Public health officials in Spain are increasingly focused on strategies to combat Respiratory Syncytial Virus (RSV),a common respiratory illness that can be severe for both infants and older adults. This week, leading experts from Madrid and Extremadura convened at the IX public health Forum to discuss expanding vaccination efforts and surveillance programs, notably for vulnerable populations Fundamed hosted the forum with support from GSK, Sanofi, and Shionogi. The discussions come as ten Spanish autonomous communities have already begun RSV vaccination programs for the elderly this year, signaling a growing national response to the virus.
Respiratory syncytial virus (RSV) vaccination strategies for vulnerable populations were the focus of discussion at the IX Public Health Forum, organized by Fundamed with support from GSK, Sanofi, and Shionogi. The forum highlighted growing understanding of RSV’s impact and the evolving approaches to protect those most at risk.
The session was moderated by Ángel Gil, Professor of Preventive Medicine and Public Health at the Rey Juan Carlos University, and featured Elena Andradas, Director General of Public Health of the Community of Madrid; Yolanda Márquez, Director General of Public Health of Extremadura; and José Antonio Navarro, Honorary Consultant of the Vaccine Advisory Committee of the Ministry of Health.
Prior to the COVID-19 pandemic, RSV already posed a significant health challenge, particularly for young children, but its impact on older adults was increasingly recognized, Gil noted during the introduction. This year, ten Spanish autonomous communities have already begun vaccinating elderly individuals in long-term care facilities against the virus. This expansion of vaccination efforts reflects a growing awareness of RSV’s potential severity across all age groups.
Gil then introduced Andradas, whose region has been at the forefront of implementing the new vaccination coverage. Andradas emphasized the importance of studying the virus’s impact to inform decisions about incorporating vaccination programs, such as those for children and now, older adults in institutional settings.
Analyzing the results of the immunization campaign in young children led the Community of Madrid to begin monitoring the virus’s impact on the broader population, Andradas explained. “We detected that 47% of all hospitalizations for respiratory syncytial virus occurred in people aged 65 and over.”
This was the first time the Community of Madrid was able to monitor this disease burden, “knowing that it was likely still underestimated.” “This allows us, once a new tool like the RSV vaccine for adults is available, to conduct a swift technical assessment of the benefit of incorporating it into the National Health System as another program for the protection and prevention of the health of our elderly,” she said.
Based on the technical results, Andradas stated, they were confident in finding ways to facilitate the inclusion of this vaccine coverage, “always within a framework of consensus.” “That is why we decided this year, 2025, and we are not alone, to begin vaccinating, protecting those people in whom there is a greater disease burden.” These groups include elderly individuals in institutional settings and those with compromised immune systems.
“VACCINE COVERAGE FOR RSV IN RESIDENCES IS CURRENTLY OVER 90%”
Elena Andradas, Director General of Public Health of the Community of Madrid
“We believe that we should be able to use the RSV vaccine in the same way as the pneumococcal vaccine, outside of seasonal campaigns,” Andradas proposed. She believes it’s necessary “to be able to use it as a mechanism, as a prevention tool throughout the year so that when the virus circulates, our population is protected.” This year, they designed a priority organization starting in September, with vaccination teams visiting residences.
“RSV vaccination coverage in nursing homes is currently over 90%, just like what was achieved with the risk vaccination units in hospitals,” Andradas revealed, adding that, responsibly, the results of incorporating RSV vaccination in these populations will be evaluated at the end of the season.
Surveillance and Vaccination in Adults
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Turning to the same question, Márquez recalled that when she joined the Directorate General in 2023, the focus was on immunizing children with RSV monoclonal antibodies. Now, just two years later, Extremadura has also launched immunization against RSV in elderly adults in institutional settings. “And we realized that we were right,” she said.
However, Márquez stressed that this situation is the result of “a lot of responsibility and a lot of technical study.” This combination has made it possible “to implement vaccination against RSV in adults over 60 years of age in institutional settings and over 50 years of age who have received a lung transplant.” “It’s a laborious task. And the scenario we have in Extremadura is complicated, because we are going to have more and more people of a considerable age, over 65 years old, a problem that we have to take into account when implementing certain types of vaccines,” Márquez explained.
The Director General of Public Health of the Extremadura region specified that the region has already reached 40% vaccination coverage in older adults. “It is true that this is a very targeted vaccination, but we started a week and a half ago, so we are expectant now. Márquez’s concern now is the data: “We won’t have data until next year, but they are important because, above all, these vaccination programs are an investment.”
“WE SHOULD NOT ONLY VACCINATE INSTITUTIONALIZED ELDERS AGAINST RSV, WE SHOULD OPEN UP THE AGE COHORTS A LITTLE MORE”
Yolanda Márquez, Director General of Public Health of Extremadura
For his part, Navarro provided data demonstrating the increasing relevance of RSV in the landscape of major acute respiratory infections campaign after campaign. “Speaking of adults, I can advance, in terms of epidemiology, that around 13,700 people were hospitalized during the 24/25 season. If we compare it to the flu, which was 30,000, we are talking about practically half. And of the hospitalizations, 25% have pneumonia; 3% are in the ICU; 1.9% require mechanical ventilation and 7.5% died.”
As the specialist pointed out, this is an “important data point”: “If we lower these percentages to figures, we are talking about 370 admissions to the ICU and 995 deaths. Therefore, it is clear that there is a need for a preventive measure that at least stops that situation.”
Similarly, Navarro determined which population would benefit most from immunization against RSV: “We continue to think and there is already data, even in Spain, that the profile would coincide with people who live in nursing homes, people with functional dependence, with a disease, with decompensated heart disease, severe heart disease, some immunodeficiencies, kidney solid and liver transplant, cancer, diabetes… All these more common pathologies.”
“We Must Continue to Advance”
Gil then asked about the plans for the coming years for two communities at the forefront of protecting vulnerable groups against RSV, such as Madrid and Extremadura, now that initial data from the current campaign is emerging. Andradas explained that, pending the evaluation of the results of this campaign and given “the magnitude of what RSV infection means in the elderly, as well as the safety and effectiveness results of the vaccine, we do support continuing to advance the vaccination strategy,” not only to expand risk groups, but also in some other more national line.
Márquez agreed with Andradas and expressed her support for expanding coverage in future campaigns: “I think that for subsequent years we have to realize that we should take the RSV vaccine out of the autumn vaccination. Furthermore, I think that we should not only vaccinate institutionalized or lung transplant recipients, but also we should open up the age cohorts a little more.”
The Importance of Awareness
Ideally, Navarro said, all autonomous communities would begin vaccinating this year or next, or at least have a formal commitment. He emphasized that “all the requirements are met” to venture into “a more ambitious vaccination policy.” However, unlike his fellow panelists, Navarro favors seasonality: “What we have to do is take advantage of the peak of vaccine effectiveness for the peak of the disease.”
“All the requirements are met for a more ambitious policy in vaccination”
José Antonio Navarro, Honorary Consultant of the Vaccine Advisory Committee of the Ministry of Health
Finally, Navarro stressed the importance of raising awareness about vaccination, despite the work involved in “insisting and insisting,” whether we are talking about the general population or professionals. “In general, I can say that vaccine safety is not a cause for concern. Therefore, with this package of innovations, we have managed to meet many public needs. And obviously, as a technical, not political, party, we have made our first recommendations,” the specialist concluded.
