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With the rollout of the first ever vaccination programme against respiratory syncytial virus, experts advise on this potentially fatal virus
RSV, or respiratory syncytial virus, is a common cause of coughs and colds which can also lead to severe lung infections like pneumonia and infant bronchiolitis – conditions which are highly dangerous to older people and young children. In fact, the virus kills an estimated 33,000 over-65s every year in the UK and other high-income countries, as well as hospitalising approximately 470,000 more. News that the NHS is now vaccinating vulnerable groups against RSV for the first time in its history has been welcomed by doctors whose wards are often overwhelmed with severe cases in the winter months.
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Respiratory syncytial virus is a common infection of the lungs and respiratory tract. Highly contagious, it is spread through airborne droplets when someone coughs or sneezes. “It’s a virus that affects nearly every baby under one and everyone by the age of two. Because we don’t build up complete immunity we continue to have RSV infections through life, but mostly as younger adults we just get a cold with it, and those who end up in hospital are really the very young, the very old, and those whose immune systems don’t work properly,” says Prof Sir Andrew Pollard, a professor of paediatric infection and immunity and the director of the Oxford Vaccine Group at the University of Oxford.
While generally, the symptoms are mild, particularly in adults and older, healthy children, it can cause severe infection, and sometimes even death, in children under the age of one. It’s the most important cause of hospitalisation in infants and one of the leading global causes of infant mortality, making its prevention through immunisation a public health priority. Premature infants, people with heart and lung disease, and those who are immunocompromised are also at risk of developing a more severe infection.
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In the early phase, symptoms of RSV are often mild, like a cold. If the virus moves into the lungs, it can cause coughing and wheezing, and turn into a severe respiratory disease, such as bronchiolitis – inflammation of the small airways in the lungs – and pneumonia. “Essentially, it’s a sort of pneumonia. It’s called bronchiolitis because it’s just a different bit of the airways that’s mostly affected,” says Prof Pollard.
If older individuals have underlying lung problems, they may get a lung infection if they have RSV. “But a lot of the reasons for RSV hospital admission in the elderly are related to their underlying health conditions. They may have a much milder infection than in babies, but this can make a condition like heart disease worse, potentially putting them in hospital, because the body’s having to fight against the virus infection,” says Prof Pollard. This differs from infants in whom the virus itself causes inflammation and the need for hospital treatment.
Dr Christopher Green, an associate clinical professor and a consultant physician in infectious diseases at the University of Birmingham, says: “In the elderly, the age-related changes mean natural RSV immunity built up and maintained by a lifetime of RSV exposure becomes less capable of protection, and severe RSV infection (that is infection/inflammation in the lower respiratory tract) becomes more common and this causes a similar disease burden to seasonal influenza.
The most common symptoms of RSV in young children are:
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Most babies and young children who catch RSV can be treated at home, in the same way that parents would treat a common cold. The infection usually goes away within two weeks.
More severe cases require a trip to hospital, where your child might be offered oxygen, IV fluids and medications to open their airways. “The milder cases may need a feeding tube, because when babies are very breathless, they can’t suck a bottle or take all the breast. Many may also need oxygen therapy and the more severely affected have to go on a breathing machine and have support in the intensive care unit,” says Prof Pollard. “Around one in 50 children who gets RSV will need medical care. Out of those, only a minority will need treatment in intensive care, and very few children die of it in developed countries,” says Peter Openshaw, respiratory physician and mucosal immunologist at Imperial College London.
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Dr Conall Watson, a consultant epidemiologist at UK Health Security Agency (UKHSA) says: “The vaccine in the UK programmes is made by Pfizer and contains antigens against the two RSV subtypes, A and B. Development of RSV immunisations accelerated around 10 years ago following scientific breakthroughs made in the United States to understand the structure of the RSV virus’s fusion protein used to invade cells, the equivalent of the coronavirus’s spike protein.”
The Pfizer RSV vaccine has been researched in large scale studies of pregnant women and older adults. These showed around 70 per cent protection against RSV lung disease in infants born of vaccinated mothers, up to six months of age, and around 80 per cent protection for older adults against more severe forms of RSV over two years. “The vaccine is expected to prevent many cases of the virus each year, and even prevent some deaths,” says Dr Watson.
Yes. “The best way to protect babies against RSV infection is for the mother to have the vaccine during every pregnancy. Vaccination reduces the risk of severe RSV lung infection by around 70 per cent in the first six months of life,” says Dr Watson.
RSV can also be severe in older adults, causing pneumonia and flare-ups of existing lung disease and other long-term conditions. It causes around 9,000 hospitalisations in those aged over 75 in the UK each year. So, if you’re offered the vaccine, it’s worth having.
In the UK RSV accounts for approximately 29,000 hospitalisations and 83 deaths per year in children and adolescents, the majority in infants, and 8,000 deaths per year in the UK among the elderly. The new RSV programme offers the vaccine for free where there is the strongest proven benefit in reducing the risk of severe illness. “Data on hospital admissions are consistent with the clinical risk continuing to be higher in those aged 75 years and above and those six months old and younger,” says Dr Watson. So, as part of winter preparations, the NHS will be vaccinating pregnant women and older adults aged 75 to 79, including those turning 75 on or after September 1.
GPs, community pharmacists and all other providers of a private vaccination service can order RSV vaccine directly from the manufacturer, so if you are not eligible to receive it as part of the national programme, you can pay for it privately.
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“It’s so transmissible that there isn’t really anything you can do apart from the mothers getting vaccinated during pregnancy, and uptake of the new vaccination programme,” says Prof Pollard. If you have a school-age child who has cold symptoms, it’s best to keep them away from younger siblings – especially babies – until their symptoms have disappeared.
If your child is a high risk, they can receive monthly palivizumab injections through peak RSV season, which generally runs from October through to February. These contain the virus-fighting antibody that helps to protect babies and young children from becoming seriously ill with bronchiolitis.
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