This systematic review and meta-analysis aimed to evaluate the effectiveness of respiratory syncytial virus (RSV) vaccination in preventing lower respiratory tract diseases (LRTD) in older adults (age ≥ 60 years). The study included nine studies from three databases (PubMed, Embase, and Scopus) and the preprint repository medRxiv, covering five RSV vaccines (RSVpreF, RSVPreF3, Ad26RSVpreF, MED7510, and mRNA-1345). The meta-analysis documented a pooled vaccine efficacy (VE) of 81.38% (95% CI 70.94 to 88.06) for preventing LRTD with three or more signs/symptoms during the first RSV season after vaccination. Follow-up data were available for RSVPreF3 (2 RSV seasons), RSVpreF (mid-term estimates of the second RSV season), and mRNA-1345 (12 months after vaccination), with a pooled VE of 61.15% (95% CI 45.29 to 72.40). After the first season, the overall risk for developing RSV-related LRTD increased substantially (risk ratio [RR] 4.326, 95% CI 2.415 to 7.748). However, all estimates were affected by substantial heterogeneity, likely due to inconsistencies in the design of the parent studies, particularly in case definitions. The study concluded that RSV vaccination is quite effective in preventing LRTD in older adults, but the overall efficacy rapidly decreased in the second season after vaccination. Further analyses are needed due to the heterogeneous design of the parent studies before tailoring specific public health interventions.This systematic review and meta-analysis aimed to evaluate the effectiveness of respiratory syncytial virus (RSV) vaccination in preventing lower respiratory tract diseases (LRTD) in older adults (age ≥ 60 years). The study included nine studies from three databases (PubMed, Embase, and Scopus) and the preprint repository medRxiv, covering five RSV vaccines (RSVpreF, RSVPreF3, Ad26RSVpreF, MED7510, and mRNA-1345). The meta-analysis documented a pooled vaccine efficacy (VE) of 81.38% (95% CI 70.94 to 88.06) for preventing LRTD with three or more signs/symptoms during the first RSV season after vaccination. Follow-up data were available for RSVPreF3 (2 RSV seasons), RSVpreF (mid-term estimates of the second RSV season), and mRNA-1345 (12 months after vaccination), with a pooled VE of 61.15% (95% CI 45.29 to 72.40). After the first season, the overall risk for developing RSV-related LRTD increased substantially (risk ratio [RR] 4.326, 95% CI 2.415 to 7.748). However, all estimates were affected by substantial heterogeneity, likely due to inconsistencies in the design of the parent studies, particularly in case definitions. The study concluded that RSV vaccination is quite effective in preventing LRTD in older adults, but the overall efficacy rapidly decreased in the second season after vaccination. Further analyses are needed due to the heterogeneous design of the parent studies before tailoring specific public health interventions.