Protecting the vulnerable: Narrative review on RSV vaccines in adults and pregnancy

Recent years have seen substantial advances in the prevention of respiratory syncytial virus (RSV) lower respiratory tract disease (LRTD) among adults and pregnant individuals. Three RSV vaccines have been licensed for adults, one of which is also authorized during pregnancy.

To provide the first pharmacist-centered narrative review of the efficacy, immunogenicity, and safety data for 3 novel RSV vaccines; to summarize early postmarketing surveillance findings that prompted labeling updates; and to offer practical guidance for pharmacists to support vaccine uptake among adult and pregnant populations.

A narrative review was conducted following PRISMA-ScR principles. MEDLINE, Web of Science, and Embase were searched for English-language studies published from January 2022 through June 2025 to capture pivotal phase 2 and 3 trial data for licensed RSV vaccines. Additional data were obtained from regulatory documents, clinical trial registries, and Centers for Disease Control and manufacturer websites. Eligible studies evaluated the safety, immunogenicity, or efficacy of RSVPreF3 OA, RSVpreF, or mRNA-1345 in adults or pregnant individuals. Data were extracted by 2 reviewers and synthesized descriptively. Although no formal risk-of-bias tool was applied due to heterogeneous study designs, study quality elements were qualitatively considered during interpretation.

Three vaccines demonstrated efficacy, immunogenicity, and safety in preventing RSV-LRTD in adults. One vaccine is FDA-licensed for maternal RSV vaccination during pregnancy and confers protection against RSV respiratory disease in infants. Vaccine selection in adults may be influenced by comparative efficacy, comorbid conditions, and side-effect profiles.

This review summarizes current evidence supporting licensed RSV vaccines, including early postmarketing safety findings, and underscores the role of pharmacists in addressing gaps in RSV vaccine equity. Recent RSV vaccine licensure provides a novel strategy to mitigate disease severity, with pharmacists well positioned to educate patients and support informed vaccination decisions.