cold-like symptoms, it can lead to severe respiratory complications like pneumonia and bronchiolitis, particularly in high-risk groups.
RSV remains a leading cause of lower respiratory tract infections, and among adults 65 and older it accounts for an estimated 100,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths in the U.S. each year.
For decades, there was no way to prevent serious RSV infection. That changed in 2023, when the FDA approved the first two RSV vaccines. A third followed in 2024, and the approved age ranges have expanded substantially since.
If you last read about RSV vaccines a couple of years ago, a fair amount has changed — including who’s eligible. Let’s get you current.
In This Article:
- The three RSV vaccines available
- Who’s eligible now (this has changed)
- How to choose — and why comparing the trial numbers is trickier than it looks
- What we carry
- Side effects, including the GBS question
Overview of RSV Vaccine Options
All three vaccines work by targeting the RSV prefusion F protein — the structure the virus uses to enter your cells. Teach the immune system to recognize it, and the body is better equipped to fight the virus off. They get there by different routes.
Arexvy (GSK)
Protein-based and adjuvanted, using the same class of immune-boosting compound found in the shingles vaccine.
In clinical trials, Arexvy reduced symptomatic RSV lower respiratory tract disease by 82.6% in the first season after vaccination, and 56.1% in the second.
Not for use in pregnancy.
Abrysvo (Pfizer)
Protein-based, without an adjuvant, and bivalent — it includes prefusion F protein from both RSV-A and RSV-B.
In trials, Abrysvo reduced lower respiratory tract disease by about 67% and RSV-related hospitalization by about 85%.
This is the only RSV vaccine used in pregnancy, given at 32 to 36 weeks to pass protection to the newborn.
mRESVIA (Moderna)
The newest of the three and the only mRNA option, approved in 2024. Rather than delivering the protein, it delivers instructions for your cells to build it.
Clinical trial data showed efficacy against symptomatic RSV of roughly 80% during the first four months after vaccination.
Not for use in pregnancy.
Who’s Eligible Now? (This Part Has Changed)
If you were told a couple of years ago that you were too young for an RSV vaccine, check again. The recommendations have moved twice.
Current CDC recommendations:
- All adults 75 and older — a single dose.
- Adults 50 to 74 at increased risk — a single dose. The lower bound dropped from 60 to 50 in 2025.
- Pregnant patients at 32-36 weeks during September through January, using Abrysvo.
“Increased risk” includes chronic heart or lung disease, diabetes, chronic kidney or liver disease, severe obesity, weakened immunity, and living in a nursing home or long-term care facility. It’s not an exhaustive list — ask us.
One wrinkle worth understanding. As of March 2026, all three vaccines are FDA-approved down to age 18 for adults at increased risk. But CDC recommendations still stop at 50. Approval and recommendation are two different things, and the gap affects insurance coverage. If you’re under 50 with a serious underlying condition, that’s a real conversation to have — just not a routine recommendation yet.
And this one isn’t annual. A single dose is what’s recommended. Revaccination is not currently advised, so most people vaccinated in 2023, 2024, or 2025 don’t need another. Check your records, or let us check.
Comparing RSV Vaccines: How to Choose
Here’s something we should have said more carefully in earlier versions of this article.
You can’t cleanly compare those trial percentages against each other. We previously set Abrysvo’s 85% next to Arexvy’s 82.6% as though they were the same measurement. They aren’t. One is hospitalization, the other is symptomatic lower respiratory tract disease. The trials used different endpoints, different case definitions, different seasons, and different populations. Lining the numbers up side by side produces a comparison that looks precise and isn’t.
What the evidence actually supports: all three provide substantial protection against serious RSV outcomes, and none is preferred over the others for adults 50 and up. Real-world data from the 2023-24 season put Arexvy and Abrysvo at roughly 77-83% effective against RSV-associated hospitalization in adults 60+. More recent CDC network data found about 57% effectiveness against hospitalization measured across two full seasons — strong initially, meaningfully reduced but still real by year two.
So the honest factors for choosing:
Pregnancy. This is the only genuine product-level decision. Abrysvo is the one. Arexvy and mRESVIA are not for use in pregnancy.
Platform preference. If you’d rather have an mRNA vaccine, mRESVIA. If you’d rather not, Arexvy or Abrysvo.
Availability. Take what your pharmacy has. The gaps between these products are small relative to the gap between vaccinated and not.
Your health status and your provider’s read. If you’ve got a complicated history, that conversation is worth having.
What We Carry
We stock mRESVIA. If you specifically need Arexvy or Abrysvo, call us first and we’ll tell you honestly what we can do.
For pregnant patients: Abrysvo is the required product, and we’re glad to help you find a provider who has it if we can’t fill that need directly.
Learn More: 2026-2027 RSV Vaccine Rundown: Everything You Need to Know
Side Effects — Including the Question People Actually Ask
The common stuff
All three have similar profiles: pain, redness, or swelling at the injection site, plus fatigue, headache, and muscle or joint pain. Generally mild, generally gone in a day or two.
Worth knowing: younger recipients tend to feel it more. In trials, adults 18-49 reported muscle aches and fatigue at noticeably higher rates than adults 50-59.
About Guillain-Barré syndrome
Earlier versions of this article didn’t address GBS, and we should have. Here’s where the evidence stands.
There does appear to be a small increased risk of GBS following RSV vaccination in older adults. U.S. post-licensure surveillance found an elevated rate, confirmed in follow-up analysis. One large analysis estimated roughly 18 excess cases per million doses of Abrysvo and roughly 5 per million doses of Arexvy. A national study in England covering 2.5 million people aged 75-79 found an increased risk independently.
GBS is serious — a rare disorder in which the immune system attacks nerves, usually causing weakness that resolves over weeks to months, though recovery can be slow. We’re not going to wave that off.
It’s also genuinely rare at these rates. Eighteen per million is about one case in 55,000 doses, against a disease that hospitalizes over 100,000 older adults a year and kills thousands. And there’s evidence that RSV infection itself can trigger GBS, meaning some cases prevented by vaccination may offset some associated with it.
CDC’s 2026 assessment is that benefits continue to outweigh risks in older adults, and we agree with that read. But you deserve the numbers rather than a shrug — and if this is what’s making you hesitate, come talk to us about it directly rather than deciding alone.
About pregnancy
Preterm birth was flagged as a possible concern in earlier trial data. More recent evidence is reassuring: no significant association with preterm birth was observed when Abrysvo was given at 32 to 36 weeks — which is exactly why that window is the recommended one.
Although Abrysvo and Arexvy are currently the two primary RSV vaccines available, several other vaccines are in the pipeline.
Some of these focus on providing broader protection across age groups or improving efficacy for particularly vulnerable populations. As more vaccines become approved, individuals will have even more options for RSV prevention in the coming years.
What About Babies?
Worth a brief note, since RSV is most dangerous in infants and this is the question we get from grandparents.
Infants aren’t protected by vaccinating them directly. They’re protected two ways: through maternal vaccination with Abrysvo during pregnancy, or through monoclonal antibodies given to the infant — nirsevimab, and now clesrovimab, which joined the toolkit for the 2025-26 season. These are antibody products rather than vaccines, and they’re administered through pediatric providers.
If you’re an expectant parent or grandparent trying to sort this out, ask your OB or pediatrician which route applies to your situation.
RSV Vaccines in 2026: Now You Know
RSV still poses a real threat to vulnerable people, but we now have three good vaccines and a wider eligible population than when these first arrived.
The most important thing in this article isn’t which brand to pick. It’s this: the eligibility age dropped to 50 for at-risk adults, and a lot of people who now qualify still think they don’t.
If you’re 75 or older, or 50 to 74 with a condition that raises your risk, and you haven’t had an RSV vaccine — you’re the person this article is for. It’s one dose; it’s not annual, and late summer is the ideal time.
Talk to one of our experts or your healthcare provider, and let’s get you sorted.