Purpose <p>The burden of respiratory syncytial virus (RSV)-associated respiratory tract infections in older and frail adults should not be underestimated. As no treatment is available, two prefusion F vaccines and an mRNA-1345 vaccine have been approved by the EMA for patients ≥ 60&#xa0;years. Several national European guidelines have been published recommending RSV vaccination in older persons. We aimed to analyse the differences between these recommendations and to review the underlying motivation for the proposed guidelines.</p> Methods <p>A literature review was conducted. A summary of existing European recommendations was compiled, including those for older patients and vulnerable populations.</p> Results <p>Fifteen governmental guidelines on RSV vaccination in older persons were identified. Ten guidelines advise vaccination for all adults ≥ 75&#xa0;years old, while three countries recommend vaccination from ≥ 60&#xa0;years old. Irish guidelines for those ≥ 65&#xa0;years old. The Norwegian guidelines recommend vaccination only for individuals aged ≥ 60&#xa0;years with underlying conditions. For individuals with risk factors, most countries advise vaccination at younger ages. Risk factors vary slightly between countries, but they can generally be categorized into chronic organ diseases, older age and frailty, immunosuppression and metabolic syndromes. We presume that vaccine efficacy, vaccine safety and cost-effectiveness are key considerations in the formulation of these different guidelines.</p> Conclusion <p>Fifteen official governmental European guidelines were found on RSV vaccination, most of which recommend vaccination for the general population aged ≥ 75&#xa0;years and at younger ages for at-risk individuals.</p> <p>There remains a need for more harmonized European guidelines.</p>