IDSA 2025 Guidelines on the Use of Vaccines for the Prevention of Seasonal RSV Infections in Immunocompromised Patients

Immunocompromised individuals experience disproportionately severe outcomes from respiratory syncytial virus (RSV) infection, yet direct evidence to guide vaccination in this population remains limited. To support clinical and shared decision-making for the 2025-2026 respiratory virus season, the Infectious Diseases Society of America (IDSA) convened a multidisciplinary expert panel to develop rapid, evidence-based recommendations on RSV vaccination among immunocompromised adults and children. The panel conducted a systematic review of comparative effectiveness and harms data published between August 2024 and July 2025, supplemented by additional evidence from the Vaccine Integrity Project. Certainty of evidence and recommendation strength were assessed using the GRADE approach. Two test-negative case-control studies in immunocompromised adults showed vaccination reduced RSV-associated hospitalization by 70% (95% CI: 66%-73%). Indirect evidence from older-adult populations demonstrated 81% effectiveness (95% CI: 52%-92%) against critical illness. Across three randomized trials, serious adverse events were comparable between vaccinated and unvaccinated groups. Guillain-Barré syndrome was rare, with an estimated 11 excess cases per million doses. Given substantial reduction in severe disease and low likelihood of serious harm, the panel issued a strong recommendation for age-appropriate RSV vaccination in adults and adolescents with compromised immunity. For immunocompromised patients