Nurse consultant Linda Nazarko explains the new RSV vaccination programme and how nurses can support patients to understand the benefits of taking up the vaccine
This month, general practice nurses (GPNs) in England, Wales and Northern Ireland are starting to roll out the respiratory syncytial virus (RSV) vaccination programme. The Scottish programme is already underway having started in August.
The programme aims to protect infants and older adults, who are most at risk from severe disease from RSV infection. As such the year-round programme involves:
- Vaccination of older adults aged 75 to 79 years old
- Vaccination of pregnant women to protect infants
The UK vaccination programme is using the same RSV vaccine (Abrysvo; Pfizer) for older adults and pregnant women. Detailed information on the vaccine and its administration are available from the UKHSA here, and some key points are summarised in Box 1 below.
Why is the RSV vaccination programme being introduced?
RSV is an enveloped, single-stranded RNA virus that belongs to the Orthopneumovirus genus of the Pneumoviridae family. It usually causes mild self-limiting upper respiratory tract infections (URTIs), but can cause more severe disease in infants and older adults who are at increased risk of acute lower respiratory tract infection (LRTI). RSV infections tend to increase during winter months, peaking in December and declining by March. The virus is transmitted by droplets and secretions by contact with an infected person. It infects up to 90% of children within their first 2 years, and people are frequently reinfected throughout life.
RSV infection typically causes common cold symptoms including rhinitis (sneezing, a runny or blocked nose) and a cough, although it can also lead to wheeze, breathlessness and difficulty eating and drinking.
In children if it progresses further to acute LRTI it can cause bronchiolitis (inflammation of the small airways of the lung; predisposing them to asthma in later life) or pneumonia, as well as croup or ear infections (otitis media).
Infants under one year of age are at particularly increased risk of developing severe disease as their immune system is not fully developed; those most at risk of severe or occasionally fatal RSV infection include very young infants born prematurely who have predisposing conditions like heart or lung disease or immunodeficiency.
Among these babies, government advisors from the Joint Committee on Vaccination and Immunisation (JCVI) estimate that RSV causes 108,000 GP consultations, 74,000 visits to A&E, 20,000 paediatric admissions and 22 deaths each year.
They have calculated that achieving just 60% coverage with the new RSV vaccination programme to protect infants could prevent 20,000 GP consultations, 15,000 A&E visits, 5,000 paediatric admissions, and 200 ICU admissions every year.
Older adults, in particular those aged 75 and over, are also vulnerable to severe RSV infections as the immune system becomes less effective with age. In this age group RSV infection can lead to pneumonia as well as exacerbations of underlying asthma, COPD or cardiovascular disease.
Although the burden of RSV in older adults is less well understood than in infants, it has been estimated that each year RSV leads to 175,000 GP appointments, 14,000 hospitalisations and 8,000 deaths of older people. A recent analysis suggested that the first season of the older adult’s programme could avoid around 15,000 GP visits, 2,500 hospital admissions and prevent over 400 deaths in adults in the over-75 age group.
Related Article: Mothers with anaemia more likely to have a baby with congenital heart disease
Box 1. Information on RSV vaccine (Abrysvo). Source: UKHSA information for HCPs on RSV vaccine
Mechanism
Abrysvo is a recombinant RSV vaccine. The vaccine targets an RSV surface protein – F protein – that enables it to enter the person’s cells and cause an infection.
It is bivalent, containing recombinant RSV prefusion F protein (pre-F) antigens developed from each of subtypes A and B.
Licence
It is licensed for prevention of RSV lower respiratory tract infection (LRTI) in individuals from 60 years of age and to protect infants from RSV LRTI through vaccination of pregnant women. The maternal indication is licensed by the UK Medical and Healthcare products Regulatory Agency (MHRA) as between 28 and 36 weeks gestation.
Storage
RSV vaccine should be stored in their original packaging in a refrigerator at 2°C to 8°C The vaccine is packaged in powder form, is reconstituted with sterile water for injections, to form 0.5ml. It is given in older adults as a single, one-off dose. It confers active immunity in older adults. This immunity is thought to last two years, studies on longevity of effect are ongoing.
Administration
Abrysvo is licensed to be given via the intramuscular route, preferably into the deltoid muscle in the upper arm.
In both older adults and pregnant women, a single dose of 0.5 ml is given.
A long orange 25 gauge, 25 mm needle is supplied in each pack. Larger adults may require a longer length needle such as a 38 mm (on the basis of individual assessment).
Precautions
If the person has a bleeding disorder, and in the opinion of their doctor there are no concerns regarding bleeding risk, the vaccine may be administered intramuscularly. A fine, 25-gauge needle should be used and pressure applied for two minutes post injection. The person should be warned of the possibility of bruising.
Adverse events
RSV vaccination has been associated with a small potential increased risk of Guillain-Barré syndrome (GBS) in older adults. This is a rare autoimmune condition that generally affects people aged 50 and over and is more common in men. It can be triggered by infection and causes problems such as numbness and weakness, and in severe cases difficulty moving, breathing and swallowing.
The UKHSA advises that cases of GBS after RSV vaccination may have occurred by chance, and that the benefits of RSV vaccination outweigh any risks from serious adverse events. People who have a history of GBS should be vaccinated, if eligible, as there is no evidence to suggest that vaccination will trigger further episodes of GBS. Healthcare staff should be alert to the clinical features of GBS to ensure prompt diagnosis and treatment should it occur, however.
Details of the older adults RSV vaccination programme
This aim is to reduce the incidence and severity of RSV disease, and hospitalisation as a result of RSV disease, in older adults.
For those who turn 75 years of age after the campaign starts:
- People become eligible for the single-dose vaccination on their 75th birthday. They then remain eligible, until they take up the offer of vaccination, up to the day before their 80th birthday.
- Those who turn 75 between March and October this year should ideally be vaccinated by the end of October before RSV activity increases.
- Those whose birthday falls during the RSV season (November to February) should be vaccinated as soon after they turn 75 as possible.
For those already aged 75-79:
- Individuals who are aged 79 years, and therefore have their 80th birthday within the first year of the campaign, will remain eligible up to and including 31 August 2025 (31 July 2025 in Scotland) to ensure that they have sufficient opportunity to be vaccinated.
- Others in this age group are eligible until and including the day before their 80th birthday.
- People eligible for the catch-up campaign should be called and offered vaccination as soon as possible after the programme commences, ideally in September or October 2024 for protection ahead of RSV activity.
The RSV vaccine protects for at least two years, with studies ongoing to see how long protection lasts. There are no data currently to support second doses in older adults.
Related Article: ‘Potential’ introduction of chickenpox vaccine in early 2026
Co-administration concerns – older adults
UK guidance recommends that RSV and influenza or Covid vaccines should not usually be co-administered in older people. If the person is unlikely to return for a second immunisation, they can be co-administered, however. (Some data suggest that influenza vaccine and RSV vaccines are less effective when co-administered, and that RSV vaccines are less effective when co-administered with Covid vaccines.)
The RSV vaccine can be safely co-administered with pneumococcal or shingles vaccines.
Where vaccines are co-administered, each vaccine should be given in a different limb whenever possible. If more than one vaccine is given in the same limb, they should be given at least 2.5 cm apart. The sites at which each vaccine is given should be noted in the individual’s health records.
Details of the programme for pregnant women to protect infants
The infant protection programme is offered to all pregnant women from 28 weeks’ gestation, in every pregnancy, for infant protection. Vaccinating the pregnant woman enables her to produce RSV antibodies which then pass across the placenta and provide the baby with protection during the first six months of infancy. Vaccinating at 28 weeks’ gestation provides sufficient time for antibody generation.
The following messages may help with prompt uptake among pregnant women:
- While most women will have had RSV infection before, this does not give them good immunity to pass on to their baby in the womb.
- Having the RSV vaccine from week 28 of pregnancy means the vaccine will temporarily boost the mother’s antibodies to high levels.
- This enables the mother to transfer a high level of RSV antibodies across the placenta to their unborn child which should passively protect the infant against RSV disease for at least the first 6 months of life (when infants are most vulnerable to severe RSV infection).
- Vaccination should be offered ideally in week 28 or soon after, but women can be offered vaccination up until delivery.
- Trials have shown vaccination is highly effective at preventing severe lower respiratory disease caused by RSV in infants born to vaccinated mothers.
Co-administration considerations – pregnant women
The RSV vaccine can be given at the same time as inactivated influenza vaccine to pregnant women. It can be given concomitantly to pregnant teenagers who are due to have, or who have recently had, a live attenuated influenza vaccine nasal spray.
The vaccine can also be given at the same time as the Covid vaccine to pregnant women.
Co-administration of the RSV vaccine with pertussis vaccine may reduce the response to the pertussis components. Any impact on protection is likely to be small but the UKHSA advises maintaining the usual vaccine scheduled times of around 20 weeks for pertussis and from 28 weeks for RSV.
Nonetheless, if a woman has not had a pertussis vaccine by the time she presents for an RSV vaccine, both vaccines can and should be given at the same appointment to provide timely protection against both infections to the infant.
Related Article: ‘Sustained effort’ required to bring child vaccination rates to 95% target
Key points
- RSV causes respiratory infections – usually with mild cold/cough symptoms, but sometimes leading to more serious respiratory disease including bronchiolitis and pneumonia.
- The RSV vaccination programme aims to protect those who are most vulnerable to serious illness from RSV infection, namely infants and older adults.
- The two groups being offered RSV vaccination are:
- All pregnant women, in every pregnancy, from 28 weeks’ gestation (so their babies are protected from birth). The vaccine can be co-administered with influenza vaccine or Covid vaccine in this group. However, it should not be given concomitantly with pertussis vaccine (unless the woman does not present until 32 weeks in which case both may be given at the same time).
- Older people aged 75-79 years. The one-off vaccination should not usually be given at the same time as influenza or Covid vaccine in this group. It can be given at the same time as pneumococcal or shingles vaccinations.
- The same RSV vaccine (Abryvso) is used for older adults and pregnant women. It is given as a single dose.
- It is hoped the programme will save lives and reduce long-term health effects following infection. The programme should also reduce pressure on primary and acute care.
Linda Nazarko is a specialist frailty nurse, Sutton Health and Care, part of Epsom and St Helier NHS Trust
Sources and further reading / resources
- UKHSA RSV immunisation programme collection. Includes the ‘information for healthcare practitioners’ document, RSV training slide set and relevant patient leaflets.
- NHS England » Maximising uptake of antenatal vaccinations and the introduction of a maternal vaccine against respiratory syncytial virus (RSV) for infant protection this autumn and winter: letter
- NHS England » New respiratory syncytial virus vaccine to protect millions most at risk this winter
- The Green Book: Immunisation against infectious disease: RSV Green Book Chapter (27a)
- UKHSA Patient Group Direction (PGD): RSV vaccine
- Abrysvo vaccine preparation instructional video
- NHS website: Bronchiolitis
- UKHSA RSV overview: RSV: symptoms, transmission, prevention, treatment
- Leaflets, posters and stickers for pregnant women are available from the NHS health publications
- Maternal RSV Leaflet: product code: C24RSV03EN
- Maternal RSV Poster: product code: RSVPGEN
