Dear Dr. Roach: My daughter-in-law and son are expecting their first baby in late January. I am a 65-year-old healthy, fit woman. I walk daily and do yoga. Other than perhaps my age, I have no medical risk factors. She is requesting that I received the respiratory syncytial virus (RSV) vaccine. I do not see any reason that it is necessary. She feels RSV is more prevalent in her area than where I live.
I have also received the Tdap vaccine when my other granddaughter was born six years ago. I told my daughter-in-law that it’s typically administered every 10 years, but she is also asking that I receive this vaccine again. I do feel like I have some knowledge on the subject, but can you please offer your medical expertise on this topic?
C.P., R.N.
I recognize your expertise as an infection control nurse, and I hope I can frame things in a way to help you.
There are two infections your son and daughter-in-law are concerned about: pertussis (whooping cough) and RSV, both of which can be transmitted from adults to newborns. Both of these illnesses are potentially serious to newborns, who have very little protection as they have undeveloped immune systems. The decision for grandparents to get the vaccine isn’t completely straightforward, so some clinical judgment is in order.
For pertussis, you are completely right that adults are recommended to have the Tdap vaccine every 10 years. You had the vaccine six years ago, but the vaccine’s efficacy does wane over time. My personal opinion is that the harm of vaccinating you before you are due is outweighed by the benefit of getting more-robust protection against pertussis. This is particularly important now, as whooping cough cases are five times higher this year than they were last year at this time. The harm from getting the vaccine before you are due is very small.
The RSV vaccine is recommended for all adults over 75, but adults between 60-74 with high-risk conditions (such as any chronic heart or lung disease or any deficiency in the immune system) should consider the vaccine as well. At this time, the vaccine is intended to be a one-time-only vaccine, but it is possible that the Advisory Committee on Immunization Practices will decide whether boosters would be beneficial.
Again, you do not fit the strongest recommendation for getting the vaccine now, but it would be entirely reasonable to do so. The added benefit of protecting your new grandchild would prompt me to recommend the vaccine to patients in your situation.
I looked up the current RSV levels in wastewater (available through the U.S. Centers for Disease Control), and at the time of this writing, the levels are low in your state and minimal in hers. However, RSV typically begins in the fall and ends in the spring. Mask-wearing during the pandemic made the RSV season later than usual during these past few years, so it’s not clear whether this year will be part of the usual pattern.
Overall, the benefit to you, your grandchild, and your daughter-in-law’s peace of mind is worth the small cost of getting these vaccines earlier than strictly necessary.
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