Episode 175 RSV vaccine

Curious about how the new RSV vaccine could protect your baby? Join me, Florence, as we uncover the latest addition to the UK’s maternal vaccination program. In this episode of the OBSpod, I break down everything you need to know about the respiratory syncytial virus (RSV) vaccine. Learn how this innovative recombinant vaccine works & why it's crucial for infants under a year old.

Expectant mothers, healthcare professionals, and anyone interested in maternal and infant health will find this episode particularly enlightening. I'll guide you through the rationale behind the vaccine's introduction and its expected impact on both families and the NHS. We’ll also revisit some key points from our previous discussions on pregnancy vaccinations, offering a well-rounded perspective on this significant healthcare advancement. Tune in to arm yourself with the knowledge needed to make informed decisions about the RSV vaccine or to confidently advise others about it.

Want to know more?
https://www.gov.uk/government/publications/respiratory-syncytial-virus-rsv-maternal-vaccination/a-guide-to-rsv-vaccination-for-pregnant-women
https://www.gov.uk/government/collections/respiratory-syncytial-virus-rsv-vaccination-programme
https://www.gov.uk/government/publications/rsv-immunisation-programme-jcvi-advice-7-june-2023/respiratory-syncytial-virus-rsv-immunisation-programme-for-infants-and-older-adults-jcvi-full-statement-11-september-2023#:~:text=JCVI%20advised%20that%20a%20RSV,and%20conclusions%20of%20the%20committee.

Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
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Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
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Transcript

Florence: 0:00

Hello, my name's Florence. Welcome to the OBSpod. I'm an NHS obstetrician hoping to share some thoughts and experiences about my working life. Perhaps you enjoy Call the Midwife, maybe birth fascinates you, or you're simply curious about what exactly an obstetrician is. You might be pregnant and preparing for birth. Perhaps you work in maternity and want to know what makes your obstetric colleagues tick, or you want some fresh ideas and inspiration. Whichever of these is the case and, for that matter, anyone else that's interested, the OBS pod is for you.

Florence: 1:01

Episode 175, the RSV vaccine. This is a super topical episode because we're about to introduce the RSV, or respiratory syncytial virus vaccine in the UK in pregnancy. I've talked before about vaccination in pregnancy and before you listen to this episode, you might like to go back to episode 64, vaccination for a quick recap about vaccinations in pregnancy, because the RSV vaccine is just the latest vaccination in a number of vaccinations that we recommend during pregnancy either to protect the pregnant woman or to protect her baby. I recorded that original episode when there was lots of controversy and discussion about the COVID vaccine and I wondered in that episode why we were so obsessed with the COVID vaccine but didn't query other vaccines like flu and whooping cough. So if you want a well-rounded think about vaccination in general in pregnancy, head back to episode 64. But today I'm going to focus on the RSV vaccine, and that's because it's about to be introduced, in September, to all pregnant women between 28 and 36 weeks in the UK. Therefore, I thought this might be a helpful episode for pregnant women currently pregnant at the moment and assessing and deciding whether they want this vaccination, but also for healthcare staff, midwives and obstetricians who are suddenly having a new vaccination that they need to be confident to talk to women about.

Florence: 2:53

So what is RSV? Rsv is short for respiratory syncytial virus and it's a very common cause of respiratory tract infections and in adults mainly causes a mild, self-limiting respiratory infection. But in infants, particularly babies under a year old, and in older adults who are at increased risk, it can cause more severe problems. It is spread via droplets, so very similar to what you're thinking of with Covid, it's spread through respiratory secretions, close contact with someone else who has the illness. So this might be something passed around at work, or perhaps by small children at nursery or older kids at school. Globally, data suggests 90% of children will have an RSV infection in the first two years of life. So if it's a very common respiratory illness, why are we going to think about vaccination?

Florence: 4:11

The issue is that for babies under a year old, there is significant morbidity. It's a seasonal infection and if you've ever worked in paediatrics you know there's something called bronchiolitis season and the wards fill up with babies with bronchiolitis. This is respiratory distress, babies needing perhaps respiratory support and hospitalisation. And bronchiolitis is the name given to the infection caused by RSV or respiratory syncytial virus. The season runs roughly from October to March, with a peak around December time, and although it doesn't cause much in the way of mortality, thankfully, it can cause significant numbers of hospital admissions. If you look at the stats that are behind the discussion around the introduction of the vaccine, around 20,000 babies a year are admitted to hospital with bronchiolitis. That's not only very frightening as a new parent to have a severely unwell baby needing hospitalisation, but that's also a significant burden for the NHS in terms of beds, healthcare staff and treatment. So it makes sense on all fronts if we could prevent this illness, to try and do so, and that's where vaccination comes in. That's where vaccination comes in.

Florence: 6:03

So in the last few years, some vaccines for RSV have been developed, and these are what we call recombinant vaccines. That means, rather than injecting a live or changed version of the virus itself to trigger immunity, they take some of the proteins off the virus and create a vaccine so that the body is reacting to the proteins on the virus but has no risk of actually being infected because you're not actually injecting the virus itself, actually being infected because you're not actually injecting the virus itself. So the vaccine developed is a recombinant vaccine and this is a similar type of vaccine to the vaccine for HSV that's given to teenagers now to prevent cervical cancer, now to prevent cervical cancer. So to decide whether or not to go ahead with a new vaccination programme, they look at the prevalence of the disease, but then also they have to look at the efficacy of the vaccine. Is it going to be helpful in preventing the illness and also how safe is the vaccine, because we're always cautious giving things to pregnant women. So they've looked at data from clinical trials in a number of countries and also the usage in the US analysis of the impact RSV has on hospital admissions in some specific areas of the UK to decide whether or not it's worth rolling out this programme and the answer is that the vaccine is pretty effective.

Florence: 7:54

Actually, what the vaccine does is it boosts your own immune system. So you have the vaccine. During pregnancy, your body produces antibodies and these antibodies pass to the baby through the placenta and also through breast milk. These antibodies have been found to reduce the chance of severe bronchiolitis, so needing hospital admission, perhaps by 70% in the first six months of life, which is huge. That's a really big reduction. So it's not to say that your baby can't get bronchiolitis if you have been vaccinated. Your baby can't get bronchiolitis if you have been vaccinated, but that is a very significant reduction.

Florence: 8:40

When they were looking at the data initially, there were some possible concerns about the possibility of giving the vaccine increasing the chance of preterm birth. However, when they undertook more detailed analysis, it appeared that this higher chance of preterm birth was only observed in low-income countries and not high-income countries, and the UK counts as a high-income country, so that isn't applicable to us and they felt that it may be that there were confounding reasons why there was an apparent disparity in pre-term birth. They did some plotting of the gestational age, so the numbers of weeks of pregnancy at vaccination stratified against the weeks of pregnancy when giving birth and there wasn't a relationship between the time of vaccination and prematurity. So the Joint Committee on Vaccination and Immunisation, who make the decision for vaccination programmes in the UK, were assured that this was a safe vaccine to give and that this wasn't going to have a negative impact on pregnancy outcome or increase the chance of preterm birth. And that's obviously a very, very important thing to be sure of. And if you look at the information sheet for pregnant women, they've included that information that there were slightly more premature babies in the vaccine group 2.1% than the group that didn't have the vaccine 1.9% but that this difference is likely to be due to chance. But it's important. We as clinicians are aware of that data and can discuss it with women if they're concerned about those numbers.

Florence: 10:53

So the next question is if it's a seasonal illness, much like flu or COVID, are we going to be giving seasonal vaccination from about October every year and the vaccine is updated every year to the previous year's latest variant so that it's as efficacious as possible. So the months during which you're pregnant will vary whether or not you are offered and encouraged to have a flu or COVID vaccination. So because they're starting this vaccination programme in September, I thought this may be a seasonal vaccination programme that's going to go along with flu and COVID. However, looking into it more, they've actually decided that it's better to have a continuous vaccination programme, that that's more beneficial, so that, although they're starting in September, we will be offering vaccination to women throughout the year, more similar to the whooping cough vaccination programme that's already in existence. So you will be offered the vaccine around 28 weeks the data suggests it's most efficacious between 28 and 36 weeks which will enable you to build that immunity and pass it to your baby before birth, and that gives your baby the best protection early on in its life, because babies are more at risk in the first six months of life. So for me, the next question I immediately thought people are going to start asking me in my antenatal clinic is can I have all these vaccines at the same time or do I need to have them separately?

Florence: 13:00

If we're going to be advising whooping cough vaccine, rsv vaccine and then seasonally flu and covid vaccine, that's a lot of vaccines. So the current guidance is that the whooping cough vaccine is usually given a bit earlier in pregnancy, so around the 20 week scan, and the RSV vaccine is going to be around 28 weeks. So those usually would be given separately, and the flu vaccine can be given at any point in pregnancy, because that is the flu and COVID vaccine are more protecting the mother. I mean, obviously they protect the baby, because by protecting the mother you protect the baby, but we're trying to prevent significant maternal disease, whereas the whooping cough and RSV vaccine we're giving them to the mother, but they're for the benefit of the newborn baby.

Florence: 14:02

The advice and the information leaflet for women does say, though, that if you go for your RSV vaccine and you haven't had your whooping cough or flu vaccines already, you can actually have them all at the same time. You might not fancy having them all at the same time, but it's perfectly safe to do so, and I think implementing the new RSV vaccine is going to probably be a lot easier for us as maternity staff, because we've already got in place, in a lot of units now, facilities to give vaccines, because this has become a core part of maternity care in a way that it really wasn't at the beginning of my career. So we have a vaccination nurse or midwife in our antenatal clinic so that when women come for scans or appointments, we can offer them the vaccine as a drop-in basis. So we're very well set up for that and so to add in the RSV vaccine is not a big deal. So hopefully that's given you a little bit of information about the upcoming implementation of the RSV vaccine. I've put some links in the show notes that you can have a look at, both information for pregnant women and also information for professionals. So in terms of zesty bit, I think the important thing to remember is, just like other vaccinations in pregnancy, we're recommending this because there is a significant health benefit for either you or your baby, and we really would not be recommending this if it wasn't safe. I think women are very hesitant to take medication or have vaccination in pregnancy and hopefully by doing a quick episode on this, it will reassure women that this is the right thing to do and could be extremely helpful and protective for their baby and hopefully help health professionals be a bit more confident in talking about it, because when something new is implemented, it can be difficult to get up to speed quickly and know what we're advising and why we are advising it.

Florence: 16:35

I very much hope you found this episode of the OBS pod interesting. If you have, it'd be fantastic if you could subscribe, rate and review on whatever platform you find your podcasts. As well as recommending the OBS pod to anyone you think might find it interesting, there's also tons of episodes to explore in my back catalogue from clinical topics, my career and journey as an obstetrician and life in the NHS more generally. I'd like to assure women I care for that I take confidentiality very seriously and take great care not to use any patient identifiable information unless I have expressly asked the permission of the person involved on that rare occasion when it's been absolutely necessary.

Florence: 17:34

If you found this episode interesting and want to explore the subject a little more deeply, don't forget to take a look at the programme notes where I've attached some links. If you want to get in touch to suggest topics for future episodes, you can find me at TheObsPod, on Twitter and Instagram, and you can email me theobspod at gmailcom. Finally, it's very important to me to keep TheObsPod free and accessible to as many people as possible, but it does cost me a very small amount to keep it going and keep it live on the internet. So if you've enjoyed my episodes and, by chance, you do have a tiny bit to spare, you can now contribute to keep the podcast going and keep it free via my link to buy me a coffee. Don't feel under any obligation, but if you'd like to contribute, you now can. Thank you for listening.