It has long been recognized that the public health burden of winter respiratory viruses is not solely attributable to influenza. Numerous studies have identified respiratory syncytial virus (RSV) as a major problem in children, and its burden in older adults is increasingly recognized as broadly comparable to that of influenza even though public awareness of it is far lower. Since 2020, SARS-CoV-2 has emerged as a third major pathogen. Although it initially displaced influenza and RSV owing to the nonspecific effect of global social distancing, both viruses reemerged strongly from 2023 onwards. Influenza, RSV, and SARS-CoV-2 now form the “Big 3” of respiratory viruses with significant public health impact.
There are notable differences between the Big 3.
Influenza has always been highly seasonal in temperate zones in winter (less so in tropical regions, where it is generally associated with wet seasons), albeit somewhat unpredictable in its exact timing.
RSV is also highly seasonal with, if anything, more predictable timing before and after short-term perturbations in 2022-2023 and 2023-2024.
Human populations are still emerging from the first-ever SARS-CoV-2 pandemic. Most experts expected, on the basis of first principles, that SARS-CoV-2 would also adopt a winter seasonal pattern. Yet, at the present time, epidemics and resurgences are not obviously season-dependent and instead are closely related to the emergence of new variants. Nevertheless, it remains plausible that SARS-CoV-2 will eventually settle into a more seasonal pattern. Equally, it is plausible that the current rate of virus mutation will slow down in terms of its ability to produce even fitter variants that are better adapted to humans than their predecessors. This could mean that the virus may yet recede in public health importance over a period of one decade or more until it falls back to a status similar to that of other endemic human coronaviruses.
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Epidemiologic history tells us that influenza has circulated in humans for well over a century — long before identification of the main causative virus, influenza A, in 1933. Setting aside pandemics in 1918, 1957, 1968, and 2009, there have been persistent winter epidemics of influenza A of variable intensity every year. The origins of influenza B can only be traced back to its discovery in 1936. Human populations can experience separate or overlapping epidemics of influenza A and B in the same winter season. Periodic reinfection is common, in line with known high virus mutability and immune escape.
RSV was discovered in humans in 1957 and is also markedly seasonal. It is well-recognized as a major autumn and winter respiratory problem in young children aged 0-2 years, resulting in bronchiolitis and hospitalization. However, the effects of reinfection in adults and the burden of winter hospitalization in older adults, with accompanying mortality, are less well quantified, mainly owing to underuse of diagnostic tests in primary and secondary care. Still, RSV’s effects in adults are becoming increasingly recognized as being substantial. Virus mutability in RSV is intrinsically far less than in influenza.
Understanding Current Capability
In the past 2 years, the world entered an era in which the Big 3 human respiratory viruses can all now be classed as vaccine-preventable illnesses; three RSV vaccines having been recently licensed. A more precise definition would be that they are vaccine-modifiable illnesses because influenza vaccines, despite enhancements, are still relatively poor at preventing infection, with modest-to-good effectiveness in reducing severe disease. Similarly, COVID-19 vaccines, in the face of new variants, appear to produce potent reductions in disease severity but very short duration of protection against infection. It remains to be fully seen what the full public health impact of RSV vaccines will be, but early data from the UK on reduced hospitalization in older adults appear promising.
With the advent of adult respiratory vaccines for three major pathogens, immunization schedules offer increased challenges relating to complexity of choice for providers and patients and to the development of recommendations and implementation plans for national immunization technical advisory groups (NITAGs) and health authorities.
First, the influenza vaccine market is diversifying rapidly in terms of technological enhancement. Alone or in combination, techniques such as adjuvantation, egg-free manufacturing, recombinant formulation, and increased antigen content expand choice and complexity for NITAGs, frontline providers, and patients. There are very few head-to-head studies offering gold-standard clinical evidence to guide choices and relatively few high-quality observational datasets capable of making robust interproduct evaluations. Conducting such studies is primarily the responsibility of public health agencies, not manufacturers, but progress is slow. For the foreseeable future, influenza vaccines will require annual strain change updates due to the mutability of the virus and the dependence — so far — on targeting the major surface antigen, hemagglutinin, as opposed to more conserved epitopes.
In contrast, RSV vaccine programs are in their infancy. Vaccine choices are fewer in number and many NITAGs do not yet have fully settled recommendations in terms of target population, the frequency of revaccination needed (possibly biennial), or even which of these vaccines can be adequately boosted and whether homologous or heterologous boosting will ultimately prove better.
Postpandemic COVID-19 vaccine programs have now settled into targeting older adults and younger high-risk patients, and periodic boosters (6-monthly in very high-risk populations) appear necessary. But it is important to recognize that these vaccines came into being during a global public health emergency when price was almost no object to many governments who placed orders for products that did not even exist at the time of ordering. Reintroducing the normal rules of cost-effectiveness may further modify the demand for COVID-19 vaccines over time. Of the three mono-pathogen vaccines, it is least predictable whether the COVID-19 vaccine will need to be an enduring or “forever” recommendation for NITAGs.
Challenges That Need to Be Addressed
Many vaccine companies and health professionals have envisioned the promise of combination respiratory vaccines, especially in older adults. Several companies are now actively engaged in the development of bi- or tri-pathogen combination vaccines for influenza, RSV, and COVID-19.
The intrinsic attraction is obvious. It would be nothing short of brilliant if older adult patients could present in the autumn for a single vaccine that would offer reliable protection against severe disease associated with influenza, RSV, and COVID-19. This would minimize administration costs, potentially improve overall uptake, and drastically improve convenience for patients wishing to have protection against all three pathogens. But behind the attractive simplicity of this prospect lie a series of challenges for developers and public health authorities to resolve.
First, developers must decide whether to pursue bi- or tri-pathogen combinations.
Although it may be obvious to target all three pathogens as the best combination, this may not be optimal if one pathogen — potentially COVID-19 — drops from NITAG preference for epidemiologic reasons or if cost-effectiveness constraints suggest that only two of the three antigens offer good value for payers. It will also be the most technically demanding option.
In immunologic terms, increasing the number of pathogens in a single vaccination may offer technical constraints in terms of immune interference leading to blunting of pathogen-specific immunogenicity compared with mono-pathogen vaccine equivalents. For example, data already demonstrate that co-administration of mono-pathogen protein-based RSV (RSVPreF) and inactivated influenza vaccines can lower the immune response to both RSV and influenza A/H3N2, although the clinical significance is currently uncertain.
Second, if NITAG choices gravitate towards bi-pathogen vaccines, developers need to hedge on which combination (influenza-RSV, influenza-COVID-19, or RSV-COVID-19) would be the primary goal.
Influenza and RSV combined vaccines will address two perennial public health problems whose timing is broadly similar, meaning administration could be well-timed for both. However, whereas the need for annual vaccination is clear for influenza, it is far less so for RSV. It is a given that the influenza component will require annual reformulation, but changes to the RSV component currently appear unlikely. NITAGs, providers, and patients will also want reassurance on lack of immune interference between vaccine components.
Influenza and COVID-19 combined vaccines will incorporate one pathogen where the public health need is certain and another where the need might change in the longer term. The seasonality of COVID-19 is not established and it is unclear how often or when the US Vaccines and Related Biological Products Advisory Committee (VRBPAC) and the World Health Organization (WHO) will need to issue renewed advice on COVID-19 vaccine strain changes, which may not be fully in synchrony with the well-embedded “battle rhythm” of biannual WHO strain change advice for influenza vaccines. The timing of administration of an influenza-COVID-19 vaccine would probably be tied to the known need for revaccination of patients in the autumn in anticipation of winter influenza activity, yet this may not always be optimal for COVID-19 strain changes.
RSV and COVID-19 combined vaccines may seem the least intuitive of possible bi-pathogen combinations. Yet, if the recommended interval for COVID-19 revaccination was to become less frequent in the future and more attuned to what might become the interval for RSV revaccination, this combination cannot be entirely discounted and would leave influenza in the clear for the incorporation of annual strain changes.
Finally, there are very few, if any, countries where the official NITAG recommendations for influenza, RSV, and COVID-19 are coterminous, apart from large overlaps in the targeting of older adults. These national- or provider-driven choices will also shape the portion of the market that is truly available for the adoption of combination vaccines, now and in the future.
The Outlook
So, given the challenges above, what could the outlook be for combination respiratory vaccines for older adults?
First, the utility and advantages are worth pursuing for patients, developers, and public health authorities. This is a worthy aspiration.
However, the sheer complexity of the challenges ahead call for meticulous steps and a pathway that involves frequent and early touchpoints between developers, public health agencies (eg, Centers for Disease Control and Prevention, UK Health Security Agency), and NITAGs (eg, Advisory Committee on Immunization Practices, Joint Committee on Vaccination and Immunisation) in a commerce-free safe space. The more typical discursive pathways during new product development are between developers and regulatory agencies (eg, the US Food and Drug Administration, the European Medicines Agency, and the Medicines and Healthcare products Regulatory Agency). Although these will remain necessary, they are unlikely to prove sufficient to assure the pathway to adoption into practical public health policy.
Second, although progress needs to be at speed, it should not run ahead of current uncertainties, such as how RSV revaccination will evolve and the future epidemiologic pattern of COVID-19, both of which might yet produce decisive course corrections in the journey ahead.
Professor Sir Jonathan Van-Tam, DM, was, until recently, pro-vice chancellor for medicine and health sciences at the University of Nottingham, UK, and is now a self-employed consultant in health policy, biopharmaceuticals, and market access. He was Deputy Chief Medical Officer for England during the pandemic.
Van-Tam developed an interest in influenza and respiratory viruses when he turned to academic training in public health and epidemiology following 5 years of hospital-based clinical medicine. He became a senior lecturer at the University of Nottingham and consultant regional epidemiologist for UK public health laboratory services in 1997, before joining the pharmaceutical industry as an associate director at SmithKline Beecham in 2000. In April 2001, he moved to Roche as head of medical affairs before joining Aventis Pasteur MSD in February 2002 as UK medical director. He returned to the public sector in 2004 by joining the Health Protection Agency Centre for Infections as head of the Pandemic Influenza Office until October 2007. He then returned to Nottingham as professor of health protection, maintaining his now 34-year special interest in influenza: epidemiology, transmission, vaccinology, antiviral drugs, and pandemic preparedness. Van-Tam chaired the European Centre for Disease Prevention and Control Expert Advisory Group on H5N1 human vaccines, sat on the UK national Scientific Pandemic Influenza Committee, and the UK Scientific Advisory Group for Emergencies (SAGE) during the 2009-10 influenza pandemic. He is co-editor of the highly rated textbook Introduction to Pandemic Influenza, first published in 2009 and now in its second edition. He was editor-in-chief of the journal Influenza and Other Respiratory Viruses from 2014 to 2017. His research group was an officially designated WHO Collaborating Centre for pandemic influenza and research from 2010-2017. It was also a UK Faculty of Public Health “National Treasure” research training location from 2010 to 2017. Van-Tam was seconded to the Department of Health and Social Care, England as deputy chief medical officer from late 2017 to early 2022. He was knighted in 2022 for his services to public health.
Resources
Athan E, Baber J, Quan K, et al; Study C3671006 Investigator Group. Safety and immunogenicity of bivalent RSVpreF vaccine coadministered with seasonal inactivated influenza vaccine in older adults. Clin Infect Dis. 2024;78:1360-1368. Source
Johannesen CK, Gideonse D, Osei-Yeboah R, et al; PROMISE investigators. Estimation of respiratory syncytial virus-associated hospital admissions in five European countries: a modelling study. Lancet Reg Health Eur. 2025;51:101227. Source
Mensah AA, Whitaker H, Andrews NJ, Watson CH. Early impact of RSV vaccination in older adults in England. Lancet. 2025 March 24. Source
Nguyen-Van-Tam JS, O’Leary M, Martin ET, et al. Burden of respiratory syncytial virus infection in older and high-risk adults: a systematic review and meta-analysis of the evidence from developed countries. Eur Respir Rev. 2022;31:220105. Source
Public Health Scotland. Early evidence of population impact of RSV vaccination on hospitalisations among older adults in Scotland. February 14, 2025. Source
Shi T, Denouel A, Tietjen AK, et al; RESCEU Investigators. Global disease burden estimates of respiratory syncytial virus-associated acute respiratory infection in older adults in 2015: a systematic review and meta-analysis. J Infect Dis. 2020;222(Suppl 7):S577-S583. Source
UK Health Security Agency. Chapter 27a: Respiratory syncytial virus. In: Immunisation Against Infectious Diseases. February 21, 2025: Source
Zhou G, Dael N, Verweij S, et al. Effectiveness of COVID-19 vaccines against SARS-CoV-2 infection and severe outcomes in adults: a systematic review and meta-analysis of European studies published up to 22 January 2024. Eur Respir Rev. 2025;34:240222. Source
COMMENTARY
Is There a Future for Combination Respiratory Vaccines?
DISCLOSURES
Authors and Disclosures
Disclosure: Professor Sir Jonathan Van-Tam, DM, has disclosed the following relevant financial relationships:
Serve(d) as an advisor or consultant for: Sanofi; Seqirus; Moderna; Novavax; PharmaJet; Stablepharma; SC Johnson; Gilead; Shionogi; Vietnam Vaccine Joint Stock Company
Received income in an amount equal to or greater than $250 from: Sanofi; Seqirus; Moderna; Novavax; PharmaJet; Stablepharma; SC Johnson; Gilead; Pfizer; Shionogi; Vietnam Vaccine Joint Stock Company
Other: A close family member is an employee of the Medicines and Healthcare products Regulatory Agency (MHRA)
It has long been recognized that the public health burden of winter respiratory viruses is not solely attributable to influenza. Numerous studies have identified respiratory syncytial virus (RSV) as a major problem in children, and its burden in older adults is increasingly recognized as broadly comparable to that of influenza even though public awareness of it is far lower. Since 2020, SARS-CoV-2 has emerged as a third major pathogen. Although it initially displaced influenza and RSV owing to the nonspecific effect of global social distancing, both viruses reemerged strongly from 2023 onwards. Influenza, RSV, and SARS-CoV-2 now form the “Big 3” of respiratory viruses with significant public health impact.
There are notable differences between the Big 3.
Influenza has always been highly seasonal in temperate zones in winter (less so in tropical regions, where it is generally associated with wet seasons), albeit somewhat unpredictable in its exact timing.
RSV is also highly seasonal with, if anything, more predictable timing before and after short-term perturbations in 2022-2023 and 2023-2024.
Human populations are still emerging from the first-ever SARS-CoV-2 pandemic. Most experts expected, on the basis of first principles, that SARS-CoV-2 would also adopt a winter seasonal pattern. Yet, at the present time, epidemics and resurgences are not obviously season-dependent and instead are closely related to the emergence of new variants. Nevertheless, it remains plausible that SARS-CoV-2 will eventually settle into a more seasonal pattern. Equally, it is plausible that the current rate of virus mutation will slow down in terms of its ability to produce even fitter variants that are better adapted to humans than their predecessors. This could mean that the virus may yet recede in public health importance over a period of one decade or more until it falls back to a status similar to that of other endemic human coronaviruses.
Epidemiologic history tells us that influenza has circulated in humans for well over a century — long before identification of the main causative virus, influenza A, in 1933. Setting aside pandemics in 1918, 1957, 1968, and 2009, there have been persistent winter epidemics of influenza A of variable intensity every year. The origins of influenza B can only be traced back to its discovery in 1936. Human populations can experience separate or overlapping epidemics of influenza A and B in the same winter season. Periodic reinfection is common, in line with known high virus mutability and immune escape.
RSV was discovered in humans in 1957 and is also markedly seasonal. It is well-recognized as a major autumn and winter respiratory problem in young children aged 0-2 years, resulting in bronchiolitis and hospitalization. However, the effects of reinfection in adults and the burden of winter hospitalization in older adults, with accompanying mortality, are less well quantified, mainly owing to underuse of diagnostic tests in primary and secondary care. Still, RSV’s effects in adults are becoming increasingly recognized as being substantial. Virus mutability in RSV is intrinsically far less than in influenza.
Understanding Current Capability
In the past 2 years, the world entered an era in which the Big 3 human respiratory viruses can all now be classed as vaccine-preventable illnesses; three RSV vaccines having been recently licensed. A more precise definition would be that they are vaccine-modifiable illnesses because influenza vaccines, despite enhancements, are still relatively poor at preventing infection, with modest-to-good effectiveness in reducing severe disease. Similarly, COVID-19 vaccines, in the face of new variants, appear to produce potent reductions in disease severity but very short duration of protection against infection. It remains to be fully seen what the full public health impact of RSV vaccines will be, but early data from the UK on reduced hospitalization in older adults appear promising.
With the advent of adult respiratory vaccines for three major pathogens, immunization schedules offer increased challenges relating to complexity of choice for providers and patients and to the development of recommendations and implementation plans for national immunization technical advisory groups (NITAGs) and health authorities.
First, the influenza vaccine market is diversifying rapidly in terms of technological enhancement. Alone or in combination, techniques such as adjuvantation, egg-free manufacturing, recombinant formulation, and increased antigen content expand choice and complexity for NITAGs, frontline providers, and patients. There are very few head-to-head studies offering gold-standard clinical evidence to guide choices and relatively few high-quality observational datasets capable of making robust interproduct evaluations. Conducting such studies is primarily the responsibility of public health agencies, not manufacturers, but progress is slow. For the foreseeable future, influenza vaccines will require annual strain change updates due to the mutability of the virus and the dependence — so far — on targeting the major surface antigen, hemagglutinin, as opposed to more conserved epitopes.
In contrast, RSV vaccine programs are in their infancy. Vaccine choices are fewer in number and many NITAGs do not yet have fully settled recommendations in terms of target population, the frequency of revaccination needed (possibly biennial), or even which of these vaccines can be adequately boosted and whether homologous or heterologous boosting will ultimately prove better.
Postpandemic COVID-19 vaccine programs have now settled into targeting older adults and younger high-risk patients, and periodic boosters (6-monthly in very high-risk populations) appear necessary. But it is important to recognize that these vaccines came into being during a global public health emergency when price was almost no object to many governments who placed orders for products that did not even exist at the time of ordering. Reintroducing the normal rules of cost-effectiveness may further modify the demand for COVID-19 vaccines over time. Of the three mono-pathogen vaccines, it is least predictable whether the COVID-19 vaccine will need to be an enduring or “forever” recommendation for NITAGs.
Challenges That Need to Be Addressed
Many vaccine companies and health professionals have envisioned the promise of combination respiratory vaccines, especially in older adults. Several companies are now actively engaged in the development of bi- or tri-pathogen combination vaccines for influenza, RSV, and COVID-19.
The intrinsic attraction is obvious. It would be nothing short of brilliant if older adult patients could present in the autumn for a single vaccine that would offer reliable protection against severe disease associated with influenza, RSV, and COVID-19. This would minimize administration costs, potentially improve overall uptake, and drastically improve convenience for patients wishing to have protection against all three pathogens. But behind the attractive simplicity of this prospect lie a series of challenges for developers and public health authorities to resolve.
First, developers must decide whether to pursue bi- or tri-pathogen combinations.
Although it may be obvious to target all three pathogens as the best combination, this may not be optimal if one pathogen — potentially COVID-19 — drops from NITAG preference for epidemiologic reasons or if cost-effectiveness constraints suggest that only two of the three antigens offer good value for payers. It will also be the most technically demanding option.
In immunologic terms, increasing the number of pathogens in a single vaccination may offer technical constraints in terms of immune interference leading to blunting of pathogen-specific immunogenicity compared with mono-pathogen vaccine equivalents. For example, data already demonstrate that co-administration of mono-pathogen protein-based RSV (RSVPreF) and inactivated influenza vaccines can lower the immune response to both RSV and influenza A/H3N2, although the clinical significance is currently uncertain.
Second, if NITAG choices gravitate towards bi-pathogen vaccines, developers need to hedge on which combination (influenza-RSV, influenza-COVID-19, or RSV-COVID-19) would be the primary goal.
Influenza and RSV combined vaccines will address two perennial public health problems whose timing is broadly similar, meaning administration could be well-timed for both. However, whereas the need for annual vaccination is clear for influenza, it is far less so for RSV. It is a given that the influenza component will require annual reformulation, but changes to the RSV component currently appear unlikely. NITAGs, providers, and patients will also want reassurance on lack of immune interference between vaccine components.
Influenza and COVID-19 combined vaccines will incorporate one pathogen where the public health need is certain and another where the need might change in the longer term. The seasonality of COVID-19 is not established and it is unclear how often or when the US Vaccines and Related Biological Products Advisory Committee (VRBPAC) and the World Health Organization (WHO) will need to issue renewed advice on COVID-19 vaccine strain changes, which may not be fully in synchrony with the well-embedded “battle rhythm” of biannual WHO strain change advice for influenza vaccines. The timing of administration of an influenza-COVID-19 vaccine would probably be tied to the known need for revaccination of patients in the autumn in anticipation of winter influenza activity, yet this may not always be optimal for COVID-19 strain changes.
RSV and COVID-19 combined vaccines may seem the least intuitive of possible bi-pathogen combinations. Yet, if the recommended interval for COVID-19 revaccination was to become less frequent in the future and more attuned to what might become the interval for RSV revaccination, this combination cannot be entirely discounted and would leave influenza in the clear for the incorporation of annual strain changes.
Finally, there are very few, if any, countries where the official NITAG recommendations for influenza, RSV, and COVID-19 are coterminous, apart from large overlaps in the targeting of older adults. These national- or provider-driven choices will also shape the portion of the market that is truly available for the adoption of combination vaccines, now and in the future.
The Outlook
So, given the challenges above, what could the outlook be for combination respiratory vaccines for older adults?
First, the utility and advantages are worth pursuing for patients, developers, and public health authorities. This is a worthy aspiration.
However, the sheer complexity of the challenges ahead call for meticulous steps and a pathway that involves frequent and early touchpoints between developers, public health agencies (eg, Centers for Disease Control and Prevention, UK Health Security Agency), and NITAGs (eg, Advisory Committee on Immunization Practices, Joint Committee on Vaccination and Immunisation) in a commerce-free safe space. The more typical discursive pathways during new product development are between developers and regulatory agencies (eg, the US Food and Drug Administration, the European Medicines Agency, and the Medicines and Healthcare products Regulatory Agency). Although these will remain necessary, they are unlikely to prove sufficient to assure the pathway to adoption into practical public health policy.
Second, although progress needs to be at speed, it should not run ahead of current uncertainties, such as how RSV revaccination will evolve and the future epidemiologic pattern of COVID-19, both of which might yet produce decisive course corrections in the journey ahead.
Professor Sir Jonathan Van-Tam, DM, was, until recently, pro-vice chancellor for medicine and health sciences at the University of Nottingham, UK, and is now a self-employed consultant in health policy, biopharmaceuticals, and market access. He was Deputy Chief Medical Officer for England during the pandemic.
Van-Tam developed an interest in influenza and respiratory viruses when he turned to academic training in public health and epidemiology following 5 years of hospital-based clinical medicine. He became a senior lecturer at the University of Nottingham and consultant regional epidemiologist for UK public health laboratory services in 1997, before joining the pharmaceutical industry as an associate director at SmithKline Beecham in 2000. In April 2001, he moved to Roche as head of medical affairs before joining Aventis Pasteur MSD in February 2002 as UK medical director. He returned to the public sector in 2004 by joining the Health Protection Agency Centre for Infections as head of the Pandemic Influenza Office until October 2007. He then returned to Nottingham as professor of health protection, maintaining his now 34-year special interest in influenza: epidemiology, transmission, vaccinology, antiviral drugs, and pandemic preparedness. Van-Tam chaired the European Centre for Disease Prevention and Control Expert Advisory Group on H5N1 human vaccines, sat on the UK national Scientific Pandemic Influenza Committee, and the UK Scientific Advisory Group for Emergencies (SAGE) during the 2009-10 influenza pandemic. He is co-editor of the highly rated textbook Introduction to Pandemic Influenza, first published in 2009 and now in its second edition. He was editor-in-chief of the journal Influenza and Other Respiratory Viruses from 2014 to 2017. His research group was an officially designated WHO Collaborating Centre for pandemic influenza and research from 2010-2017. It was also a UK Faculty of Public Health “National Treasure” research training location from 2010 to 2017. Van-Tam was seconded to the Department of Health and Social Care, England as deputy chief medical officer from late 2017 to early 2022. He was knighted in 2022 for his services to public health.
Resources
Athan E, Baber J, Quan K, et al; Study C3671006 Investigator Group. Safety and immunogenicity of bivalent RSVpreF vaccine coadministered with seasonal inactivated influenza vaccine in older adults. Clin Infect Dis. 2024;78:1360-1368. Source
Johannesen CK, Gideonse D, Osei-Yeboah R, et al; PROMISE investigators. Estimation of respiratory syncytial virus-associated hospital admissions in five European countries: a modelling study. Lancet Reg Health Eur. 2025;51:101227. Source
Mensah AA, Whitaker H, Andrews NJ, Watson CH. Early impact of RSV vaccination in older adults in England. Lancet. 2025 March 24. Source
Nguyen-Van-Tam JS, O’Leary M, Martin ET, et al. Burden of respiratory syncytial virus infection in older and high-risk adults: a systematic review and meta-analysis of the evidence from developed countries. Eur Respir Rev. 2022;31:220105. Source
Public Health Scotland. Early evidence of population impact of RSV vaccination on hospitalisations among older adults in Scotland. February 14, 2025. Source
Shi T, Denouel A, Tietjen AK, et al; RESCEU Investigators. Global disease burden estimates of respiratory syncytial virus-associated acute respiratory infection in older adults in 2015: a systematic review and meta-analysis. J Infect Dis. 2020;222(Suppl 7):S577-S583. Source
UK Health Security Agency. Chapter 27a: Respiratory syncytial virus. In: Immunisation Against Infectious Diseases. February 21, 2025: Source
Zhou G, Dael N, Verweij S, et al. Effectiveness of COVID-19 vaccines against SARS-CoV-2 infection and severe outcomes in adults: a systematic review and meta-analysis of European studies published up to 22 January 2024. Eur Respir Rev. 2025;34:240222. Source
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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