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Bivalent RSVpreF effectiveness against RSV-related lower respiratory tract disease hospitalization and ED visits across three RSV Seasons

Tartof, S. Y.; Zasowski, E. J.; Aliabadi, N.; Goodwin, G.; Slezak, J.; Hong, V.; Frankland, T. B.; Ackerson, B.; Liu, Q.; Shaw, S.; Welsh, S.; Kapadia, B.; Spence, B. C.; Davis, G. S.; Lewnard, J. A.; Chowdhry, H.; Dutro, M.; Chilson, E.; Cane, A.; Hayford, K.; Begier, E.

2026-07-13 infectious diseases
10.64898/2026.07.08.26357564 medRxiv
Show abstract

Introduction: RSV vaccines reduce the risk of severe outcomes such as hospitalization and emergency department (ED) visits for at least 2 RSV seasons following vaccination. No data have been published on real-world RSV vaccine effectiveness (VE) beyond the second season after vaccination. This study evaluates bivalent RSVpreF VE against RSV-related lower respiratory tract disease (LRTD) hospitalizations/ED visits throughout 3 seasons after vaccination. Methods: This retrospective test-negative case-control evaluates bivalent RSVpreF VE among adults aged >/= 60 years at Kaiser Permanente Southern California with LRTD over 3 RSV seasons (11/24/20230-4/18/2026). Cases were RSV-positive without coinfection. Controls were negative for RSV, hMPV, influenza, SARS-CoV-2, and positive for a non-vaccine preventable disease pathogen. Exposure was bivalent RSVpreF (Abrysvo) receipt >/= 21 days before LRTD. Adjusted VE was estimated using odds ratios from multivariable logistic regression or generalized estimating equations. Results: Overall, adjusted VE against RSV-related LRTD hospitalization/ED visits was 80% (95% CI:68-87), 70% (95% CI:53-81), and 51% (95% CI:-12-78) in the first, second, and third season after vaccination, respectively. Among non-immunocompromised individuals, adjusted VE against RSV-related LRTD was 87% (95% CI:75-94), 76% (95% CI:55-87), and 58% (95% CI:-21-86) in the first, second, and third season after vaccination, respectively. Adjusted VE across the 3 combined seasons was 73% (95% CI: 64-80) overall and 80% (95% CI: 69-87) among non-immunocompromised individuals. Conclusion: These results suggest Bivalent RSVpreF provides protection against RSV-related LRTD outcomes for at least three seasons after vaccination in this population of older adults with a prevalence of comorbidities. This suggests RSV vaccination results in substantial individual and public health benefit.

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