20th January 2025
Head of Public Health Transformation at NHS England Northwest, former paediatric nurse and health visitor Tracey Malkin explains why the Respiratory Syncytial Virus (RSV) vaccination during pregnancy is so important, and the role of healthcare practitioners in helping parents decide.
Tracey Malkin, Head of Public Health Transformation at NHS England Northwest
I remember the first baby with bronchiolitis I cared for on a ward.
She was wrapped in her mother’s arms, six months old, crying and couldn’t get her breath. She had runny eyes, runny nose and mouth, and dribbling excessively. And she had that cry! Not a high-pitched cry because a baby with bronchiolitis is too exhausted for that. It’s a constant distress type of cry that you recognise as a nurse or health visitor.
And I remember the baby’s mother, the look of distress on her face as if to say, “What can I do?”
Like me, anyone who has worked on a paediatric medical ward knows what to expect in a case of bronchiolitis, which is mostly caused by respiratory syncytial virus (known as RSV for short).
They’ll have the knowledge of a babe in arms, nought to 1 years old. They’ll know it’s a very distressed baby, unable to feed, with bubbling mucus and a wheeze. You can really hear their difficulties breathing.
They will know the course of action – oxygen monitoring, of course, making sure the baby can breathe, and methods to get rid of some of that mucus. And then to give some nutrition they can tolerate, so they’re not being sick all the time. Little and often, usually with a nasogastric tube, because these babies no longer have the energy to suck.
In extreme cases, sometimes they need to be sedated, and we take over the breathing for them. So, they’re on a form of ventilation because they get exhausted quickly; it’s hard to breathe, cough and feed when they’re in this type of distress.
They’ll also see extremely anxious parents, because they can’t pacify their baby, and they know their baby’s hungry. But feeding them makes things worse. And they’re watching their baby physically struggling, afraid of the worst, and it’s hard.
I’m painting the worst-case scenario, and of course it’s a spectrum. Some cases of RSV are mild, some severe. But there are so many – cot after cot in a ward – which is why hospitals prepare early for what they call ‘Bronch season’.
Understanding the real-life consequences and possible severity of bronchiolitis, you’ll want to prevent it. And the new RSV vaccine which has been available from September can help us to do just that. Yes, it’s a vaccine against RSV and, for babies, it provides protection against bronchiolitis – the infection causing severe inflammation that clogs up their airways, stopping them from breathing and feeding.
I spent the rest of my 7-hour shift that day sitting by this mother’s side, holding the baby in my arms, with attempts to feed and suction; providing reassurance that things were getting better. And then going home late and coming back early and that baby was still there, still crying, still hungry, still struggling to breathe.
It took a good three days of intensive interventions, but eventually, slowly, things picked up.
Was that the end of it? Possibly not. Because after such a severe illness their lungs can be compromised. And every time that baby has a cold, they’re more unwell. It goes to their chest, they get a hacking cough, and they can also develop other problems.
The two most vulnerable groups to RSV are babies in the first 12 months of life and older adults, who’ll be offered vaccination if they’re aged 75 to 79. We can’t vaccinate infants, but they receive protection when an RSV vaccine is given during pregnancy, from 28 weeks.
Parents want their pregnancy to be a healthy one and the outcome to be a healthy baby. They need information that says, whilst infections are not 100% preventable, you give your baby a better chance with vaccination. As professionals, we need to be armed with evidence-based information to answer any questions that they may have, and ensure our services are accessible, to make getting vaccinated easy.
Of course, it’s the parents’ decision, but we each carry with us a wealth of information and expertise. When I was a practising health visitor, I referred to it as my “toolkit”. And in my toolkit were things like, what do I need to know about X, Y and Z? Do I have all the facts? Can I talk with confidence, to say these are the things to look out for; these are the things you can do?
Then you make that clinical judgement about when is the right time for that conversation, not to overwhelm them but to guide them. You need a relationship with the parent so you can become their trusted advisor. But you must earn that, and that’s about knowing your information and tailoring it to meet their needs; making sure you include all parents, seeking out those less likely to engage with health services, or who come from countries where immunisation status for any vaccine is either non-existent or partial.
As health practitioners, we need to use our experience of this nasty disease, and our knowledge of why it’s so important to vaccinate. Let’s get the information out there and put an end to Bronch season.
RSV vaccination factbox
RSV accounts for approximately 33,500 hospitalisations in children aged under 5 in the UK annually, leading to around 20-30 deaths
From 1 September 2024, the RSV vaccine is offered to:
- all pregnant women from 28 weeks’ gestation
- adults aged 75 to 79 years old
- Those who turned 80 after 1 September 2024 are eligible for the RSV vaccine until 31 August 2025.
Over 75s can get in touch with their GP practice to book a vaccination if they haven’t been invited
More than 1.3 million people have so far been vaccinated. Over 126,000 women have had their maternal RSV vaccination to protect their babies in the first months of life. An RSV vaccination is recommended in every pregnancy.
For further information:
Tracey Malkin, Head of Public Health Transformation at NHS England Northwest
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