Review Article
Respiratory Syncytial Virus Vaccination Recommendations for Adults Aged 60 Years and Older: The NeumoExperts Prevention Group Position Paper
Esther Redondoa, Irene Rivero-Calleb,c,d, Enrique Mascaróse, Daniel Ocañaf, Isabel Jimenog, Ángel Gild,h, Manuel Linaresi, María Ángeles Onieva-Garcíaj,k, Fernando González-Romol, José Yusted,m, Federico Martinón-Torresb,c,d,◊,
Corresponding author
a Infectious, Migrant, Vaccines and Preventive Activities Group of SEMERGEN, International Healthcare Centre of the City Council of Madrid, Madrid, Spain
b Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
c Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain
d CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
e Health Department, Hospital la Fe, Primary Care Centre Arquitecto Tolsá, Valencia, Spain
f Primary Care, Health Care Centre Algeciras, Algeciras, Spain
g Primary Care Health Centre Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain
h Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain
i Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación io, Madrid, Spain
j Preventive Medicine and Public Health Unit, Hospital Universitario Reina Sofía, Cordoba, Spain
k Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain
l Clinical Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
m National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
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class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:13 [ 0 => array:3 [ "entidad" => "Infectious, Migrant, Vaccines and Preventive Activities Group of SEMERGEN, International Healthcare Centre of the City Council of Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Translational Paediatrics and Infectious Diseases Section, Paediatrics Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Genetics, Vaccines, and Infections Research Group (GENVIP), Healthcare Research Institute of Santiago de Compostela, University of Santiago de Compostela, Santiago de Compostela, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "CIBER of Respiratory Diseases (CIBERES), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Health Department, Hospital la Fe, Primary Care Centre Arquitecto Tolsá, Valencia, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Primary Care, Health Care Centre Algeciras, Algeciras, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Primary Care Health Centre Isla de Oza, Vaccine Responsible of SEMG, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Preventive and Public Health, Rey Juan Carlos University, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] 8 => array:3 [ "entidad" => "Specialist in Primary Care and Clinical Microbiology, Infectious Diseases Group SEMERGEN, Fundación io, Madrid, Spain" "etiqueta" => "i" "identificador" => "aff0045" ] 9 => array:3 [ "entidad" => "Preventive Medicine and Public Health Unit, Hospital Universitario Reina Sofía, Cordoba, Spain" "etiqueta" => "j" "identificador" => "aff0050" ] 10 => array:3 [ "entidad" => "Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Spain" "etiqueta" => "k" "identificador" => "aff0055" ] 11 => array:3 [ "entidad" => "Clinical Microbiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain" "etiqueta" => "l" "identificador" => "aff0060" ] 12 => array:3 [ "entidad" => "National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "m" "identificador" => "aff0065" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3266 "Ancho" => 3341 "Tamanyo" => 1066911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vaccination guide against community-acquired pneumonia in adults caused by vaccine-preventable diseases. CSF: cerebrospinal fluid; IPD: invasive pneumococcal disease.</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Adapted from Redondo et al.<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">70</span></a></p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Respiratory syncytial virus (RSV) is a common respiratory pathogen that significantly affects vulnerable populations, including infants, older adults, and individuals with chronic medical conditions and immunocompromised status.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">1</span></a> More than 158,000 RSV-associated hospitalizations occur annually among adults in the EU, 92% of which happen in adults ≥<span class="elsevierStyleHsp" style=""></span>65 years.<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">2</span></a> RSV causes 10,000 deaths among the elderly annually in the US alone.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">3</span></a> Furthermore, its mortality rate is comparable to that of influenza.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">4</span></a> Given the substantial burden of RSV-related illness in adults,<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">5</span></a> there is an urgent need to develop effective prevention strategies, particularly through vaccination, and the WHO has emphasised RSV vaccine development as a top priority.<a class="elsevierStyleCrossRefs" href="#bib0395"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the last two decades, several vaccine candidates have been designed, targeting young children and older adults.<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">8–10</span></a> In 2023, three vaccine formulations designed for older adults successfully completed Phase 3 trials and two already received marketing approval.<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">11</span></a> These recent approvals have revolutionised the field and warrant the exploration of potential vaccination strategies and prophylaxis positioning of available products to prevent and control RSV infections. This paper aims to offer evidence-based recommendations for the vaccination of adult patients against RSV.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">A comprehensive literature review was conducted using electronic databases, including PubMed, Embase, and Cochrane Library until December 2023, to identify relevant studies, clinical trials, and guidelines for RSV infection and vaccination in adults. The search terms included “<span class="elsevierStyleItalic">respiratory syncytial virus</span>”, “<span class="elsevierStyleItalic">adults</span>”, “<span class="elsevierStyleItalic">vaccine</span>”, and related keywords. The selected articles were critically appraised, and data were synthesised to develop evidence-based recommendations.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Epidemiology and Clinical Manifestations</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">RSV Epidemiology in Adults</span><p id="par0020" class="elsevierStylePara elsevierViewall">RSV has long been recognised as a leading cause of respiratory tract infections in infants and young children. However, recent research has also shed light on the significant burden of RSV infections in adults.<a class="elsevierStyleCrossRefs" href="#bib0390"><span class="elsevierStyleSup">5,9</span></a> Based on data from the Global Burden of Disease report, which covers 204 countries and territories, the mortality rate for individuals aged 70 years and older in 2019 exceeded that of other age groups. It is worth noting that the mortality rate for people aged 70 years and older compared to infants under 5 years old increased from 0.57 in 1990 to 1.85 in 2019.<a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">12</span></a> Understanding the epidemiology of RSV in adults is crucial to identifying high-risk populations and implementing effective preventive measures, such as vaccination.</p><p id="par0025" class="elsevierStylePara elsevierViewall">RSV peaks are typically observed during the fall and winter, but inter-seasonal RSV activity exists, and its reservoir is exclusively human.<a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">13</span></a> Occupational exposure is a crucial factor in the epidemiology of RSV in adults. Healthcare and daycare workers are at a higher risk of contracting RSV due to their frequent contact with infected individuals. These occupations play a critical role in the transmission dynamics of RSV, as infected healthcare workers can spread the virus within healthcare settings and vulnerable patient populations.<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">14–16</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Adults aged 60 years and older, especially those residing in long-term care facilities or nursing homes, are at increased risk of severe RSV-related illness.<a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">17</span></a> A recent meta-analysis found that in adults aged 60 years and older, the attack rate for RSV-associated acute respiratory infection was estimated at 1.62%; the hospitalisation attack rate was 0.15%, and the in-hospital case fatality rate (hCFR) was 7.13%.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">3</span></a> In Spain, Heppe-Montero et al. estimated an hCFR of 7.91% for patients aged 60 years or older.<a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">18</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Additionally, age-related comorbidities, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, stroke, chronic kidney disease and diabetes, further heighten the risk of severe RSV infections and the need for hospitalisation.<a class="elsevierStyleCrossRefs" href="#bib0460"><span class="elsevierStyleSup">19–23</span></a> Furthermore, individuals with compromised immune systems, such as those undergoing immunosuppressive therapy, solid organ transplant recipients, people with HIV infection, and especially those with haematologic malignancies undergoing chemotherapy, are at an elevated risk of severe RSV infections.<a class="elsevierStyleCrossRef" href="#bib0485"><span class="elsevierStyleSup">24</span></a> The chronic use of inhaled corticosteroids has also been associated with the increased risk of RSV pneumonia (aOR 2.08 [95% CI: 1.39–3.09]).<a class="elsevierStyleCrossRef" href="#bib0490"><span class="elsevierStyleSup">25</span></a> These individuals often experience more prolonged and severe illness and are at an increased risk of complications, including hospitalisation and death.<a class="elsevierStyleCrossRefs" href="#bib0495"><span class="elsevierStyleSup">26–28</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Complications include bacterial co-infection in up to 29% of adults hospitalised for RSV pneumonia, the most common pathogens being <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>, <span class="elsevierStyleItalic">Haemophilus influenzae</span>, and <span class="elsevierStyleItalic">Staphylococcus aureus</span>.<a class="elsevierStyleCrossRef" href="#bib0510"><span class="elsevierStyleSup">29</span></a> This co-infection rate is even higher than in influenza patients, estimated to occur in 20% of patients.<a class="elsevierStyleCrossRef" href="#bib0515"><span class="elsevierStyleSup">30</span></a> RSV infection may also be complicated by cardiovascular events, including acute coronary syndrome, worsening congestive heart failure and arrhythmias in 14–22%.<a class="elsevierStyleCrossRef" href="#bib0520"><span class="elsevierStyleSup">31</span></a> Finally, acute functional loss has been associated with a significant short- and long-term reduction in quality of life, which may last for months.<a class="elsevierStyleCrossRefs" href="#bib0405"><span class="elsevierStyleSup">8,32</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In sum, RSV infections in adults represent a significant public health concern and have a substantial impact on morbidity, mortality, and healthcare utilisation. Older adults, individuals with chronic medical conditions, immunocompromised individuals, and those with occupational exposure face an elevated risk of severe RSV-related illness<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">14–16,18,33–36</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Adult RSV Clinical Manifestations</span><p id="par0050" class="elsevierStylePara elsevierViewall">RSV infection in adults can present with a wide spectrum of clinical manifestations, ranging from mild respiratory symptoms to severe lower respiratory tract infections. Individual risk factors, comorbidities, and immunological status influence the clinical presentation of RSV in adults.<a class="elsevierStyleCrossRef" href="#bib0550"><span class="elsevierStyleSup">37</span></a> The most common clinical symptoms of RSV infection in adults include cough, rhinorrhoea (runny nose), sore throat, nasal congestion, and fever. These symptoms often resemble those of other respiratory viral infections, so clinical diagnosis is challenging without laboratory confirmation. RSV infection may be mistaken for a common cold or influenza, especially during seasonal peaks of respiratory viral activity.<a class="elsevierStyleCrossRefs" href="#bib0555"><span class="elsevierStyleSup">38,39</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">While RSV infections in adults can be self-limiting and resolve without complications, they can also progress to more severe respiratory illnesses, including pneumonia, as a complication of RSV infection that may require hospitalisation.<a class="elsevierStyleCrossRefs" href="#bib0475"><span class="elsevierStyleSup">22,40</span></a> In some individuals, particularly those with underlying chronic respiratory conditions, RSV infection can lead to exacerbations of pre-existing conditions, such as COPD or asthma.<a class="elsevierStyleCrossRef" href="#bib0570"><span class="elsevierStyleSup">41</span></a> In severe cases, RSV infection may result in lower respiratory tract infections, such as bronchiolitis and pneumonia. Bronchiolitis is more commonly observed in infants and young children but can also occur in adults, especially those with compromised lung function or immunocompromised status.<a class="elsevierStyleCrossRef" href="#bib0575"><span class="elsevierStyleSup">42</span></a> RSV is also a cause of pneumonia in 49.3% of patients with confirmed RSV infection, primarily in the form of consolidations (23.8%) or ground-glass opacities (19.9%).<a class="elsevierStyleCrossRef" href="#bib0565"><span class="elsevierStyleSup">40</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">RSV infections in the elderly are frequent and more severe than those with influenza A/B, especially in vulnerable populations, and can result in hospitalisation and, in rare cases, lead to fatal outcomes. These severe outcomes are more likely in individuals with multiple risk factors, advanced age, and significant comorbidities.<a class="elsevierStyleCrossRefs" href="#bib0385"><span class="elsevierStyleSup">4,22</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In summary, RSV infection in adults has different presentations, ranging from asymptomatic or mild respiratory symptoms to exacerbations of underlying chronic conditions and severe lower respiratory tract infections, such as bronchiolitis and pneumonia. Clinical manifestations can vary widely, and individual risk factors and comorbidities influence the severity of illness. Early identification through efficient diagnostic testing, suitable treatment and specific preventive measures like vaccination are essential in reducing the morbidity and mortality linked to RSV infection in adults.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">The Virus and Its Diagnosis</span><p id="par0070" class="elsevierStylePara elsevierViewall">RSV is a negative-sense, non-segmented RNA virus of more than 15,000 nucleotides. Unlike influenza viruses, it cannot reassort segments, so a large-scale pandemic is unlikely.<a class="elsevierStyleCrossRef" href="#bib0580"><span class="elsevierStyleSup">43</span></a> RSV has two major specific antigenic subgroups (A and B) that differ in a number of proteins, but the major genetic diversity lies within the attachment glycoprotein G. However, glycoprotein F is highly conserved between RSVA and RSVB, making it an ideal candidate as a vaccine antigen, once stabilised in its “pre-fusion” structural conformation, which induces more potent neutralising antibodies by presenting more important epitopes.<a class="elsevierStyleCrossRefs" href="#bib0580"><span class="elsevierStyleSup">43,44</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Clinical features in adults are not sufficiently helpful in distinguishing RSV from other respiratory agents; therefore, laboratory confirmation may be required. Molecular testing, such as polymerase chain reaction (PCR)-based assays, are rapid, highly sensitive and specific, making them the preferred tool in hospitalised adult patients, particularly when using lower respiratory tract samples. The preferred sample for detecting RSV in adults is a nasopharyngeal swab, but adding additional samples such as saliva, sputum, and serology increases diagnosis accuracy by 2.6-fold.<a class="elsevierStyleCrossRef" href="#bib0590"><span class="elsevierStyleSup">45</span></a> Multiplex PCR-based assays enable the simultaneous detection of several respiratory pathogens, albeit at a higher cost. Rapid antigen detection tests (RADTs) provide a quicker, cheaper and more useful point-of-care diagnostic tool, although their sensitivity is less than 10% compared to serological tests and PCR. Immunochromatographic assays targeting RSV F-glycoprotein are used for most RADTs.<a class="elsevierStyleCrossRef" href="#bib0595"><span class="elsevierStyleSup">46</span></a> Viral culture is time-consuming and demands trained staff, limiting it to reference labs. Serology offers limited value for immediate diagnosis or patient care, yet when paired with PCR in acute and convalescent phases, its sensitivity is heightened beyond that of viral culture. Whole-genome sequencing and next-generation sequencing techniques are presently unavailable for clinical purposes. These techniques are intended mostly for public health research due to their capacity for detecting evolutionary diversity and potential transmission patterns.<a class="elsevierStyleCrossRef" href="#bib0600"><span class="elsevierStyleSup">47</span></a></p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">RSV Older Adult Vaccination: Current Status</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Vaccine Development for RSV</span><p id="par0080" class="elsevierStylePara elsevierViewall">Historically, the development of an RSV vaccine has been challenging.<a class="elsevierStyleCrossRef" href="#bib0735"><span class="elsevierStyleSup">48</span></a> In light of recent advances in understanding the biology and structure of the RSV virus, particularly the importance of the pre-fusion configuration of the F antigen (Pre-F Ag),<a class="elsevierStyleCrossRef" href="#bib0740"><span class="elsevierStyleSup">49</span></a> numerous vaccine candidates have been developed and tested. Each candidate uses a distinct but all use Pre-F Ag. Here, we discuss the current status of RSV vaccine development for the elderly population and highlight key characteristics of various vaccine candidates (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Subunit Vaccines</span><p id="par0085" class="elsevierStylePara elsevierViewall">Subunit vaccines are either protein- or particle-based. Protein-based vaccines employ purified RSV antigens, including the F or G protein, often formulated with adjuvants to enhance the immune response. Two vaccines have successfully completed Phase 3 trials and have recently been approved for use in older adults (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>).<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">50,51</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">The first one, a prefusion F protein RSV vaccine (RSVPreF3, Arexvy, GSK), reported efficacy results in Phase 3 clinical trial in adults ≥<span class="elsevierStyleHsp" style=""></span>60 years (AReSVi 006 Study) of 82.6% (95% CI: 57.9–94.1%) for RSV-associated lower respiratory tract disease (LRTD), and 94.1% (95% CI: 62.4–99.9%) for severe RSV-associated LRTD.<a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">52</span></a> Further analyses stratified by season revealed that one dose of the RSVPreF3vaccine in preventing symptomatic, laboratory-confirmed RSV-associated LRTD was 82.6% (96.95% CI: 57.9–94.1%) during the first RSV season and 56.1% (95% CI: 28.2–74.4%) during the second full season (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The cumulative efficacy of a single dose over the two combined seasons was 74.5% (97.5% CI: 60.0–84.5%) in preventing RSV-associated LRTD and 77.5% (95% CI: 57.9–89.0%) in preventing medically attended RSV-associated LRTD. In addition, the vaccine was well tolerated, with no safety concerns.<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">53,54</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The second one, a bivalent RSV-A and RSV-B stabilised prefusion F protein vaccine (RSVpreF, Abrysvo, Pfizer) reported efficacy results in Phase 3 clinical trial in adults ≥<span class="elsevierStyleHsp" style=""></span>60 years (RENOIR study) of 66.7% (96.66% CI: 28.8–85.8%) for RSV lower respiratory tract infection (LRTI) with at least two signs or symptoms and 85.7% (96.66% CI: 32.0–98.7%) for most severe respiratory disease defined by the presence of three or more symptoms associated with RSV (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">55</span></a> Analyses by season reported that one dose of the RSVpreF vaccine prevented symptomatic, laboratory-confirmed RSV-associated LRTD with 88.9% efficacy (95% CI: 53.6–98.7%) during the first RSV season and 78.6% (95% CI: 23.2–96.1%) during the partial second season (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The efficacy of a single dose over the two combined seasons was 84.4% (95% CI: 59.6–95.2%) in preventing RSV-associated LRTD and 81.0% (95% CI: 43.5–95.2%) in preventing medically attended RSV-associated LRTD. In addition, the vaccine was well tolerated, with no safety concerns.<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">53,54</span></a> Nanoparticle-based vaccines use self-assembling nanoparticles presenting key RSV antigens, such as the F glycoprotein or the RSV prefusion-stabilised F protein. They aim to induce a robust neutralising antibody response and have shown promising results in preclinical and early clinical studies.<a class="elsevierStyleCrossRef" href="#bib0645"><span class="elsevierStyleSup">56</span></a> IVX-A12, a bivalent vaccine candidate based on nanoparticle technology for treating older adults with RSV and human metapneumovirus (hMPV), started its Phase 3 clinical trial in older adults in June 2023.<a class="elsevierStyleCrossRef" href="#bib0650"><span class="elsevierStyleSup">57</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Live Attenuated Vaccines</span><p id="par0100" class="elsevierStylePara elsevierViewall">Live attenuated vaccines (LAV) mimic natural infection to induce a strong immune response.<a class="elsevierStyleCrossRefs" href="#bib0655"><span class="elsevierStyleSup">58,59</span></a> RSV-MinL4-0 (modified polymerase gene), a codon-pair deoptimised LAV, has shown a humoral and cellular immune response similar to wild-type infection in non-human primates and has completed Phase 1 trials.<a class="elsevierStyleCrossRef" href="#bib0665"><span class="elsevierStyleSup">60</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Chimeric Vaccines</span><p id="par0105" class="elsevierStylePara elsevierViewall">Chimeric live virus vaccine candidates express RSV proteins in related attenuated viruses with favourable safety profiles. Unlike vector vaccine candidates, chimeric vaccines show favourable antigen presentation that activates an adaptive immune response. CPI-RSV-F (BLB201), currently in Phase 1 trials, is a chimeric RSV vaccine candidate that includes older adults. Based on an attenuated strain of canine parainfluenza virus expressing the RSV-F protein, a Phase 1 trial is ongoing in the elderly population. The first study cohort showed that 64% of subjects had serum anti-RSV antibody responses above baseline levels.<a class="elsevierStyleCrossRef" href="#bib0670"><span class="elsevierStyleSup">61</span></a></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Messenger Ribonucleic Acid (mRNA) Vaccines</span><p id="par0110" class="elsevierStylePara elsevierViewall">mRNA vaccines have revolutionised vaccine development, exemplified by their successful application in COVID-19 vaccines.<a class="elsevierStyleCrossRefs" href="#bib0675"><span class="elsevierStyleSup">62,63</span></a> Moderna's mRNA-1345, an mRNA candidate encoding stabilised RSV pre-F protein, recently reported efficacy results in Phase II<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>III trial clinical trial in adults ≥<span class="elsevierStyleHsp" style=""></span>60 years of 83.7% (95.88% CI: 66.1–92.2%; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) against RSV LRTD as defined by two or more symptoms and 82.4% (96.36% CI, 34.8–95.3) against the disease with at least three signs or symptoms.<a class="elsevierStyleCrossRef" href="#bib0685"><span class="elsevierStyleSup">64</span></a> In addition, vaccine efficacy was 68.4% (95% CI, 50.9–79.7) against RSV-associated acute respiratory disease. In general, the vaccine was well tolerated, with no safety concerns. Supported by these results, the company requested the market approval of mRNA-1345 in July 2023.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Recombinant Vector Vaccines</span><p id="par0115" class="elsevierStylePara elsevierViewall">Recombinant vector vaccines use a genetically modified, replication-deficient virus as a vehicle to elicit both humoral and cellular immune responses by delivering genes encoding specific RSV antigens. Two candidates in clinical development in the elderly population were discontinued due to strategic decisions (Ad26.RSV.preF)<a class="elsevierStyleCrossRef" href="#bib0690"><span class="elsevierStyleSup">65</span></a> or failure to meet one of the primary endpoints (MVA-BN-RSV).<a class="elsevierStyleCrossRef" href="#bib0695"><span class="elsevierStyleSup">66</span></a></p></span></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Positioning and Recommendations for Vaccination in Older Adult Patients</span><p id="par0120" class="elsevierStylePara elsevierViewall">The rationale for the recommendations to use RSV vaccines in older adults is based on the known burden of the disease and the evidence of moderate to high efficacy in preventing symptomatic RSV-associated LRTD.<a class="elsevierStyleCrossRefs" href="#bib0625"><span class="elsevierStyleSup">52,55</span></a> It is important to note that the trials had limited enrollment of individuals at highest risk for RSV disease, and that protection duration and eventual need for additional doses have not yet been established. From an individual protection perspective, healthcare providers should consider individual risk factors, patient preferences, and vaccine characteristics when deciding whether to vaccinate. Post-marketing surveillance and additional studies will provide further information on the safety and effectiveness of RSV vaccines in older adults, which will guide future recommendations.<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">54</span></a></p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Target Population for RSV Vaccination</span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Age-based Indication Strategy</span><p id="par0125" class="elsevierStylePara elsevierViewall">The age-based indication strategy involves recommending RSV vaccination for all individuals within a specific age range, regardless of their individual risk levels or underlying conditions. This approach does not require identifying and targeting specific high-risk groups, making it a convenient and efficient strategy. The decision on the age threshold should balance the greatest impact on disease burden and its efficiency.<a class="elsevierStyleCrossRef" href="#bib0700"><span class="elsevierStyleSup">67</span></a></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">High-risk Groups Targeting Strategy</span><p id="par0130" class="elsevierStylePara elsevierViewall">The strategy of targeting high-risk groups involves prioritising RSV vaccination for populations at higher risk of severe RSV infection or its complications (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). The main justifications for a strategy of targeting high-risk groups would be: (1) high-risk groups, such as older adults, people with chronic respiratory diseases, immunocompromised individuals and healthcare workers, are more likely to experience severe RSV infection or transmit the virus to vulnerable populations<a class="elsevierStyleCrossRefs" href="#bib0705"><span class="elsevierStyleSup">68,69</span></a>; (2) limited vaccine supply or higher vaccine costs may necessitate prioritising high-risk groups to achieve the greatest public health impact; and (3) targeting high-risk groups allows for a more targeted approach, ensuring that those most susceptible to severe RSV illness are protected.<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">70</span></a></p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Timing and Scheduling of RSV Vaccination</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Timing of RSV Vaccination: Maximising Protection</span><p id="par0135" class="elsevierStylePara elsevierViewall">To ensure maximum protection, it is important to consider the following:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0140" class="elsevierStylePara elsevierViewall">Seasonal outbreaks: RSV infection typically occurs in seasonal outbreaks, with the highest incidence in temperate regions occurring during the autumn and winter months. However, RSV activity can vary geographically. Therefore, local surveillance data should be considered when determining the optimal timing of vaccination.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0145" class="elsevierStylePara elsevierViewall">Ideal timing: Vaccination should ideally be administered before the onset of the RSV season to provide the highest level of protection. However, considering that the currently available vaccines induce protection for at least two seasons,<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">53,54</span></a> timing should be as early as possible for those eligible, irrespective of RSV activity.</p></li></ul></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Schedule of RSV Vaccination: Tailoring to Vaccine Type and Individual Factors</span><p id="par0150" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0155" class="elsevierStylePara elsevierViewall">Vaccine type: The schedule may vary depending on the specific vaccine. This includes the number of doses required and the interval between doses. Both currently approved RSV vaccines are recommended for administration as a single dose.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0160" class="elsevierStylePara elsevierViewall">Booster doses: Evidence to determine the need for revaccination is not currently available.</p></li></ul></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Integrating RSV Vaccination With Other Vaccines: Optimising Immunisation Coverage</span><p id="par0165" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0170" class="elsevierStylePara elsevierViewall">Recommended timing and schedules: RSV vaccination in adults can be seamlessly integrated into routine immunisation schedules by considering the recommended timing and schedules of other vaccines. This allows for efficient and convenient administration of multiple vaccines.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0175" class="elsevierStylePara elsevierViewall">Co-administration with other vaccines: By combining vaccines, individuals can receive multiple vaccinations during a single healthcare visit, reducing the need for additional appointments and associated costs. Both RSVpreF3 (Arexvy, GSK) and RSVpreF (Abrysvo, Pfizer) can be administered concurrently with the seasonal influenza vaccine. RSVpreF3 shows non-inferior immune responses in adults aged 60 and older, but co-administration resulted in numerically lower RSV A and B neutralising titres and influenza A and B hemagglutination inhibition titres, with unknown clinical relevance. RSVpreF, studied in adults aged 65 and older, also demonstrated non-inferior immune responses, but co-administration with adjuvanted influenza vaccine showed similar reductions. RSVpreF requires a two-week interval before tetanus, diphtheria, and acellular pertussis vaccine, and is associated with lower immune responses to pertussis components in co-administration; the clinical relevance remains unknown.<a class="elsevierStyleCrossRefs" href="#bib0615"><span class="elsevierStyleSup">50,51</span></a> Despite the lack of specific studies, public health authorities can decide to authorise the co-administration of RSV with other vaccines, favouring the opportunity of vaccination against the eventual immunological interference.<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">53,54</span></a></p></li></ul></p></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">NEP Positioning and RSV Prophylaxis Recommendations in Adults</span><p id="par0180" class="elsevierStylePara elsevierViewall">The Spanish Neumoexperts Prevention Group (NEP; <a href="http://www.neumoexpertos.org/">www.neumoexpertos.org</a>) publishes updated immunisation recommendations to prevent community-acquired pneumonia in adults.<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">70</span></a> The proposed vaccine schedule prioritises individual protection to effectively prevent CAP in adults. This schedule is designed to assist healthcare professionals in daily practice by offering the most optimal vaccination recommendations based on the latest evidence. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> illustrates the most recent NEP recommendations, including those for RSV vaccination.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0185" class="elsevierStylePara elsevierViewall">Concerning RSV prevention, NEP recommends the following measures:<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">1.</span><p id="par0190" class="elsevierStylePara elsevierViewall">Implement infection control measures in healthcare facilities and long-term care settings.<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">71</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">2.</span><p id="par0195" class="elsevierStylePara elsevierViewall">Promote public awareness and education regarding RSV transmission and preventive measures.<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">71</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">3.</span><p id="par0200" class="elsevierStylePara elsevierViewall">Develop and reinforce surveillance systems to monitor community RSV activity and promptly identify outbreaks.<a class="elsevierStyleCrossRef" href="#bib0720"><span class="elsevierStyleSup">71</span></a></p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">4.</span><p id="par0205" class="elsevierStylePara elsevierViewall">Recommendations for vaccination.</p></li></ul></p><p id="par0210" class="elsevierStylePara elsevierViewall">From an individual protection perspective, the NEP in Spain recommends RSV vaccination for older adults aged ≥<span class="elsevierStyleHsp" style=""></span>60, especially those with chronic pulmonary disease, chronic cardiovascular disease, and other diagnoses or conditions that cause impaired lung function or poor cough strength and stagnation of secretions (extreme obesity or neurological impairments),<a class="elsevierStyleCrossRef" href="#bib0725"><span class="elsevierStyleSup">72</span></a> kidney disease, diabetes, immunosuppression, or institutionalised status. Although there are currently two approved vaccines for adults, RSVpreF (Abrysvo, Pfizer) and RSVpreF3 (Arexvy, GSK) that are difficult to compare, given their different clinical studies, varying case definitions, and analysis criteria, both vaccines have demonstrated their efficacy and safety and are recommended in this age group.</p><p id="par0215" class="elsevierStylePara elsevierViewall">From a public health perspective, we believe that an aged-based indication is the most recommendable strategy, although the concrete age threshold should be determined balancing the burden of disease prevented and the associated costs of the intervention. The Centres for Disease Control and Prevention (CDC) recommends RSV vaccination for individuals aged ≥<span class="elsevierStyleHsp" style=""></span>60 based on shared clinical decision-making between the healthcare provider and the vaccine (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>) using either available vaccine.<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">54</span></a> In the United Kingdom, the Joint Committee on Vaccination and Immunisation (JCVI) used their modelling to establish the indication for RSV vaccination among older adults aged ≥<span class="elsevierStyleHsp" style=""></span>75 (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">73</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0220" class="elsevierStylePara elsevierViewall">Irrespective of the age indication, any adult aged over 60 years with specific risk factors for severe RSV disease (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) should be prioritised for vaccination. This strategy likely constitutes a good starting point for any RSV vaccination policy and should be warranted to protect the most vulnerable (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>). Also, healthcare workers should be offered RSV vaccination because they are at a higher risk of contracting RSV and to the increased risk of transmitting RSV to their patients.<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">14–16</span></a></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conclusion</span><p id="par0225" class="elsevierStylePara elsevierViewall">Severe RSV disease can have significant consequences in individuals aged ≥<span class="elsevierStyleHsp" style=""></span>60 years, particularly those with chronic medical conditions or other risk factors. Vaccination effectively reduces the risk of disease, lessens the severity of illness, and protects vulnerable populations. It is imperative for individuals aged ≥<span class="elsevierStyleHsp" style=""></span>60 years to prioritise their health by considering vaccination against RSV as part of their healthy lifestyle and ideal immunisation schedule against pneumonia. Ongoing research, including studies on new vaccine candidates and antiviral therapies, offers hope for the development of even more effective interventions. As vaccines reach the population, implementing positioning strategies, such as improved infection control measures in healthcare facilities and targeted education campaigns, and promoting preventive measures, such as hand hygiene and respiratory etiquette, can help mitigate the impact of RSV on adult health. However, RSV vaccination constitutes a key pillar in the prevention strategy. Continued research, collaboration between scientists, vaccine manufacturers, healthcare professionals and policymakers, and investment in RSV surveillance systems are indispensable to advance our understanding of RSV epidemiology, risk factors, and clinical outcomes in adults and to develop evidence-based interventions to safeguard this vulnerable population.</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Authors’ Contributions</span><p id="par0230" class="elsevierStylePara elsevierViewall">All authors have significantly contributed to the conceptualization and performance of the study. The literature analysis workload has been equally divided among the authors. The elaboration of recommendations has been discussed and agreed among the members, including the multidisciplinary perspective of the NeumoExpert group. All authors have contributed to the critical review of the manuscript.</p></span><span id="sec0125" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Funding Sources</span><p id="par0235" class="elsevierStylePara elsevierViewall">This work was supported by <span class="elsevierStyleGrantSponsor" id="gs1">consorcio Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias</span> (<span class="elsevierStyleGrantNumber" refid="gs1">CB21/06/00103</span>; FM-T), <span class="elsevierStyleGrantSponsor" id="gs2">DIAVIR (Instituto de Salud Carlos III (ISCIII)/DTS19/00049/Cofinanciado FEDER; Proyecto de Desarrollo Tecnológico en Salud)</span>, <span class="elsevierStyleGrantSponsor" id="gs3">Resvi-Omics (Instituto de Salud Carlos III (ISCIII)/PI19/01039/Cofinanciado FEDER)</span>, <span class="elsevierStyleGrantSponsor" id="gs4">BI-BACVIR (PRIS-3; Agencia de Conocimiento en Salud (ACIS)—Servicio Gallego de Salud (SERGAS)—Xunta de Galicia; Spain)</span>, <span class="elsevierStyleGrantSponsor" id="gs5">Programa Traslacional COVID-19 (ACIS—Servicio Gallego de Salud (SERGAS)—XUNTA de Galicia; Spain)</span> and <span class="elsevierStyleGrantSponsor" id="gs6">Axencia Galega de Innovacion (GAIN; IN607B 2020/08—XUNTA de Galicia; Spain)</span>; and <span class="elsevierStyleGrantSponsor" id="gs7">ReSVinext (Instituto de Salud Carlos III (ISCIII)/PI16/01569/Cofinanciado FEDER)</span>, <span class="elsevierStyleGrantSponsor" id="gs8">Enterogen (Instituto de Salud Carlos III (ISCIII)/PI19/01090/Cofinanciado FEDER)</span>, <span class="elsevierStyleGrantSponsor" id="gs9">OMI-COVI-VAC (PI22/00406/Cofinanced European Regional Development Fund, Grupos de Referencia Competitiva</span> (<span class="elsevierStyleGrantNumber" refid="gs9">IIN607A2021/05</span>) and <span class="elsevierStyleGrantSponsor" id="gs10">Axencia Galega de Innovación (GAIN; IN845D 2020/23—Xunta de Galicia; Spain)</span>.</p></span><span id="sec0130" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of Interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">FM-T has acted as principal investigator in randomised controlled trials of Ablynx, Abbot, Seqirus, Sanofi Pasteur MSD, Sanofi Pasteur, Cubist, Wyeth, Merck, Pfizer, Roche, Regeneron, Jansen, Medimmune, Novavax, Novartis and GSK, with honoraria paid to his institution. FM-T reports a relationship with GSK Vaccines SRL that includes consulting or advisory. FM-T reports a relationship with Pfizer Inc that includes consulting or advisory. FM-T reports a relationship with Sanofi Pasteur Inc that includes consulting or advisory. FM-T reports a relationship with Janssen Pharmaceuticals Inc that includes consulting or advisory. FM-T reports a relationship with MSD that includes consulting or advisory. FM-T reports a relationship with Seqirus Pty Ltd that includes consulting or advisory. ER has participated in advisory boards, conferences, courses and lectures organised by Sanofi Pasteur, MSD, GSK, Seqirus, Pfizer and AstraZeneca. IRC has participated in advisory boards organised by MSD, GSK, Sanofi and Pfizer. IRC has been involved in clínica trials funded by Ablynx, Abbot, Seqirus, Sanofi Pasteur MSD, Cubist, Wyeth, Merck, Pfizer, Roche, Regeneron, Jansen, Medimmune, Novavax, Novartis and GSK, alt-hough the funds were paid to the institution. EM has participated in advisory boards by Astra-Zeneca, Boehringer Ingelheim, Esteve, GSK, MSD, Menarini, Mundifarma, Novartis, Orion, Pfizer, Roche, Rovi, Takeda and TEVA. DO has participated in advisory boards from Lilly, Boehringer Ingelheim, Novartis, Pfizer, Takeda, Esteve, Almirall, GlaxoSmithKline, Astra-Zeneca, Chiesi, Mundipharma, Teva, Solvay Pharma, Rovi, Gebro Pharma, Janssen, MSD, Novo Nordisk and Menarini. IJ has participated in advisory boards from Pfizer, Sanofi Pasteur, and conference attendance scholarships paid by Menarini, Esteve. AG has participated in advisory boards by Pfizer, GlaxoSmithKline, Janssen, MSD and Sanofi Pasteur. ML has participated in advisory boards and research projects organised by Pfizer. FGR has participated in advisory boards, conferences, courses and lectures organised by Sanofi Pasteur, MSD, GSK, Pfizer and Moderna. JY received grants from MSD-USA (Merck Investigator Studies Programme), and Pfizer, outside of this work and the funds were awarded to the Institution. JY participated in advisory boards or-ganized by MSD and Pfizer. The remaining authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:16 [ 0 => array:3 [ "identificador" => "xres2163338" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1835076" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Epidemiology and Clinical Manifestations" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "RSV Epidemiology in Adults" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Adult RSV Clinical Manifestations" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "The Virus and Its Diagnosis" ] ] ] 5 => array:3 [ "identificador" => "sec0035" "titulo" => "RSV Older Adult Vaccination: Current Status" "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0040" "titulo" => "Vaccine Development for RSV" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Subunit Vaccines" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Live Attenuated Vaccines" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Chimeric Vaccines" ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Messenger Ribonucleic Acid (mRNA) Vaccines" ] 4 => array:2 [ "identificador" => "sec0065" "titulo" => "Recombinant Vector Vaccines" ] ] ] ] ] 6 => array:2 [ "identificador" => "sec0070" "titulo" => "Positioning and Recommendations for Vaccination in Older Adult Patients" ] 7 => array:3 [ "identificador" => "sec0075" "titulo" => "Target Population for RSV Vaccination" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0080" "titulo" => "Age-based Indication Strategy" ] 1 => array:2 [ "identificador" => "sec0085" "titulo" => "High-risk Groups Targeting Strategy" ] ] ] 8 => array:3 [ "identificador" => "sec0090" "titulo" => "Timing and Scheduling of RSV Vaccination" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0095" "titulo" => "Timing of RSV Vaccination: Maximising Protection" ] 1 => array:2 [ "identificador" => "sec0100" "titulo" => "Schedule of RSV Vaccination: Tailoring to Vaccine Type and Individual Factors" ] 2 => array:2 [ "identificador" => "sec0105" "titulo" => "Integrating RSV Vaccination With Other Vaccines: Optimising Immunisation Coverage" ] ] ] 9 => array:2 [ "identificador" => "sec0110" "titulo" => "NEP Positioning and RSV Prophylaxis Recommendations in Adults" ] 10 => array:2 [ "identificador" => "sec0115" "titulo" => "Conclusion" ] 11 => array:2 [ "identificador" => "sec0120" "titulo" => "Authors’ Contributions" ] 12 => array:2 [ "identificador" => "sec0125" "titulo" => "Funding Sources" ] 13 => array:2 [ "identificador" => "sec0130" "titulo" => "Conflicts of Interest" ] 14 => array:2 [ "identificador" => "xack750774" "titulo" => "Acknowledgements" ] 15 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-12-18" "fechaAceptado" => "2024-01-09" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1835076" "palabras" => array:8 [ 0 => "Respiratory syncytial virus" 1 => "RSV" 2 => "Adult patients" 3 => "Vaccination" 4 => "Recommendations" 5 => "Preventive measures" 6 => "High-risk populations" 7 => "Chronic obstructive pulmonary disease" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Respiratory syncytial virus (RSV) is a major cause of respiratory tract infections in adults, particularly older adults and those with underlying medical conditions. Vaccination has emerged as a potential key strategy to prevent RSV-related morbidity and mortality. This Neumoexperts Prevention (NEP) Group scientific paper aims to provide an evidence-based positioning and RSV vaccination recommendations for adult patients. We review the current literature on RSV burden and vaccine development and availability, emphasising the importance of vaccination in the adult population. According to our interpretation of the data, RSV vaccines should be part of the adult immunisation programme, and an age-based strategy should be preferred over targeting high-risk groups. The effectiveness and efficiency of this practice will depend on the duration of protection and the need for annual or more spaced doses. Our recommendations should help healthcare professionals formulate guidelines and implement effective vaccination programmes for adult patients at risk of RSV infection now that specific vaccines are available.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0090">Web: <span class="elsevierStyleInterRef" id="intr0135" href="http://www.serviciodepediatriasantiago.es/">www.serviciodepediatriasantiago.es</span>/<span class="elsevierStyleInterRef" id="intr0140" href="http://www.genvip.org/">www.genvip.org</span>.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="par2220" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix B" "titulo" => "Supplementary data" "identificador" => "sec2115" ] ] ] ] "multimedia" => array:9 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3266 "Ancho" => 3341 "Tamanyo" => 1066911 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Vaccination guide against community-acquired pneumonia in adults caused by vaccine-preventable diseases. CSF: cerebrospinal fluid; IPD: invasive pneumococcal disease.</p> <p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Adapted from Redondo et al.<a class="elsevierStyleCrossRef" href="#bib0715"><span class="elsevierStyleSup">70</span></a></p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ab: antibodies; GSK: GlaxoSmithKline; hMPV: human metapneumovirus; mRNA: messenger ribonucleic; RSV: respiratory syncytial virus; SHe: small hydrophobic glycoprotein; VLP: virus-like particle.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Type of vaccine \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Candidate vaccine | sponsor \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Antigen \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjuvant \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mechanism of action \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Phase 1 trial (no. participants) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Phase 2 trial (no. participants) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Phase 3 trial (no. participants) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="7" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subunit vaccine</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VN-0200 | Daiichi Sankyo \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">VAGA-9001a \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MABH-9002b \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Protein-based</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0005" href="ctgov:NCT04914520">NCT04914520</span> (48) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DPX-RSV |Immunovaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SHe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">DepoVax aluminium hydroxide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Protein-based:</span> SHe generates a non-neutralising Ab and CD4+ T-cell response \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0010" href="ctgov:NCT02472548">NCT02472548</span> (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BARS13 | Advaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">G \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None or cyclosporine A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Protein-based:</span> RSV G; immunosuppressant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0015" href="ctgov:NCT04851977">NCT04851977</span> and ACTRN12618 – 000948291 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0020" href="ctgov:NCT04681833">NCT04681833</span> (120) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RSVPre -F3/GSK3844766A | GSK \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PreF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AS01E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Protein-based:</span> Induce immune response with stabilised preF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0025" href="ctgov:NCT04090658">NCT04090658</span>, <span class="elsevierStyleInterRef" id="intr0030" href="ctgov:NCT03814590">NCT03814590</span>, and <span class="elsevierStyleInterRef" id="intr0035" href="ctgov:NCT04657198">NCT04657198</span> (1055) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0040" href="ctgov:NCT04090658">NCT04090658</span> and <span class="elsevierStyleInterRef" id="intr0045" href="ctgov:NCT04657198">NCT04657198</span> (1055) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0050" href="ctgov:NCT04886596">NCT04886596</span> (25,000)<span class="elsevierStyleInterRef" id="intr0055" href="ctgov:NCT04732871">NCT04732871</span> (1720)<span class="elsevierStyleInterRef" id="intr0060" href="ctgov:NCT05059301">NCT05059301</span> (750) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RSVPreF | Pfizer \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PreF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Protein-based:</span> Induce immune response with stabilised preF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0065" href="ctgov:NCT03529773">NCT03529773</span> (1235)<span class="elsevierStyleInterRef" id="intr0070" href="ctgov:NCT04785612">NCT04785612</span> (62)<span class="elsevierStyleInterRef" id="intr0075" href="ctgov:NCT04071158">NCT04071158</span> (713) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0080" href="ctgov:NCT04032093">NCT04032093</span> (1153)<span class="elsevierStyleInterRef" id="intr0085" href="ctgov:NCT05035212">NCT05035212</span> (30,000) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVX-121 | Icosavax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Stabilised Pre-F DS-Cav1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None or aluminium hydroxide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Particle-based:</span> Presentation of DS-Cav1 on computationally designed VLP generates a neutralising Ab response against preF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2020-003633-38 (90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">IVX-A12 (RSV/hMPV) | Icosabax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RSV-F/hMPV-F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MF59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Particle-based</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0090" href="ctgov:NCT05664334">NCT05664334</span>, 120 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0095" href="ctgov:NCT05903183">NCT05903183</span> (264) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nucleic acid vaccine</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">mRNA-1345 | Moderna \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PreF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">mRNA encodes for a stabilised preF glycoprotein eliciting neutralising antibodies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0100" href="ctgov:NCT04528719">NCT04528719</span> (100 healthy adults, 300 older adults, 180 women, and 40 children) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Phase 2 and 3; <span class="elsevierStyleInterRef" id="intr0105" href="ctgov:NCT05127434">NCT05127434</span> (34,000) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0110" href="ctgov:NCT05127434">NCT05127434</span> (34,000) <span class="elsevierStyleInterRef" id="intr0115" href="ctgov:NCT05330975">NCT05330975</span> (1350) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">mRNA LNP | Sanofi \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PreF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">mRNA encodes for a stabilised preF glycoprotein eliciting neutralising antibodies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0120" href="ctgov:NCT05639894">NCT05639894</span> (790) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Live attenuated vaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">RSV-MinL4·0 | Codagenix \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">All viral proteins \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">L altered for attenuation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0125" href="ctgov:NCT04295070">NCT04295070</span> (36) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="8" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chimeric \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CPI-RSV-F Vaccine (BLB-201) | Blue Lake Biotechnology Inc. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PreF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Parainfluenza virus type 5-vectored live attenuated RSV vaccine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleInterRef" id="intr0130" href="ctgov:NCT05281263">NCT05281263</span> (30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564711.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Summary of Vaccine Candidates in Development for Older Adults Categorised by Design Strategy.<a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">11</span></a></p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Endpoint \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n</span>/<span class="elsevierStyleItalic">N</span>, Vaccinated group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">n/N</span>, placebo group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vaccine efficacy (CI), % \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">RSVpreF3 protein vaccine (GSK)</span><a class="elsevierStyleCrossRef" href="#bib0625"><span class="elsevierStyleSup">52</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">RSV acute respiratory illness</span>: ≥<span class="elsevierStyleHsp" style=""></span>2 respiratory symptoms/signs for ≥<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h OR ≥<span class="elsevierStyleHsp" style=""></span>1 respiratory symptom/sign<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>1 systemic sign for ≥<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27/12,466 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95/12,494 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.7 (56.2–82.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">RSV LRTD:</span> ≥<span class="elsevierStyleHsp" style=""></span>2 lower respiratory symptoms/signs for ≥<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h including ≥<span class="elsevierStyleHsp" style=""></span>1 lower respiratory sign OR ≥<span class="elsevierStyleHsp" style=""></span>3 lower respiratory symptoms for ≥<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7/12,466 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40/12,494 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.6 (57.9–94.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RSV LRTD with ≥<span class="elsevierStyleHsp" style=""></span>2 lower respiratory signs or assessed as ‘severe’ by the investigator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1/12,466 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17/12,494 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.1 (62.4–99.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="4" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Bivalent RSV prefusion F vaccine (Pfizer)</span><a class="elsevierStyleCrossRef" href="#bib0640"><span class="elsevierStyleSup">55</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RSV LRTI: ≥<span class="elsevierStyleHsp" style=""></span>1 respiratory symptom lasting more than 1 day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22/16,306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58/16,308 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">62.1 (37.1–77.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RSV LRTI ≥<span class="elsevierStyleHsp" style=""></span>2 symptoms: ≥<span class="elsevierStyleHsp" style=""></span>2 lower respiratory signs/symptoms lasting more than 1 day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11/16,306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33/16,308 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.7 (28.8–85.8)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>RSV LRTI ≥<span class="elsevierStyleHsp" style=""></span>3 symptoms: ≥<span class="elsevierStyleHsp" style=""></span>3 lower respiratory signs/symptoms lasting more than 1 day \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/16,306 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14/16,308 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.7 (37.9–98.4)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564713.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">96.66% of confidence interval. CI: confidence interval; LRTD: lower respiratory tract disease; LRTI: lower respiratory tract infection; <span class="elsevierStyleItalic">n</span>: number of events; <span class="elsevierStyleItalic">N</span>: numbers of participants; RSV: respiratory syncytial virus.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Efficacy of Currently Licensed RSV Vaccines for Adults 60 Years or Older Based on Phase 3 Trial Results.<a class="elsevierStyleCrossRefs" href="#bib0625"><span class="elsevierStyleSup">52,55</span></a></p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0945" class="elsevierStyleSimplePara elsevierViewall">CI: confidence interval; LRTD; lower respiratory tract disease; LRTI: lower respiratory tract infection; RSV: respiratory syncytial virus.</p>" "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="\n \t\t\t\t\ttable-head\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Efficacy evaluation period \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vaccine efficacy against outcome<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">h</span></a></th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RSV-associated LRTD<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RSV-associated medically attended LRTD<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">RSVpreF3 protein vaccine (GSK)</span><a class="elsevierStyleCrossRefs" href="#tblfn0040"><span class="elsevierStyleSup">g,i</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Season 1<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.6 (57.9–94.1)<a class="elsevierStyleCrossRef" href="#tblfn0065"><span class="elsevierStyleSup">m</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.5 (58.9–97.6)<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">l</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Season 2 (full)<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">d</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.1 (28.2–74.4)<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">l</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">k</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Combined seasons 1 and 2 (interim)<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">f</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74.6 (62.1–83.5)<a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">n</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.5 (57.9–89.0)<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">l</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564710.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Bivalent RSVpreF vaccine (Pfizer)<a class="elsevierStyleCrossRef" href="#tblfn0050"><span class="elsevierStyleSup">j</span></a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RSV-associated LRTD \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RSV-associated medically attended LRTD \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Season 1c \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88.9 (53.6–98.7)l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.6 (32.0–98.3)l \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Season 2 (interim)<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">e</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.6 (23.2–96.1)l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">–<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">k</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Combined seasons 1 and 2 (interim)<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">f</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.4 (59.6–95.2)l \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.0 (43.5–95.2)l \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564714.png" ] ] ] "notaPie" => array:14 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">For RSVpreF3 (GSK), LRTD was defined as two or more lower respiratory symptoms (new or increased sputum, cough, and dyspnoea) or signs (new or increased wheezing, crackles or rhonchi detected during chest auscultation, respiratory rate ≥<span class="elsevierStyleHsp" style=""></span>20 respirations per minute, low or decreased oxygen saturation [<95% or ≤<span class="elsevierStyleHsp" style=""></span>90% if baseline was <95%], and need for oxygen supplementation) for ≥<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h, including one or more lower respiratory signs, or three or more lower respiratory symptoms for ≥<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>h. For RSVpreF (Pfizer) estimates, LRTD refers to the RSVpreF trial endpoint of RSV LRTI with three or more lower respiratory signs or symptoms (see <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Medically attended RSV-associated LRTD defined as LRTD plus attention at one or more inpatient or outpatient health care services. Estimates were not included in per-protocol assessments.</p>" ] 2 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Season 1 vaccine efficacy estimates reflect efficacy against first events occurring during the first complete RSV season for Northern Hemisphere participants, partial first RSV season for Southern Hemisphere participants for GSK (May 2021–April 2022; exact study-defined season dates were site-dependent) and complete RSV season Southern Hemisphere participants for Pfizer (August 2021–October 2022; exact study-defined season dates were site-dependent).</p>" ] 3 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Season 2 vaccine efficacy estimates (GSK) reflect efficacy against first events occurring during the second complete Northern Hemisphere RSV season for Northern Hemisphere participants (August 2022–March 2023; exact study-defined season dates were site-dependent). In addition to Northern Hemisphere participants, Southern Hemisphere participants were also included in these analyses, but this time span reflects an interseason period with low RSV incidence in the Southern Hemisphere.</p>" ] 4 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "e" "nota" => "<p class="elsevierStyleNotepara" id="npar0040">Season 2 (interim) vaccine efficacy estimates (Pfizer) reflect efficacy against first events occurring during the second complete RSV season for Northern Hemisphere participants only (July 2022–January 2023; Southern Hemisphere data not yet available).</p>" ] 5 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "f" "nota" => "<p class="elsevierStyleNotepara" id="npar0045">Combined season 1 and 2 (interim) vaccine efficacy estimates reflect efficacy against first events occurring any time during Season 1 or Season 2. The mean time from start to end of efficacy surveillance was approximately 15 months (GSK) or 12 months (Pfizer) per participant.</p>" ] 6 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "g" "nota" => "<p class="elsevierStyleNotepara" id="npar0050">Interim analysis underpowered to estimate efficacy.</p>" ] 7 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "h" "nota" => "<p class="elsevierStyleNotepara" id="npar0055">Manufacturer-calculated efficacy. Includes events<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>14 days after injection and person-time available from the manufacturer's pivotal Phase 3 trial.</p>" ] 8 => array:3 [ "identificador" => "tblfn0945" "etiqueta" => "i" "nota" => "<p class="elsevierStyleNotepara" id="npar0060">Estimates adjusted for participant age and region.</p>" ] 9 => array:3 [ "identificador" => "tblfn0050" "etiqueta" => "j" "nota" => "<p class="elsevierStyleNotepara" id="npar0065">Estimates are unadjusted.</p>" ] 10 => array:3 [ "identificador" => "tblfn0055" "etiqueta" => "k" "nota" => "<p class="elsevierStyleNotepara" id="npar0070">Interim analysis underpowered to estimate efficacy.</p>" ] 11 => array:3 [ "identificador" => "tblfn0060" "etiqueta" => "l" "nota" => "<p class="elsevierStyleNotepara" id="npar0075">95% CI.</p>" ] 12 => array:3 [ "identificador" => "tblfn0065" "etiqueta" => "m" "nota" => "<p class="elsevierStyleNotepara" id="npar0080">96.95% CI; the CI for the primary trial endpoint was adjusted for multiplicity.</p>" ] 13 => array:3 [ "identificador" => "tblfn0070" "etiqueta" => "n" "nota" => "<p class="elsevierStyleNotepara" id="npar0085">97.5% CI; the CI for the primary trial endpoint was adjusted for multiplicity.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Efficacy of One Dose of Currently Licensed RSV Vaccines for Adults Aged ≥<span class="elsevierStyleHsp" style=""></span>60 Years During the First RSV Season, the Second RSV Season and Both Seasons, 2021–2023.<a class="elsevierStyleCrossRefs" href="#bib0630"><span class="elsevierStyleSup">53,54</span></a></p>" ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">COPD: chronic obstructive pulmonary disease; HIV; human immunodeficiency virus; RSV: respiratory syncytial virus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">High-risk group \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rationale \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic respiratory disease (COPD/asthma) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Higher risk of severe respiratory complications \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic cardiovascular disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Greater vulnerability to RSV-related morbidity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Immunocompromised individuals (including solid organ transplant recipients, HIV) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heightened risk of severe RSV infection, Impaired immune function and susceptibility to RSV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Chronic hepatic or renal disease \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Impaired immune function, greater susceptibility to RSV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased risk of RSV-related illness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neurological impairment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increased risk of RSV-related illness \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adults living in nursing homes or long-term care facilities \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Increase risk of RSV disease \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564712.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">High-risk Groups for RSV Vaccination Recommendations Irrespective of Age.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">CDC: Centres for Disease Control and Prevention; JCVI: Joint Committee on Vaccination and Immunisation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Agency/society \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Risk groups \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vaccine implementation practice \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CDC (US)<a class="elsevierStyleCrossRef" href="#bib0635"><span class="elsevierStyleSup">54</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥<span class="elsevierStyleHsp" style=""></span>60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary/Heart Disease, Immunosuppression, Institutionalised \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arexvy (GSK) and Abrysvo (Pfizer), Shared Clinical Decision-Making \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">JCVI (UK)<a class="elsevierStyleCrossRef" href="#bib0730"><span class="elsevierStyleSup">73</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥<span class="elsevierStyleHsp" style=""></span>75 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No specified risk groups \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arexvy (GSK) and Abrysvo (Pfizer), Vaccination Programme \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NEP (SP) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥<span class="elsevierStyleHsp" style=""></span>60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pulmonary/Heart Disease, Cardiac Disease, Hepatic Insufficiency, Kidney Disease, Diabetes, Immunosuppression, Institutionalised, Neurological Diseases \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Arexvy (GSK) and Abrysvo (Pfizer), Individual recommendation ≥<span class="elsevierStyleHsp" style=""></span>60 Vaccination Programme: at least risk group \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564709.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Official Recommendations on the Use of Licensed RSV Vaccines for Older Adults.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">RSV: respiratory syncytial virus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. RSV is a significant cause of respiratory pathology in adults, with a potentially underestimated burden and a significant mortality rate.2. There are currently two approved vaccines for adults, RSVpreF (Abrysvo, Pfizer) and RSVpreF3 (Arexvy, GSK) that are difficult to compare, given their different clinical studies, varying case definitions, and analysis criteria. Nevertheless, both vaccines have demonstrated their efficacy and safety.3. The opportunity of co-administration of any available RSV vaccines with other vaccines should be highly considered even in the absence of specific studies.4. From an individual protection perspective, any individual aged 60 years and older can benefit from vaccination.5. From a public health perspective, determining the most efficient age recommendation for RSV vaccination in Spain will depend on the applied pharmacoeconomic models/studies. However, it seems reasonable and advisable to at least include it in the adult vaccination schedule for adults aged 60 years and older in the following risk groups: institutionalised individuals, those with chronic cardiovascular, pulmonary or renal diseases, individuals with diabetes mellitus, individuals with immunosuppression and those with neurological impairments. \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3564715.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Summary of NEP Group Positioning on RSV Vaccination in Older Adults.</p>" ] ] 7 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.mp3" "ficheroTamanyo" => 9806724 ] ] 8 => array:6 [ "identificador" => "202406110503106921" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 196 "Ancho" => 192 "Tamanyo" => 6243 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "sat0005" "detalle" => "Twitter Ico" "rol" => "short" ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:73 [ 0 => array:3 [ "identificador" => "bib0370" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Centers for Disease Control and Prevention (CDC). RSV in older adults and adults with chronic medical conditions. 2022. Available from: <a target="_blank" href="https://www.cdc.gov/rsv/high-risk/older-adults.html">https://www.cdc.gov/rsv/high-risk/older-adults.html</a> [updated 15.10.23]." ] ] ] 1 => array:3 [ "identificador" => "bib0375" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estimation of the number of respiratory syncytial virus-associated hospitalizations in adults in the European union" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Osei-Yeboah" 1 => "P. Spreeuwenberg" 2 => "M. Del Riccio" 3 => "T.K. Fischer" 4 => "A.M. Egeskov-Cavling" 5 => "H. 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Pircon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Influenza Other Respir Viruses" "fecha" => "2023" "volumen" => "17" "paginaInicial" => "e13031" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0385" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Focusing on severe infections with the respiratory syncytial virus (RSV) in adults: risk factors, symptomatology and clinical course compared to influenza A/B and the original SARS-CoV-2 strain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Ambrosch" 1 => "D. Luber" 2 => "F. Klawonn" 3 => "M. Kabesch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2023.105399" "Revista" => array:5 [ "tituloSerie" => "J Clin Virol" "fecha" => "2023" "volumen" => "161" "paginaInicial" => "105399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36863135" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0390" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Burden of respiratory syncytial virus infection in community-dwelling older adults in Europe (RESCEU): an international prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Korsten" 1 => "N. Adriaenssens" 2 => "S. Coenen" 3 => "C. Butler" 4 => "B. Ravanfar" 5 => "H. Rutter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.02688-2020" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2021" "volumen" => "57" "paginaInicial" => "2002688" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33060153" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0395" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The 2016 vaccine development pipeline: a special issue from the World Health Organization Product Development for Vaccine Advisory Committee (PDVAC)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B.K. Giersing" 1 => "K. Modjarrad" 2 => "D.C. Kaslow" 3 => "J.M. Okwo-Bele" 4 => "V.S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 3 | 3 | 6 |
| 2024 September | 18 | 6 | 24 |
| 2024 August | 15 | 4 | 19 |
| 2024 July | 17 | 8 | 25 |
| 2024 June | 47 | 20 | 67 |
| 2024 May | 20 | 8 | 28 |
| 2024 April | 58 | 25 | 83 |
| 2024 March | 281 | 112 | 393 |
| 2024 February | 621 | 196 | 817 |
| 2024 January | 16 | 19 | 35 |
