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The Side Effects of RSV Vaccines

Risk of serious illness from respiratory syncytial virus in older adults can outweigh possible reaction to shot

spinner image a woman lying down on the couch pinching the bridge of her nose due to RSV vaccine side effects
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The first two vaccines for RSV were approved in mid-2023, and since then roughly a quarter of the 60-plus population has rolled up their sleeves for one to reduce the risk of getting seriously sick from the common respiratory infection.

While often thought of as an illness that affects babies and young kids, RSV, or respiratory syncytial virus, is “a really serious medical problem” among older adults, says Kawsar R. Talaat, M.D., an associate professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. And it’s one that’s poorly recognized, she adds, since historically there was no way to prevent or treat it, so there was less incentive to test for it.  

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And while we still don’t have medications to treat the illness, like we do for flu and COVID-19, we now have tools to help prevent it: three RSV vaccines for older adults, including a new one that gained approval on May 31.

RSV Vaccines: What Are the Options?

Two RSV vaccines for adults 60 and older were approved in 2023:

  • Abrysvo, from Pfizer
  • Arexvy, from GSK

A third vaccine was approved May 31, 2024:

  • mRESVIA, from Moderna

Moderna’s vaccine hasn’t been formally recommended by the CDC and its advisory committee, but it could get that stamp of approval in June.

“[These vaccines] will keep people out of the hospital and keep people alive,” Talaat says.

Here’s what we know so far about the side effects people have experienced after getting an RSV vaccine and what to expect when you get one.

Common RSV shot side effects are nothing new

The common side effects of RSV vaccines that have been reported — both in clinical trials and through the national Vaccine Adverse Event Reporting System (VAERS) — are similar to the common symptoms people experience after a flu shot or COVID-19 vaccine. They include:

  • Injection site pain
  • Fatigue
  • Muscle pain
  • Headache
  • Joint stiffness/pain
  • Nausea

These post-shot symptoms “can happen with any vaccine,” says William Schaffner, M.D., a professor of medicine at Vanderbilt University School of Medicine in Nashville, and are generally a sign that the body is mounting an immune response.  

“There’s no free lunch out there. And there is no perfect drug or vaccine. All of them have some sort of side effects,” Schaffner says.


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Scientists probe link between vaccines, Guillain-Barré syndrome

Serious side effects from vaccines are uncommon, but they can happen. And a new report from the Centers for Disease Control and Prevention (CDC) finds that a small number of older adults have developed a rare neurological disorder known as Guillain-Barré syndrome (GBS) after RSV vaccination.

While its cause is not fully understood, GBS often occurs after an infection with a virus or bacteria, and on very rare occasions can develop in the days or weeks after getting a vaccine, the CDC says. When GBS occurs, the immune system mistakenly attacks part of the nervous system, resulting in symptoms that can range from mild (for example, some muscle weakness) to severe (paralysis).

Most people who get GBS — an estimated 3,000 to 6,000 each year in the U.S. — fully recover from the syndrome, the CDC says, but some are left with permanent nerve damage. And while anyone can get it, adults 50 and older are at greatest risk.

Federal researchers analyzed data from VAERS and found about five cases of GBS were reported for every 1 million older adults who received Pfizer’s vaccine (Abrysvo), and about 1.5 cases of GBS were reported for every 1 million older adults who received GSK’s vaccine (Arexvy) between May 2023 and April 2024. The researchers acknowledge the rates were “more common than expected,” but that the benefits of the shots continue to outweigh potential risks.

The risk for GBS is still “very, very, very low,” Schaffner says. “And you have to compare it with the serious illness that RSV can produce in people older than 60 years of age.”

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RSV typically causes cold-like symptoms, but in some cases those symptoms can progress to a lung infection or pneumonia. RSV can also worsen other health conditions like asthma or chronic obstructive pulmonary disease (COPD). “Particularly as you get progressively older, the risk goes up for serious disease,” Schaffner says. “And that can be compounded if you have chronic underlying medical conditions.”

The CDC estimates that RSV sends 177,000 older Americans to the hospital annually; about 14,000 older adults die each year from an RSV infection.  

GBS was flagged as a rare side effect in the clinical trials testing the RSV vaccines. (The CDC report notes that findings from the surveillance systems like VAERS are “generally consistent with those from trials.”) A handful of cases of atrial fibrillation, or an irregular heart rhythm, were also reported in the clinical trials, and a small number have been picked up in the surveillance system. 

In the latest CDC report, the authors note that the CDC and U.S. Food and Drug Administration are “conducting active safety evaluations to assess risks for GBS and other adverse events of special interest after RSV vaccination.”  However, the latest data does not change current recommendations,  “because the risk of RSV serious infection in these highly vulnerable populations is vastly greater than is the risk of Guillain-Barré,” Schaffner says.  

Questions? Talk to your doctor

If you’re concerned about potential side effects from the RSV vaccine, Talaat says you should talk to your doctor.

The RSV vaccine is one that’s recommended as a single dose for adults 60 and older based on “shared clinical decision-making,” meaning your doctor can help you determine whether you’re a good candidate for the shot in the first place, then can help you weigh any potential risks. “And then you can make that decision based on that,” Talaat says. 

The CDC says the best time to get vaccinated for RSV is in late summer and early fall — “just before RSV usually starts to spread in the community.”

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