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Jump to Key Points Respiratory virus season will begin soon in Canada, but recent government data indicate low respiratory syncytial virus (RSV) vaccine coverage among older Canadians. Only 34% of Canadians aged 75 years or older reported being vaccinated, along with only 21% of those aged 60-74 years with chronic conditions.
A recent update from the National Advisory Committee on Immunization (NACI) strongly recommends vaccination for everyone aged 75 years or older and for patients aged 65-74 years who are at increased risk for severe disease. But the provinces are free to determine which vaccination programs to fund.
RSV is a common respiratory virus that can cause serious complications, including hospitalization, ICU admission, and death, in older adults and patients with certain medical conditions.
Historically, RSV has been seen as a disease affecting children younger than 24 months. This is because it was first recognized in the pediatric population, and most of the surveillance, prevention, and public awareness were focused on children. But globally, the disease is associated with roughly 336,000 hospitalizations and 14,000 in-hospital deaths each year in adults aged 65 years or older, according to a systematic review.
- RSV vaccine coverage low in older Canadians: 34% ≥75 y; 21% age 60-74 w/ chronic disease.
- NACI strongly recommends RSV vaccination for all ≥75 y; 65-74 y if high-risk.
- RSV in adults ≥65 y linked to ~336,000 hospitalizations and 14,000 in-hospital deaths/year.
- Vaccine approval for ≥60 y in Canada since Aug 2023; real-world data suggest ↓ hospitalization/ICU.
- Provincial funding varies; access depends on residence, LTC setting, and high-risk group eligibility.
The first RSV vaccine for patients aged 60 years or older received Health Canada approval in August 2023.
Older Adults and RSV Risk
“For older adults, particularly those with underlying health conditions, RSV is not simply a bad cold,” Ian Culbert, executive director of the Canadian Public Health Association, told Medscape News Canada. “It can cause pneumonia, exacerbate chronic heart and lung disease, lead to hospitalization and intensive care stays, and even result in death. We definitely need to broaden the way we talk about RSV. It certainly remains an important pediatric infection, but it’s also an important cause of serious illness in older adults and adults with certain chronic conditions.”
RSV causes 5%-8% of symptomatic respiratory infections in adults aged 60 years or older. Patients in their eighties have particularly high rates of infection, and the virus becomes more prevalent with age, Culbert explained.
The benefits of the vaccine for older adults are clear, according to Isaac Bogoch, MD, infectious disease specialist at Toronto General Hospital in Toronto. “The emerging data for the RSV vaccine deployed in older Canadians appear to be pretty darn good,” Bogoch told Medscape News Canada. “Real-world experience is emulating the trials being conducted, and the vaccine is reducing the risk of hospitalization with ICU stays. The nice thing about this vaccine is its very long lifespan: It probably has decent efficacy for two or even more seasons,” he added.
When patients are admitted to the hospital for a respiratory illness such as chronic obstructive pulmonary disease (COPD) exacerbation, heart failure, or community-acquired pneumonia, it’s an opportune time to discuss their risk factors for severe infection and protective measures that will reduce their risk for further hospitalizations related to RSV or other infections, Bogoch noted.
Lack of Provincial Coverage Affects Access
Clinicians play an important role in talking to older patients about RSV vaccination. In surveys, patients often say that they weren’t told about the vaccination option. But a recommendation from a clinician doesn’t necessarily translate into access to the vaccine.
Most provinces and territories have limited or no universal public funding for routine adult RSV vaccination outside of specific high-risk groups. Despite the NACI recommendation, public funding varies wildly across various regions and residential settings, and coverage is nuanced.
British Columbia, Ontario, and Prince Edward Island cover adults aged 75 years or older, for example. British Columbia has a free, time-limited vaccination program starting in fall 2026 for Indigenous patients aged 60 years or older. Alberta pays for the vaccine for those aged 70 years or older; residents of continuing care or senior supportive living aged 60 years or older; and First Nations, Métis, and Inuit patients aged 60 years or older.
“The problem is how sick people can get and the duration of the illness. It affects their lifespan going forward,” said Jobin Varughese, MD, family physician and assistant dean of primary care education at Toronto Metropolitan University in Toronto. “The people most at risk are those with COPD, bronchitis, emphysema, or even frequent viral colds — so is anyone over age 60 years in a long-term care facility or retirement setting where they’re at close quarters with other elderly patients.”
With age, lungs lose a lot of their plasticity and their ability to fight off infection. With a decreased immune response, it’s critical that seniors be vaccinated, Varughese explained.
“A person’s access to a recommended vaccine should not depend so heavily on where they live in Canada. By investing in vaccines, we can take the pressure off hospitals and emergency rooms, especially during respiratory virus season,” concluded Culbert.
Culbert, Bogoch, and Varughese reported having no relevant financial relationships.
Evra Taylor is a widely published freelance medical writer and reporter with 20 years’ experience covering a broad range of therapeutic sectors, including family health, cardiology, psychiatry, ophthalmology, and dermatology.
