I’m in the group that was “ shared decision making “ last year and consider this year— as usual this is a brilliant review. No, you can’t cover this in an office visit or a pharmacy trip for a shot ( I was strongly urged to get a shot by a pharmacy technician just before the new guidelines came out.)
Having cared for a patient with Guillian Barre, I wasn’t ready to consider the vaccine until more real world data accumulated.
Thank you as always for clear information that we can use.
Thanks Jan - and I too have a family member who suffered a GBS-like syndrome, and has not fully recovered. Rare with these shots, but still gives me pause like CDC in not recommending for the younger crowd. Pharmacy tech had the right spirit re: vaccines in general, but maybe not the nuance ;)
I don't want to name names, bilutbthere is one prominent vaccine manufacturer whose products I do my best to avoid, although as a lowly patient sometimes I have no choice in the matter. I much prefer Moderna products, but am bound to accept what my health system has available. Seems unfair to be forced to take what I consider an inferior product. For-profit medicine at its worstest.
Thanks Ryan! I had my Pfizer shot yesterday (Friday) from Kaiser -it was the only one offered. But would it be okay to get a Novavax from Costco Monday or is that overdoing it? I like the idea of tweaking the immune system from a different direction.
As the primary caregiver for my 95 year old parent (with pulmonary hypertension and COPD) and a grandparent with grandchildren in daycare, it has been recommended that I receive the RSV to help protect my parent. I am thankful to be further educated on this vaccine.
Hi Nancy, and yes this absolutely factors into my discussions (mostly with grandparents). I think your multi-generational risk factors and considerations definitely make sense, and would tip the scales in my own decision making, too.
While I am over 65, I believe my health to be excellent, I haven't been sick since before 2019. In order to avoid COVID we don't go out among people if we can help it. I don't believe I'm the target audience for RSV vaccines, am I correct?
Hi Margaux, consistent with the CDC guidelines, I agree you are not the target population for RSV vaccination until 75, assuming excellent health. Avoiding infections in the first place is prudent if you can within the context of your life!
While pretty darn rare, isn't GBS after vaccination, including COVID have a pretty good recovery rate? Seem to recall that when the COVID shots came out.
It's caused by many viruses and other vaccinations, but having cared for a formerly healthy adolescent who had a very long and partial recovery, it's not something I want to experience.
Hi KB - I had to look this up to make sure my answers were correct. This seems about right:
The recovery rates for Guillain-Barré syndrome (GBS) can vary, but here are some general statistics. Please note that individual outcomes can differ based on various factors such as age, severity of the condition, and timely treatment. Here's a breakdown of the typical recovery patterns:
Complete recovery:
Approximately 60-80% of patients with GBS achieve a full or nearly full recovery.
Partial recovery:
About 10-20% of patients experience some residual weakness or other lingering effects.
No recovery or severe residual effects:
Around 5-10% of patients may have significant residual disability.
It's important to note that:
The recovery process can be slow, often taking months to years.
Most improvement occurs within the first year after onset.
Even among those who achieve "complete" recovery, some may experience minor residual effects that don't significantly impact daily life.
Mortality rates are generally low, around 4-7%, usually due to complications like respiratory failure or cardiac issues.
I am at an age and have conditions that suggest I should get the RSV vaccine. However, since I remain a 95% Covid hermit and wear a Powecom KN-95 mask whenever I do go into indoor places and make everyone who comes into my house wear a mask, I figure my risk for getting RSV is so low that it doesn't warrant the risk of getting Guillain Barré. I hope I'm right.
Hi Mim - there is really no better protection against these wily respiratory viruses than what you are doing. I think your calculation is logical, but ultimately your decision to be respected!
Thanks for this excellent summary and update on RSV vaccination.
Everyone should take time to read it in detail and ponder whether to get one of the 3 vaccines you discuss.
For individuals like me in the 60-74 year range (I'll term these "mature" individuals) who have stable cardiac disease it is not clear to me if the benefits outweigh the risks. I held off last year due to the GBS cases. I've seen some horrific cases of GBS and don't want it.
The CDC describes the cardiac conditions that would qualify the mature individuals as
Each of these conditions can range from very mild to very severe.
It is hard for me to imagine how patients with stable CAD and normal LV function are at increased risk for severe RSV.
It would be nice if the CDC developed a risk calculator ( a la the ASCVD risk estimator) that plugs in multiple features and spits out an estimated risk for an individual to aid in their personal decision making.
Since the EGYM at my local YMCA has determined that my biological age is 55 years and my CAD and HCM are mild and stable I'm going to skip the RSV, likely until I turn 75 years.
Great points, as usual! The calculator function would be great, combined with the personalization of counseling based on intangibles, preferences, knowns and unknowns.
"Each of these conditions can range from very mild to very severe." This is also very important to consider. Incidental atherosclerosis picked up on chest CT versus h/o CABG very different "CAD." I didn't push my own patients under age 75 or so last year, so I'm glad to see some validation from CDC this year, and you, and I totally agree with you own personal calculus. But I'm scared to know my own biological age after the stress of the past 5 years!
Thank you, Ryan, for covering all the RSV bases. I have asthma, and over the years I’ve had both bronchitis and pneumonia, so I got an RSV vax last December. Your post made me check my vax record and I did get the Arexvy. That was my preference, and that’s what my local CVS offers. If they offered only Abrysvo, I would have looked for a different pharmacy. Not everyone has that luxury.
Several years back, a friend’s brother had GBS; he did not recover. I never learned the particulars, so I don’t know if he’d had an infection or virus, or a recent vax. But I’ve been haunted by his death. I’m glad to know most people recover fully.
Hi Liz - Wow, that hits pretty close to home. Sorry to hear of that tragedy. As I commented above we also have a dear family member with permanent leg strength problems due to what I think was GBS... her docs not 100% sure, and not in the best part of the country for clinical acumen. It could have been triggered by a recent Covid illness but also had a Covid booster at almost the same time, so impossible to blame one or the other. Rare regardless. If I were over 75 I think I would certainly roll the dice, and try for the Arexvy or mResvia perhaps. Glad you are among the vast majority who did well with either of the shots last year :)
Thanks, Ryan. Your reply to KB above, with GBS recovery rates, is encouraging and I’m saving your entire discussion for future reference. When it’s something so rare, knowing people who’ve been affected makes it seem more possible. Every time I get a vax and read the GBS warning, I brace myself. Just being aware of the symptoms, and getting medical help quickly, is crucial.
Yes, no way this can be covered in a physician visit! Grateful to you all the more for taking the time to lay all this information out, and so clearly, here. I drew from this three key “I wish I’d known that” points before I got my RSV shot (I did not get it last year, as I wanted to have more info about prevalence of GBS and any other side effects). These are the “wish I’d knowns”: 1) that there were three options, and the great information you have here about them—I had no idea that was the case; 2) what is recommended for a person who is 75 (not either over or under); and 3) how often should one get this shot. I will be on the lookout for info and ask my doc about those things before I get another. It’s also interesting to see some of the comments, both re GBS and also how folks assess their risk overall of getting respiratory diseases. I will take both of those into account, also, in deciding whether to get another shot.
Hi Susan :) Those are three salient "I wish I'd knowns" indeed, and the answers are more clear this year. I saved up some of the studies and recommendations as they were published over the past year, so this post was kind of a long game one built over that time. I cut a lot of redundancy and just included the stuff I found most helpful... but it still dragged on too long. The bullet points were my way of trying to distill the topic, but I figure people don't want more of the same quick reads they can get elsewhere. If I were getting the shot I would want details and numbers, even if difficult to assess personal risk from them like you said! Will keep you posted and I'll start the updated post for 2025 tomorrow ;)
Rest assured your post here did not drag on too long. I am grateful to you for putting this all together, even read out bits to my sig other, and am saving this information for future reference. Thank you so much for all!
Hi Karla - thanks for stopping by, and I'm so glad this was a good read for you. I would expect no less research for something I'm having injected in my own arm, though I do "trust" the experts at CDC for the most part :)
I’m in the group that was “ shared decision making “ last year and consider this year— as usual this is a brilliant review. No, you can’t cover this in an office visit or a pharmacy trip for a shot ( I was strongly urged to get a shot by a pharmacy technician just before the new guidelines came out.)
Having cared for a patient with Guillian Barre, I wasn’t ready to consider the vaccine until more real world data accumulated.
Thank you as always for clear information that we can use.
Thanks Jan - and I too have a family member who suffered a GBS-like syndrome, and has not fully recovered. Rare with these shots, but still gives me pause like CDC in not recommending for the younger crowd. Pharmacy tech had the right spirit re: vaccines in general, but maybe not the nuance ;)
I don't want to name names, bilutbthere is one prominent vaccine manufacturer whose products I do my best to avoid, although as a lowly patient sometimes I have no choice in the matter. I much prefer Moderna products, but am bound to accept what my health system has available. Seems unfair to be forced to take what I consider an inferior product. For-profit medicine at its worstest.
I find it difficult to select/choose manufacturers too... frustrating.
I've tried to find Novavax for patients, and one of the only places I can find that is not opaque is Costco... they now have Novavax listed:
https://www.costco.com/pharmacy/adult-immunization-program.html
As far as mRNA options go, I've had equal Pfizer and Moderna Covid shots so far. Best of luck with yours!
Thanks Ryan! I had my Pfizer shot yesterday (Friday) from Kaiser -it was the only one offered. But would it be okay to get a Novavax from Costco Monday or is that overdoing it? I like the idea of tweaking the immune system from a different direction.
Very helpful discussion and I know you’ll keep us posted on the horizon for any future booster for those of us already vaccinated. Thanks.
Will plan on that PJJ, thanks for keeping up with this, too :)
As the primary caregiver for my 95 year old parent (with pulmonary hypertension and COPD) and a grandparent with grandchildren in daycare, it has been recommended that I receive the RSV to help protect my parent. I am thankful to be further educated on this vaccine.
Hi Nancy, and yes this absolutely factors into my discussions (mostly with grandparents). I think your multi-generational risk factors and considerations definitely make sense, and would tip the scales in my own decision making, too.
While I am over 65, I believe my health to be excellent, I haven't been sick since before 2019. In order to avoid COVID we don't go out among people if we can help it. I don't believe I'm the target audience for RSV vaccines, am I correct?
Hi Margaux, consistent with the CDC guidelines, I agree you are not the target population for RSV vaccination until 75, assuming excellent health. Avoiding infections in the first place is prudent if you can within the context of your life!
https://www.cdc.gov/rsv/hcp/vaccine-clinical-guidance/older-adults.html
Yikes! Thanks as always. I am now 68, got mine last year -- very glad I knew nothing about GBS!
Yeah, kind of didn't want to consider that either, but it's been on my radar with these shots! Glad yours went well :)
While pretty darn rare, isn't GBS after vaccination, including COVID have a pretty good recovery rate? Seem to recall that when the COVID shots came out.
GBS, in my experience, is very serious and recovery can be long and partial: https://www.mayoclinic.org/diseases-conditions/guillain-barre-syndrome/symptoms-causes/syc-20362793
It's caused by many viruses and other vaccinations, but having cared for a formerly healthy adolescent who had a very long and partial recovery, it's not something I want to experience.
Nor do I, if shingles is any indication.....
I do find this suggesting infection have a higher rate. https://www.neurology.org/doi/10.1212/WNL.0000000000207900
Hi KB - I had to look this up to make sure my answers were correct. This seems about right:
The recovery rates for Guillain-Barré syndrome (GBS) can vary, but here are some general statistics. Please note that individual outcomes can differ based on various factors such as age, severity of the condition, and timely treatment. Here's a breakdown of the typical recovery patterns:
Complete recovery:
Approximately 60-80% of patients with GBS achieve a full or nearly full recovery.
Partial recovery:
About 10-20% of patients experience some residual weakness or other lingering effects.
No recovery or severe residual effects:
Around 5-10% of patients may have significant residual disability.
It's important to note that:
The recovery process can be slow, often taking months to years.
Most improvement occurs within the first year after onset.
Even among those who achieve "complete" recovery, some may experience minor residual effects that don't significantly impact daily life.
Mortality rates are generally low, around 4-7%, usually due to complications like respiratory failure or cardiac issues.
This is really helpful additional information. Thanks, Ryan!
I am at an age and have conditions that suggest I should get the RSV vaccine. However, since I remain a 95% Covid hermit and wear a Powecom KN-95 mask whenever I do go into indoor places and make everyone who comes into my house wear a mask, I figure my risk for getting RSV is so low that it doesn't warrant the risk of getting Guillain Barré. I hope I'm right.
Hi Mim - there is really no better protection against these wily respiratory viruses than what you are doing. I think your calculation is logical, but ultimately your decision to be respected!
Thanks for this excellent summary and update on RSV vaccination.
Everyone should take time to read it in detail and ponder whether to get one of the 3 vaccines you discuss.
For individuals like me in the 60-74 year range (I'll term these "mature" individuals) who have stable cardiac disease it is not clear to me if the benefits outweigh the risks. I held off last year due to the GBS cases. I've seen some horrific cases of GBS and don't want it.
The CDC describes the cardiac conditions that would qualify the mature individuals as
"Chronic cardiovascular disease (e.g., heart failure, coronary artery disease, or congenital heart disease [excluding isolated hypertension])"
Each of these conditions can range from very mild to very severe.
It is hard for me to imagine how patients with stable CAD and normal LV function are at increased risk for severe RSV.
It would be nice if the CDC developed a risk calculator ( a la the ASCVD risk estimator) that plugs in multiple features and spits out an estimated risk for an individual to aid in their personal decision making.
Since the EGYM at my local YMCA has determined that my biological age is 55 years and my CAD and HCM are mild and stable I'm going to skip the RSV, likely until I turn 75 years.
Great points, as usual! The calculator function would be great, combined with the personalization of counseling based on intangibles, preferences, knowns and unknowns.
"Each of these conditions can range from very mild to very severe." This is also very important to consider. Incidental atherosclerosis picked up on chest CT versus h/o CABG very different "CAD." I didn't push my own patients under age 75 or so last year, so I'm glad to see some validation from CDC this year, and you, and I totally agree with you own personal calculus. But I'm scared to know my own biological age after the stress of the past 5 years!
Thank you, Ryan, for covering all the RSV bases. I have asthma, and over the years I’ve had both bronchitis and pneumonia, so I got an RSV vax last December. Your post made me check my vax record and I did get the Arexvy. That was my preference, and that’s what my local CVS offers. If they offered only Abrysvo, I would have looked for a different pharmacy. Not everyone has that luxury.
Several years back, a friend’s brother had GBS; he did not recover. I never learned the particulars, so I don’t know if he’d had an infection or virus, or a recent vax. But I’ve been haunted by his death. I’m glad to know most people recover fully.
Hi Liz - Wow, that hits pretty close to home. Sorry to hear of that tragedy. As I commented above we also have a dear family member with permanent leg strength problems due to what I think was GBS... her docs not 100% sure, and not in the best part of the country for clinical acumen. It could have been triggered by a recent Covid illness but also had a Covid booster at almost the same time, so impossible to blame one or the other. Rare regardless. If I were over 75 I think I would certainly roll the dice, and try for the Arexvy or mResvia perhaps. Glad you are among the vast majority who did well with either of the shots last year :)
Thanks, Ryan. Your reply to KB above, with GBS recovery rates, is encouraging and I’m saving your entire discussion for future reference. When it’s something so rare, knowing people who’ve been affected makes it seem more possible. Every time I get a vax and read the GBS warning, I brace myself. Just being aware of the symptoms, and getting medical help quickly, is crucial.
Yes, no way this can be covered in a physician visit! Grateful to you all the more for taking the time to lay all this information out, and so clearly, here. I drew from this three key “I wish I’d known that” points before I got my RSV shot (I did not get it last year, as I wanted to have more info about prevalence of GBS and any other side effects). These are the “wish I’d knowns”: 1) that there were three options, and the great information you have here about them—I had no idea that was the case; 2) what is recommended for a person who is 75 (not either over or under); and 3) how often should one get this shot. I will be on the lookout for info and ask my doc about those things before I get another. It’s also interesting to see some of the comments, both re GBS and also how folks assess their risk overall of getting respiratory diseases. I will take both of those into account, also, in deciding whether to get another shot.
Hi Susan :) Those are three salient "I wish I'd knowns" indeed, and the answers are more clear this year. I saved up some of the studies and recommendations as they were published over the past year, so this post was kind of a long game one built over that time. I cut a lot of redundancy and just included the stuff I found most helpful... but it still dragged on too long. The bullet points were my way of trying to distill the topic, but I figure people don't want more of the same quick reads they can get elsewhere. If I were getting the shot I would want details and numbers, even if difficult to assess personal risk from them like you said! Will keep you posted and I'll start the updated post for 2025 tomorrow ;)
Rest assured your post here did not drag on too long. I am grateful to you for putting this all together, even read out bits to my sig other, and am saving this information for future reference. Thank you so much for all!
Thank you so much for this important information and for the way you write in a way that is easy for me to understand. I feel informed and prepared.
Hi Karla - thanks for stopping by, and I'm so glad this was a good read for you. I would expect no less research for something I'm having injected in my own arm, though I do "trust" the experts at CDC for the most part :)