Respiratory Syncytial Virus in Adults in India: An Under-recognized Public Health Concern Demanding Urgent Immunization Action.

BACKGROUND: Respiratory syncytial virus (RSV) is an important global cause of acute respiratory tract infection, contributing substantially to illness, hospitalization, and deaths across all age groups worldwide. While RSV has long been associated with severe disease in infants and young children, its impact on older adults is increasingly recognized, with evidence suggesting that mortality in elderly populations may equal or exceed that in paediatric age groups. In India, demographic transition, increasing prevalence of chronic comorbidities, and limited adult vaccination programmes are likely to amplify the burden of RSV disease, which remains under-recognized and insufficiently characterized. OBJECTIVES: The article delineates the burden of RSV among Indian adults, assesses current evidence and regulatory status of RSV vaccines, and identifies priorities for strengthening surveillance, informing policy, and advancing immunization efforts. CONTENT: Although national adult-specific RSV data from India remain scarce, available evidence indicates that RSV is an important contributor to severe acute respiratory infections in hospitalized adults, with a substantial disease burden among older adults in India. Three vaccines-GSK Arexvy, Pfizer Abrysvo and Moderna mRNA-1345 are currently approved for adults ≥60 years in the United States and Europe. Early real world data from United Kingdom demonstrates significant reduction in RSV related hospitalizations following vaccine introduction within a single season [19]. In India, CDSCO conditionally approved Phase III trials of RSVPreF in June 2025, but no adult RSV vaccine is licensed for use. This review proposes for integration of routine RSV molecular testing and reporting with outcome especially in comorbid adults, inclusion of RSV vaccination in National Technical Advisory Group on Immunisation (NTAGI) deliberations for elder and high-risk groups, accelerated regulatory pathways leveraging global bridging data and implementation of prospective multicenter studies to generate robust evidence for health technology assessment, cost-effectiveness and policy formulation.