Respiratory syncytial virus (RSV) immunisation programme for infants and older adults: JCVI full statement, 11 September 2023
Updated 11 September 2023
Contents
- Introduction
- Background
- Programme to protect neonates and infants
- Programme for older adults
- Conclusions and advice
- Stakeholder engagement
- References
- Further references and evidence JCVI considered
Introduction
The Joint Committee on Vaccination and Immunisation (JCVI) is an expert scientific advisory committee which advises the UK government on matters relating to vaccination and immunisation.
JCVI has been monitoring products in development for the prevention of respiratory syncytial virus (RSV) disease for several years. Since January 2023, JCVI has been actively reviewing the latest evidence on immunisation products in the late stages of development or which are newly licensed which could protect both newborns or infants and older adults against RSV infection and disease. A series of meetings of the JCVI RSV subcommittee have taken place in 2023. JCVI has reviewed evidence from manufacturers on the efficacy, safety and duration of protection of these immunisation products alongside clinical and epidemiological data on the burden of RSV in infants and older adults. JCVI has also considered programme delivery including ensuring high uptake in different population groups and clinical settings. Modelling of the impact and cost effectiveness of potential immunisation strategies by the London School of Hygiene and Tropical Medicine (LSHTM) has been used to inform JCVI’s advice, along with second opinion modelling by other expert academic groups. Cost effectiveness is a key factor in JCVI’s considerations to ensure that the finite resources of the health service are used to maximise the health of the population.
JCVI recognises that there is a significant burden of RSV illness in the UK population and unmet public health need which has a considerable impact on NHS services during the winter months. Following the 7 June 2023 meeting, JCVI issued a short statement of its advice on a RSV immunisation programme. JCVI advised that a RSV immunisation programme should be developed for both infants and older adults. This comprehensive statement provides the detail on the evidence considered and the key discussions and conclusions of the committee.
Background
RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Globally, RSV infects up to 90% of children within the first 2 years of life and frequently reinfects older children and adults. For most people, RSV infection causes a mild respiratory illness. Babies under one year of age and the elderly are at the greatest risk of hospitalisation with more severe RSV. The clinical significance of RSV in infants is that it can cause bronchiolitis which leads to the inflammation of the small airways and significant breathing difficulties. In older adults, RSV is an important cause of acute respiratory illness, particularly those living with frailty and co-morbidities.
There is a significant burden of RSV illness in the UK population which has a considerable impact on NHS services during winter months. A typical RSV season in the UK starts in October, peaks in December and declines by March. In recent years, the RSV season has been interrupted by control measures against the COVID-19 pandemic which has resulted in unseasonal RSV activity; this included significant rebound activity in summer 2021 and summer 2022 and a very prolonged period of virus activity in 2022. RSV accounts for approximately 33,500 hospitalisations annually in children aged under 5 years old. It is a leading cause of infant mortality globally, resulting in 20 to 30 deaths per year in the UK. RSV-related mortality in low-income countries is considerably higher, and in some analyses is the second commonest cause of death (after malaria) in infancy.
The burden of RSV in older adults is less well understood and considered to be underestimated by existing routine surveillance. Sharp (reference 1) estimated the average annual hospital admission rate in England related to RSV infection to be 71 and 251 per 100,000 for those aged 65 to 74 and those over 75 years, respectively. Fleming (reference 2) estimated RSV mortality rates in the UK as high as 58 per 100,000 and 178 per 100,000 in high-risk groups and 9 per 100,000 and 133 per 100,000 in low-risk groups aged 65 to 74 and those over 75 years, respectively. Hardelid (reference 3) estimated in each winter season there are 1,200 deaths in persons aged 45 to 74 years and 4,000 deaths in those aged over 75 years.
We will be running clinics in September and all eligible patient will be contacted.
Please note *The RSV vaccination CAN be given with Shingles and or Pneumococcal vaccination but CANNOT be given at the same time as Flu and or Covid Vaccinations.