FOR many, September heralds the end of hot summer weather and the return of children to school and university.
However, for GPs, autumn brings the added workload that comes with the start of the cough and cold season.
One of the most nasty viral infections we deal with around this time of year is respiratory syncytial virus, or RSV. While, for most healthy adults, it is nothing more than a bad cold, RSV can lead to life-threatening breathing difficulties in young children and older adults.
Every year, RSV hospitalises about 30,000 children and 18,000 adults.
Heartbreakingly, around 100 children die due to the virus each season, while it also contributes to the deaths of 8,000 adults over the same period.
However, regardless of age, RSV affects everyone who uses the NHS.
Public health minister Andrew Gwynne almost lost his grandson to RSV. He said: ‘I would say to any expectant mum, take the vaccine. I don’t want you to lose your precious baby, as we almost did.’
When cases are at their peak – usually in December – hospital wards become filled with infected patients. This means routine procedures such as hip operations and heart surgery may be postponed due to a lack of bed space for patients.
This is why it is great news that, starting this month, the NHS is rolling out a first-of-its-kind RSV vaccination campaign to protect those most at-risk from the virus.
The jab, which is already used in the US and Europe, is being offered to adults aged 75 to 79 at GP surgeries, as well as pregnant women, in order to pass on protective anti-RSV antibodies to their newborn children.
Research suggests the jab is safe and could prevent thousands of hospital admissions every year.
However, it would appear that many patients do not understand the benefit of this new vaccination campaign – or have even heard about it.
Last month, I wrote in this newspaper of my concerns that many patients had told me they did not plan to get the vaccine because they were unsure of its benefits.
In response, we received hundreds of letters from readers outlining their concerns about the RSV jab rollout.
For young children and older adults, RSV can lead to breathing difficulties and even severe pneumonia-like lung infections
The virus is usually spread via coughs and sneezes, close contact with an infected person or contact with contaminated surfaces
Some had been confused by the invitation to get the jab they received by text because they did not know what RSV was. Mary Ealham, 78, says she ‘had never heard’ of RSV and declined the jab because she is ‘fit, healthy and lucky enough not to suffer any respiratory problems’.
Many said they were worried that the jab might be unsafe because it was brand new – meaning the long-term side effects were unknown.
Others, like 75-year-old Richard Jones, said they thought they’d had too many vaccines recently. ‘After the regular Covid jabs, and the winter flu jab I feel like a pin cushion,’ says Richard.
‘My friends and relatives feel this is one jab too far’.
There was also confusion over the NHS decision not to offer the vaccine to people over the age of 80. ‘I’m 76 with no breathing problems and I can get the vaccine,’ says Carol Burrells.
‘But my 81-year-old husband who has asthma and bronchiectasis [permanent enlargement of parts of the lung’s airways] isn’t eligible. It doesn’t make a lot of sense.’
So, what’s the truth about RSV? And is it worth getting vaccinated against it?
I’ve never heard of RSV before – is it a new virus like Covid-19?
No, but until now, there has been no effective way to protect patients against RSV, meaning it is not often discussed.
The virus is usually spread via coughs and sneezes, close contact with an infected person or contact with contaminated surfaces.
And for most people, the symptoms are indistinguishable from a normal cold, and may include a runny nose, cough or fever. You may not know you have RSV at all, and most likely won’t need to see your GP.
But, for young children and older adults, it can lead to breathing difficulties and even severe pneumonia lung infections. It can usually only be diagnosed in hospital via a nasal swab test.
Researchers have been attempting to develop an RSV vaccine since the 1960s, but the virus proved surprisingly difficult to immunise against.
Likewise, experts have never been able to create an effective drug treatment for severe RSV symptoms. Instead, seriously unwell patients are usually given oxygen to help them breathe and IV fluids to combat dehydration.
All this means that, until now, most people only became familiar with RSV if they – or a family member – ended up in hospital with the virus.
However, in 2023, results from a massive RSV vaccine trial brought the virus into the mainstream.
Developed by US firm Pfizer, the Abrysvo vaccine was shown to slash the rate of severe RSV side-effects by 80 per cent.
Based on this exciting evidence, the Government’s vaccine advisory group recommended rolling out the jab to pregnant women as well as those aged 75 to 79.
It can’t be that serious if I haven’t been warned about it before – do I really need the jab?
It’s true that the majority of people who get RSV do not end up seriously unwell – however, there is no way to confidently say who will have to be treated in hospital or suffer a worse fate.
The effect of RSV is best understood in young children. More than 90 per cent of youngsters will catch RSV within the first two years of life. While the vast majority will not end up in hospital, research shows that those aged less than a year are most at-risk of severe disease.
Adults are frequently infected, too, with the risk of death rising with age. It is thought there are more than 4,000 RSV deaths among those aged over 75 a year.
However, it can sometimes seriously affect younger adults. According to research, there are around 1,200 annual RSV deaths in people aged 45 to 74.
Experts agree that adults with underlying health problems are more at-risk of severe RSV symptoms. This includes those with lung or heart problems, as well as people with weakened immune systems – often known as the immunocompromised.
Smokers are also considered in danger of landing up in hospital with RSV. But, even if someone eligible for the vaccine doesn’t have one of these underlying issues, it’s still definitely worth getting it.
Research published last month shows that the NHS RSV vaccination campaign is expected to prevent 5,000 infant and 2,500 adult hospitalisations this winter. It should also protect more than 60,000 from unpleasant symptoms.
It’s also important to know that medical research is evolving.
Many older adults may remember getting the polio vaccine as drops on a sugar cube, but will likely not have heard about newer vaccinations such as those given to protect children against rotavirus and meningitis B.
Just because you haven’t heard of a disease, doesn’t mean it can’t harm you.
I’m already getting my flu jab – shouldn’t that protect me against RSV?
The symptoms of flu and RSV may sound similar, but they are different viruses, meaning separate vaccines are required to provide protection. Flu is caused by the influenza virus, and typically leads to a high temperature, muscle aches, and fatigue. Like RSV, it can also lead to life-threatening symptoms, which is why there is an annual vaccine for those aged 65 and over, pregnant women, young children, healthcare workers, and the immunocompromised.
It is crucial that, if eligible, you get the flu vaccine, too. This rollout should begin in October.
But it won’t protect you against RSV. Vaccines work by tricking the immune system into producing defensive antibodies that hunt out and destroy specific viruses.
These antibodies are so selective in what they attack that, every year, the flu vaccine has to be updated because influenza is constantly evolving. The same thing also happens with Covid.
So, you’ll need to get this RSV vaccine if you want any protection. And it’s likely you’ll need another jab in a few years – though RSV evolves more slowly than flu.
It’s a brand new vaccine – how do we know it’s safe?
The jab rollout may only just be beginning in the UK, but it has already been safely given to thousands of people over several years across the world.
The RSV vaccine has been tested in more than 17,000 adults and 4,000 pregnant women. Results from these trials showed no serious side effects. This applies to both adults given the jab and the children who were born to recently vaccinated mothers.
This evidence was carefully scrutinised by the UK medical safety regulator, the Medicines and Healthcare Regulatory Authority (MHRA), which approved it in November 2023.
In America, the health regulator, the Food and Drug Administration (FDA), also agreed the RSV vaccine is safe.
Since last September, more than 100,000 pregnant women in the US have been vaccinated. There have been no worrying side effects reported.
Of course, no medical treatment is risk-free.
Research suggests that around one in ten people who get the vaccine experience fatigue, headache, pain at the injection site and muscle pain.
Anyone with a history of severe allergic reactions – such as to food – is not allowed to get the Abrysvo vaccine. But, for the vast majority of eligible patients, the risks of not having the RSV vaccine far outweigh any danger associated with taking it.
After Covid, I worry that I’ve had too many vaccines – could getting another one be dangerous?
Far from it. This is a common concern that I hear often in my surgery.
It’s particularly prevalent among parents of newborns who worry about all the vaccines their child is getting.
But it’s true that, since the Covid pandemic, we have all had quite a few vaccines.
I believe that, in time, the RSV jab will come to be considered as standard a part of NHS care as the annual flu jab, says Dr Kaye
However, there is no evidence that having several different vaccines in a short time has any negative health effect.
In fact, research shows that taking the Covid and flu vaccines at the same time may even lead to a stronger immune response.
Meanwhile, the majority of newborns receive a six-in-one vaccine (which protects against a handful of serious diseases such as diphtheria), as well as the rotavirus and meningitis B vaccines all within 16 weeks of birth.
This sounds like a lot, but this programme has been running for many years and it has been shown to be conclusively safe and effective. The same is true for adults who take several vaccines in close succession.
Okay, I’m convinced – how can I get the vaccine?
It depends on your age. Pregnant women should be offered the RSV vaccine around the time of their 28-week check-up.
This can be done either by the GP or through their maternity service. It is safe to give the vaccine beyond 28 weeks, but research suggests this is when it provides the most protection.
For older adults, the system is different.
Patients aged between 75 and 79 will be contacted by their GP surgery about getting the RSV vaccine. Anyone who turned 80 on or after September 1 this year will be eligible until August 31, 2025.
They should be offered several dates on which they can visit the clinic to get the jab.
The surgery may get in touch by letter, text, phone call or email.
Because this is a large patient group, it may take some time for everyone to be invited. So anyone eligible who has not been invited yet should wait for the invite before requesting the jab.
Other than the vaccine, is there anything I can do to protect myself against RSV?
Yes, but the vaccine is by far the most effective means of avoiding debilitating symptoms this winter – not to mention a trip to the hospital.
As with all viruses, careful hand washing can reduce the risk of infection. Wearing a face mask in crowded spaces, such as public transport, may also lower the chances of catching RSV.
This is especially true for the immunocompromised – blood cancer patients and those who have had an organ transplant – as well as patients taking immuno-suppressant medicines, like those given to arthritis or inflammatory bowel disease patients.
That’s because these patient groups are at higher risk of viral infections. I advise anyone who smokes to give up the harmful habit. Not only does it raise the risk of terrible diseases like cancer, it also increases the chances of severe RSV.
A healthy diet and regular exercise should also help people lose weight and improve their lung function, further reducing the chances of getting badly hit with RSV. However, all the research shows that this new RSV vaccine is your best protection against the nasty virus.
I believe that, in time, it will come to be considered as standard a part of NHS care as the annual flu jab.
So, don’t delay, and take up the offer of an RSV jab when it comes.
RSV left my baby boy in a coma
After three fraught days Ethyan Gammage began to improve, and ten days after entering hospital he was discharged
WHEN Ethyan Gammage was born six weeks premature in July, his parents were relieved after doctors said he was in good health.
But the day he was allowed home from hospital, Ethyan swiftly deteriorated until he was struggling to breathe.
Panicked, his mother Fiona Walker, 41, and father Mark Gammage, 44, called 999. Paramedics arrived at their home in Larkhall, Lanarkshire, less than 20 minutes later, but the newborn had become ‘cold and grey’. He was rushed back to hospital where he was diagnosed with bronchiolitis caused by RSV.
Ethyan was placed in an induced coma and hooked up to a ventilator. After three fraught days his condition began to improve, and ten days after entering hospital he was discharged.
His mother is now urging other expectant women to get the jab. ‘I had never even heard of RSV before Ethyan got it,’ says Fiona, a pub landlady. ‘It’s completely traumatised us. I want to raise awareness of RSV and of the vaccine because I’d never want any other mother to go through what I went through.’
Her words were echoed by Health Minister Andrew Gwynne, whose newborn grandson, Lyle, caught RSV and ended up in intensive care. He said: ‘I would say to any expectant mum, take the vaccine. I don’t want you to lose your precious baby, as we almost did with Lyle.’
Why can’t over-80s get a jab?
THIS restriction has confused many – including doctors.
Who gets offered a vaccine on the NHS is decided by the Joint Committee on Vaccination and Immunisation (JCVI), the Government’s vaccine advisory group. Its job is to assess all the data and work out who would benefit the most from a new jab.
The cost of a vaccine rollout is another factor.
Last year the JCVI concluded that – along with pregnant women – those aged between 75 and 79 would benefit the most from an RSV jab. This is partly due to the fact that there is still uncertainty about how long-lasting the protection provided by the vaccine is for those over the age of 80.
As we age the body tends to have a weaker response to a vaccine, so fewer defensive antibodies are produced.
However, according to Prof Adam Finn, a vaccine expert at the University of Bristol and a member of the JCVI, another reason the jab has been offered to 75- to 79-year-olds is that health officials expect them to live longer than those over 80.
This means that protecting this younger group against RSV will have a greater value to the NHS than vaccinating older people. In a year or two there may be enough data to expand the vaccination campaign to older age groups. Until then, the vaccine is still available privately for anyone over 80. Some private pharmacies, such as Pharmadoctor, are selling it for around £100.
Prof Finn adds: ‘There’s no reason why anyone aged 85 or even 90 shouldn’t get it privately, if they want to protect themselves.’
