Two RSV Vaccines: Arexvy vs Abrysvo — What You Should Know

Two RSV Vaccines
 
Respiratory syncytial virus (RSV) vaccines became publicly available in the United States in 2023. I was genuinely pleased by this long-awaited medical advance and visited my local pharmacy for vaccination last October. Everything went smoothly—until two weeks later, when I discovered that two different RSV vaccines were available.
The pharmacist had selected one for me without explanation. That raised a simple but important question: Was the right choice made? Out of curiosity, I reviewed information published by the Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA). Here is what patients should know.
 
FDA-Approved RSV Vaccines
 
Two RSV vaccines were approved by the FDA in 2023:

• Arexvy® (GSK) – Approved May 3, 2023
• Abrysvo® (Pfizer) – Approved May 19, 2023

Both vaccines are approved for the prevention of lower respiratory tract disease (LRTD) caused by RSV in adults aged 60 years and older.

Background: What Is RSV Infection?
 
RSV is a common respiratory virus that can infect people of all ages. While most infections cause mild, cold-like symptoms, RSV can lead to severe disease in infants, older adults, and individuals with weakened immune systems.

• Nearly all children experience at least one RSV infection by age two
• Infants younger than six months are at highest risk of severe disease
• Older adults may develop serious complications such as pneumonia or respiratory failure

Common RSV Symptoms

• Runny nose
• Cough
• Wheezing
• Fever
• Shortness of breath

In infants, RSV may also cause:

• Poor feeding
• Lethargy
• Irritability
• Apnea (brief pauses in breathing)

RSV Mortality Risk
Mortality rates vary by age and risk profile:

• Infants under 6 months: ~0.5–1%
• Older adults: ~1–2%

 
How to prevent RSV infection
 
Preventive measures remain important, especially during fall and winter RSV season:

• Frequent handwashing
• Avoiding close contact with sick individuals
• Covering mouth and nose when coughing or sneezing
• Cleaning shared surfaces and children’s toys

Children showing signs of RSV infection should be evaluated promptly by a healthcare provider. The availability of effective vaccines now adds a powerful tool for prevention.
 
Key Differences Between Arexvy and Abrysvo
 
Approved Populations

• Abrysvo (Pfizer)
  • Adults aged 60 and older
  • Pregnant women between 32 and 36 weeks of gestation (to protect newborns)
• Arexvy (GSK)
  • Adults aged 60 and older
  • Not approved for use during pregnancy

In short:

• Older adults may receive either vaccine
• Pregnant women currently have only one option: Abrysvo

 
Ideal Patient Profiles
 
Abrysvo May Be Preferred For:

• Adults aged 60+
• Pregnant women (32–36 weeks)
• Individuals with chronic conditions (e.g., asthma, COPD, heart disease)
• Immunocompromised individuals

Arexvy May Be Preferred For:

• Adults aged 60+
• Individuals with a history of allergic reactions to live attenuated vaccines

These distinctions reflect differences in vaccine technology.
 
RSV Vaccine Manufacturing Technology
 
Arexvy (GSK): Subunit Vaccine
Arexvy is a recombinant subunit vaccine, meaning it contains only a purified RSV protein rather than the whole virus.

• RSV protein produced using recombinant DNA technology
• Manufactured in non-pathogenic expression systems
• Formulated with an adjuvant to enhance immune response
• Cannot cause infection

Abrysvo (Pfizer): Live Attenuated Vaccine
Abrysvo contains a weakened (attenuated) form of RSV.

• Virus is grown in cell culture
• Capable of limited replication to stimulate immunity
• Does not require an adjuvant​​

Comparison of Arexvy and Abrysvo Manufacturing Technology

Characteristic	Arexvy	Abrysvo
Vaccine type	Subunit	Live attenuated
RSV protein production method	Recombinant DNA technology	Cell culture
Adjuvant	Yes	No

 

​Advantages and Disadvantages by Vaccine Type
 
Subunit Vaccines (Arexvy)
Advantages

• Excellent safety profile
• No live virus
• Suitable for many older adults

Limitations

• May require stronger immune stimulation
• Potentially reduced effectiveness in severely immunocompromised individuals

 
Live Attenuated Vaccines (Abrysvo)
Advantages

• Strong and durable immune response
• Often effective with a single dose

Limitations

• Mild infection-like side effects possible
• Caution advised in immunocompromised patients

Summary of key differences between Arexvy and Abrysvo

Characteristic	Arexvy	Abrysvo
Vaccine type	Subunit	Live attenuated
RSV protein production method	Recombinant DNA technology	Cell culture
Adjuvant	Yes	No
Approved populations	Older adults (age 60 and older)	Older adults (age 60 and older), pregnant women between 32 and 36 weeks of pregnancy
Possible advantages for certain patients	Older adults, people who have a history of allergic reactions to live attenuated vaccines	People with weakened immune systems, people with chronic health conditions

 

Cost of RSV Vaccines
 
There is a modest difference in pricing:

• Arexvy (GSK): approximately $200–$295 per dose
• Abrysvo (Pfizer): approximately $180–$270 per dose

Actual out-of-pocket costs vary depending on:

• Pharmacy pricing
• Insurance coverage
• Administration fees (not included in vaccine price)

Patients should contact their insurance provider to confirm coverage.
 
Final Takeaway
 
Both Arexvy and Abrysvo are safe and effective RSV vaccines. The best choice depends on individual factors such as age, pregnancy status, immune health, and medical history.
Patients are encouraged to discuss options with their physician or pharmacist to determine the most appropriate vaccine.

References
CDC source:
(1) Respiratory Syncytial Virus (RSV) Immunizations
 
FDA sources:
(2) Arexvy
(3) Abrysvo
 
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