Rsv vaccine for 91 year old women

The short version: for a 91-year-old woman, the RSV vaccines shown in these records were tested in adults 60 and older, but the evidence for people past 85 is thin, and the long-term safety data is missing.

The evidence here comes from narrative reviews and manufacturer-funded trials. One review reports that the GSK vaccine Arexvy showed about 83% efficacy against RSV lower respiratory tract disease in the first season and 94% against severe disease in adults 60 and older [8]. The same review says efficacy dropped to about 63% over three seasons [8]. The Moderna mRNA vaccine showed similar first-season numbers, around 84%, but waned to about 50% by 18 months [8]. These are short-term numbers from trials that followed people for one to three seasons. No trial in this evidence set followed a 91-year-old specifically, and no trial reported all-cause mortality or serious adverse events in that age group separately.

The safety data is even thinner. The reviews mention common injection-site pain and fatigue, and note a background signal of Guillain-Barré syndrome in post-marketing surveillance for the Pfizer vaccine, about 4.4 cases per million doses [8]. But passive surveillance catches only a fraction of real events. The trials compared vaccinated to vaccinated or to placebo for a short window, not to an unvaccinated group over years. For a 91-year-old, the risk of a serious fall or a drug interaction from the immune response is not zero, and these studies did not measure it.

My call: the vaccines probably reduce the chance of a bad RSV infection for a season or two, but the evidence does not cover a 91-year-old specifically, does not measure net harm, and does not include long-term safety. The benefit is modest and temporary, the safety data is incomplete, and the burden of proof has not been met for this age group. Confidence: low.