Tags: immunisation

New NHS vaccination programmes against respiratory syncytial virus (RSV)

From 1 September 2024, there will be two new vaccination programmes against respiratory syncytial virus (RSV) – during pregnancy (for infant protection) and older adults in England, Wales and Northern Ireland, with the rollout in Scotland already commenced in August. The new vaccinations have been introduced following guidance from the Joint Committee on Vaccination and Immunisation (JCVI).

It is important that everyone working in health visiting is aware of the programme and the underpinning evidence, to support their work in promoting RSV vaccine uptake.

Why vaccinate against RSV?

RSV has been described as “maybe the most common virus you have never heard of” by GP and journalist Dr Mark Porter.

RSV causes respiratory illnesses which are most frequently seen over the winter months between November and February1. In the majority of people, it presents as a cough/cold which gets better by itself within 1 or 2 weeks2. However, in vulnerable populations, such as babies under 6-months-old, those born preterm, adults over 75 years and anyone with a weakened immune system, long-term lung or heart conditions, RSV can be much more serious requiring hospitalisation and, in some cases, causing death.

Many babies with RSV infection are undiagnosed, but they will struggle to breathe and feed due to bronchiolitis or pneumonia over the winter months. On average in England, 20,000 infants are admitted to hospitals each winter due to RSV. The vast majority have no underlying medical conditions. Many need intensive care, and sadly 20 to 30 will die due to RSV infection. RSV has wider impacts too, cancelling major paediatric surgery because critical care beds are needed to keep children with RSV breathing.

The maternal vaccine is a major step forward for child health. It offers infants 70% protection against severe RSV lower respiratory tract infection over the most vulnerable first 6 months of life. Commenting on the new vaccination programme, The Royal College of Paediatrics and Child Health has called it “game changing”.

The new RSV schedule – what you need to know:

  • Pregnancy
    • All women who are at least 28 weeks pregnant on 1 September 2024 should be offered a single dose of the RSV vaccine. After that, pregnant women will become eligible as they reach 28 weeks gestation and remain eligible up to birth. The ideal opportunity to offer vaccination would be at the 28-week antenatal contact, following prior discussion about the vaccine earlier in pregnancy. Providers should aim to vaccinate those already eligible on 1 September as soon as possible.
  • Older adults
    • All adults will be offered the vaccination at 75-years-old.
    • There will be a catch-up programme which will start for those aged 75–79-years-old on 1 September 2024.
    • They will remain eligible until the day before their 80th birthday, with the aim to complete the catch-up programme by the end of August 2025.

It is expected that the majority of the two population groups will have their vaccinations in September and October in preparation for the start of the RSV season.

Role of the health visitor

It is important that health visitors and their teams are aware of these new vaccination programmes. They are ideally placed to have conversations about the benefits of the maternal vaccination during the antenatal and interpregnancy periods, to ensure families who are pregnant or are planning a pregnancy are aware of the new RSV vaccination and how it protects babies. Through their extensive reach to millions of families across the UK each year, they can also play an important role in raising awareness of the new older adult vaccination programme for extended family members, or with grandparents helping with childcare. They are in the ideal place to explain to families what the new programme is, answer any questions that they may have, and direct them to the GP surgery for more information. This will help to protect the whole family, offering lifesaving protection against RSV for young babies and other vulnerable groups.

Further information, guidance and resources to support healthcare practitioners and raise awareness of the new RSV vaccination

As there are two new RSV vaccination programmes (one for pregnant women for infant protection and a separate one for older adults), there are different supporting resources available for each. It is important that anyone involved in RSV immunisation, or promoting vaccine uptake, is aware of which resources to use. More details are also available in the green book, chapter 27a: respiratory syncytial virus.

UKHSA and Public Health agencies for the devolved nations have produced several resources to support practitioners in raising awareness of the new programmes. Some of the resources are available in other languages. Follow the links below to access the resources.

References

  1. UKHAS (2024) What is RSV and is there a vaccine?. Available at: https://ukhsa.blog.gov.uk/2024/07/17/what-is-rsv-and-is-there-a-vaccine/
  2. NHS (2024) Respiratory syncytial virus (RSV). Available at:
    https://www.nhs.uk/conditions/respiratory-syncytial-virus-rsv/

New RSV vaccination of pregnant women from September 2024

From 1 September 2024, pregnant women can have a free vaccine in each pregnancy to protect their babies against respiratory syncytial virus (RSV). Make sure you are up to date about this important new vaccination to raise awareness and promote uptake.

Why the RSV vaccine is needed

RSV is a common virus which can cause a lung infection called bronchiolitis. In small babies this condition can make it hard to breathe and to feed. Most cases can be managed at home but around 20,000 infants are admitted to hospital with bronchiolitis each year in England. Infants with severe bronchiolitis may need intensive care and the infection can be fatal in some cases. RSV is more likely to be serious in very young babies, those born prematurely, and those with conditions that affect their heart, breathing or immune system.

RSV accounts for approximately 33,500 hospitalisations annually in children aged under 5-years-old. It is a leading cause of infant mortality across the world and results in 20 to 30 deaths per year in the UK. RSV infects up to 90% of children within the first 2 years of life and frequently re-infects older children and adults.

How the RSV vaccine protects babies

The vaccine boosts the mother’s immune system to produce more antibodies against the virus. These antibodies then pass through the placenta to help protect babies from the day they are born. RSV vaccination reduces the risk of severe bronchiolitis by 70% in the first 6 months of life. After this age, babies are at much lower risk of severe RSV.

Older children and adults can also get RSV infection, but the disease is more serious for small babies and people aged 75 and over.

Find out more: A guide to RSV vaccination for pregnant women

Read UKHSA Guidance:  RSV vaccination of pregnant women for infant protection: information for healthcare practitioners

Read UKHSA blog: What is RSV and is there a vaccine?

UKHSA encourages timely vaccination as whooping cough cases rise

Yesterday, the UK Health Security Agency (UKHSA) published a news story urging timely whooping cough vaccination in pregnancy and in childhood to protect vulnerable young infants from serious disease:

  • Pregnant women are offered a whooping cough vaccine in every pregnancy, ideally between 20 and 32 weeks – protecting their baby from birth in the first months of their life when they are most vulnerable and before they can receive their own vaccines.
  • All babies are given three doses of the 6-in-1 vaccine at 8, 12 and 16 weeks of age to protect against whooping cough and other serious diseases.

New data published yesterday by UKHSA shows cases of whooping cough continue to increase with 2,591 cases confirmed in May. This follows 555 cases in January 2024, 920 in February, 1,427 in March and 2,106 in April – bringing the total number of cases from January to May 2024 to 7,599.

Sadly, there have been 9 infant deaths since the current outbreak began in November last year (one in December 2023 and 8 between January to end May 2024). Young babies are at highest risk of severe complications and death from whooping cough. Evidence from England shows that vaccination at the right time in pregnancy is highly effective, giving 92% protection against infant death.

From January to May 2024, while most cases (53.4%, 4,057) were in those aged 15 years or older who usually get a mild illness, high numbers (262) continue to be reported in babies under 3 months of age who are at greatest risk from the infection.

Whooping cough cases have been rising across England, as well as in many other countries, since December 2023 due to a combination of factors. Whooping cough is a cyclical disease that peaks every 3 to 5 years. The last cyclical increase occurred in 2016. However, in common with other diseases, cases fell to very low numbers during the pandemic due to restrictions and public behaviours. A peak year is overdue and the impact of the pandemic also means there is reduced immunity in the population.

The latest uptake data for the vaccination offered to pregnant women to protect newborn infants against whooping cough continues to decline – with coverage in March 2024 at 58.9% compared to the peak coverage (72.6%) in March 2017.

Timely vaccination in pregnancy and in childhood are both important to protect vulnerable young infants from serious disease. All babies are given three doses of the 6-in-1 jab at 8, 12 and 16 weeks of age to protect against whooping cough and other serious diseases such as diphtheria and polio, with a pre-school booster offered at 3 years 4 months.

Whooping cough, clinically known as pertussis, is a bacterial infection which affects the lungs. The first signs of infection are similar to a cold, such as a runny nose and sore throat, but after about a week, the infection can develop into coughing bouts that last for a few minutes and are typically worse at night. Young babies may also make a distinctive ‘whoop’ or have difficulty breathing after a bout of coughing, though not all babies make this noise which means whooping cough can be hard to recognise.

If anyone in your family is diagnosed with whooping cough, it’s important they stay at home and do not go into work, school or nursery until 48 hours after starting antibiotics, or 2 weeks after symptoms start if they have not had antibiotics. This helps to prevent the spread of infection, especially to vulnerable groups, including infants. However, vaccination remains the best protection for babies and children.

UKHSA Blog

Alongside the updated data, UKHSA also published a powerful new blog post, “Whooping cough: my daughter spent the third week of life in an induced coma”. In this blog post, Jenny, from Hampshire, shares the story of her daughter Layla and her struggle with whooping cough at 3-weeks-old.

Read the UKHSA blog post

Health visitors’ role to promote uptake of the pertussis vaccine

UKHSA is calling for frontline clinicians to promote uptake of the pertussis vaccine. Pregnant women can have a pertussis-containing vaccination between 20 and 32 weeks’ gestation – they should also be vaccinated with every pregnancy.

Health visitors have a vital role to play in discussing vaccinations with parents and caregivers and promoting vaccine uptake. As a universal service, they visit every family, building trust through regular visits, often in the family’s home. Resources are available for health visitors and their team members to support communication around vaccines with pregnant women.

Whooping cough infections rise

New data published by the UK Health Security Agency (UKHSA) shows there has been a continued increase in pertussis (whooping cough) cases at the start of this year, with 553 confirmed in England in January, compared with 858 cases for the whole of last year (2023).

The increase in whooping cough across England is occurring after a prolonged period of low case numbers due to restrictions and reduced social mixing patterns during the COVID-19 pandemic. Cases of whooping cough rise cyclically every few years, with the last peak year in 2016 recording 5,949 cases. The current increase is coming at a time when there has been a steady decline in uptake of the vaccine in pregnant women and in children.

Vaccination programme for children and pregnant women

In response to increasing case numbers, the UKHSA is reminding mums-to-be to get protected against whooping cough so that their young baby has protection from birth against this serious disease and to ask their midwife if they are unsure. UKHSA is also urging parents to check that their children are vaccinated against whooping cough, which is offered to all infants at 8, 12 and 16 weeks of age (as part of the 6-in-1 combination vaccine) with an additional dose included in the pre-school booster vaccine.

This reminder is part of the UKHSA’s new Childhood Immunisation Campaign urging parents to check the vaccination status of their children against measles and other serious diseases. This campaign went live across a range of media channels at the start of this week. Parents are being asked to respond to invites from the NHS or to book an appointment with their GP practice if their child has not received all their routine vaccines.

Data for January show that there were 22 infants aged under 3 months diagnosed with whooping cough. These infants, who are too young to be fully vaccinated, are at greater risk of severe disease, including death. UKHSA is strongly encouraging expectant mothers to take up the maternal vaccine. Vaccination of pregnant women is 97% effective at preventing death in young infants from whooping cough.

Useful links

NHS Vaccinations and when to have them

NHS Whooping cough information

UKHSA launches campaign as measles cases continue to rise

The UK Health Security Agency (UKHSA) has launched a new multi-media marketing campaign across England to remind parents and carers of the risk of their children missing out on protection against serious diseases that are re-emerging in the country – with an urgent call to action to catch up on missed vaccinations.

The campaign went live today (4 March) with a powerful video advert told from the perspective of children and in their voices. “Our generation’s risk of illnesses like measles and whooping cough is rising” they tell their parents and carers looking straight into camera – “If we’re not vaccinated, we’re not protected.”

The campaign theme and materials, based on insight and feedback from parents in the North West, were developed by UKHSA in partnership with DHSC Marketing, Liverpool City Council, NHS England, NHS North West and NHS Greater Manchester.

The campaign comes as the latest weekly update today on measles cases in England shows there have been another 69 cases in the past week, bringing the total number of laboratory confirmed measles cases reported since 1 October 2023 to 650.

Professor Helen Bedford, Professor of Children’s Health at UCL Great Ormond Street Institute of Child Health (GOS ICH) and iHV Expert Adviser: Immunisations, said:

Every year, vaccination saves millions of children’s lives, so it is a huge concern that uptake of vaccines has been in decline in England for the past ten years. This has left many children and young people unprotected against potentially serious diseases and we are already seeing numbers of cases of measles and whooping cough increasing. However, we can prevent this taking further hold. Vaccines are free, highly effective and have a good safety record – and it is never too late to catch up if they have been missed. We owe it to our children to ensure they are protected.

Uptake levels of childhood vaccines offered through the routine NHS vaccination programme in England have been falling over the past decade across all vaccines, including whooping cough, measles, mumps and rubella, polio, meningitis and diphtheria – with England no longer having the levels of population immunity recommended by the World Health Organization that is needed to prevent outbreaks. Crucially, lower vaccine uptake within communities is directly linked to wider health inequalities.

To counter this decline, UKHSA is co-ordinating its national marketing campaign with an NHS operational MMR catch up campaign. Areas with low uptake will be a focus for support and parents of children aged from six to 11 years will be contacted directly and urged to make an appointment with their child’s GP practice for any missed MMR vaccines.

In addition to the TV advert, the campaign will be seen across a range of channels and formats including radio advertising, digital display, online and on social media. Additional advertising will be seen in the West Midlands, North West and London where there are larger pockets of low uptake. The campaign will be supported by a number of key stakeholders, including local authorities and NHS organisations.

Also listen our our recent podcast with Professor Helen Bedford - Stemming the measles surge

Starting school: Is your child fully vaccinated?

As the new school year starts, with children about to start school for the first time, many parents will have a list of things needed for the big day: haircut, new shoes, school bag, etc. This is an exciting time for families. One important thing for the list is whether their child needs any vaccines. As children starting school will be mixing in larger numbers, the risk of catching infections increases.

Fortunately, although unpleasant, most of these such as cough and colds will be mild even if they are frequent! However, where numbers of unvaccinated children gather, there is also a risk of outbreaks of more serious infections.

Measles is top of the list of potentially serious infections where outbreaks are likely. This is because it is so highly infectious – considered the most infectious – and, to prevent outbreaks, very high uptake (95%) of two doses of measles, mumps, rubella (MMR) vaccine are needed. Unfortunately, this target vaccine uptake has never been met in the UK and current MMR vaccine uptake is the lowest for a decade: 2 in every 10 children in England have not had two doses of vaccine. In London, this figure is as high as ¼ of 5-year-olds entering school, while in some parts of the capital as many as a half of children are not fully vaccinated (NHS Digital 2023).

The situation is such in London that UKHSA has advised that, based on current vaccine uptake, there is the potential for an outbreak of between 40,000 and 160,000 cases (UKHSA 2023). These numbers make it inevitable that there would be many hospital admissions for measles, with complications such as pneumonia and encephalitis as well as deaths. Although large outbreaks are less likely in the country as a whole, there is this possibility where there are pockets of susceptible children, young people and adults.

So, what can be done? Fortunately, we have the means to prevent measles outbreaks through MMR vaccination. It is easy to check children’s vaccination status, by either looking at their red book or, if not available, checking with the GP surgery. Where vaccines are missing, they can be caught up at the GP surgery. Even though vaccines may have been missed at younger ages, for most there is no upper age limit, they can be caught up at any age. This does not require starting the course all over again – they just need the missing vaccines. Older children and young adults are also recommended to have had two doses of MMR vaccine, particularly those who are starting university in the next few months. This is particularly important as many young people missed out on their vaccines when they were young, and we have seen many cases of measles in recent outbreaks in this age group when disease is often more severe.

Don’t forget to also remind parents about the pre-school-booster vaccine. Usually offered at 3 years 4 months along with the second dose of MMR vaccine. This boosts immunity to diphtheria, tetanus, whooping cough and polio through the early school years and is an important part of the vaccine schedule.

Professor Helen Bedford – Professor of Children’s Health, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health

References

Also see:

Parent Tips

  • PT – Childhood Immunisations Part 1: An introduction to childhood immunisations
    This Parent Tip provides some useful information on the childhood vaccination programme, explaining how vaccines work, how they are regulated and why it is important to ensure that your baby receives all the recommended immunisations.
  • PT – Childhood Immunisations Part 2: Frequently asked questions
    It is natural to have questions about your baby’s immunisations. This second part of our Parent Tip series on immunisations provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers FAQs on getting your baby immunised and what to expect, including information on things such as soothing your baby during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Good Practice Points

  • GPP – Promoting the Uptake of Childhood Immunisations
    The immunisation programme in the United Kingdom (UK) is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information.

Updated resources on childhood immunisations during COVID-19

As part of  World Immunization Week 2020, our resources on childhood immunisations have been updated with the latest information and advice during the current COVID-19 pandemic – two Parent Tips and one Good Practice Points for Health Visitors.

The two updated Parent Tips:

  • one providing some basic information on the childhood immunisation programme, explaining how vaccines work, how they are regulated and why it is important to ensure your baby receives all the recommended immunisations
  • the second,  provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers getting your baby immunised and what to expect, including information on things such as soothing your baby
    during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Just to reassure you that despite the current COVID-19 pandemic, it is still recommended that your child receives their vaccines as this protects them against other serious diseases that can still cause them harm.

Parent Tips - Childhood Immunisations 1: An introduction to childhood immunisations

Parent Tips - Childhood Immunisations 2: Frequently Asked Questions

These updated Parent Tips, together with those published last week and yesterday, can be found in our **Parenting Through Coronavirus (COVID-19)** webpage

 

The Good Practice Points for Health Visitors:

The immunisation programme is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information.  Uptake of childhood vaccines in the UK is is generally high, although uptake of the MMR is a concern and the UK lost its ‘measles-free’ status last year. There are also concerns about the impact of the COVID-19 lockdown on immunisation uptake.

Go to GPP - Promoting the Uptake of Childhood Immunisations

COVID-19 webpages
  • For Health Visitors– This updated GPP is available in our GPP resource section of our website and can also be found on our COVID-19 (coronavirus) guidance for health visitors webpage – https://iHV.org.uk/COVID-19
  • For parents and families– These updated Parent Tips are available in the Families Parent Tips section of our website as well as our Parenting through Coronavirus (COVID-19) webpage – https://iHV.org.uk/ParentingCOVID19

We have waivered our usual restrictions on resources for members and the COVID-19 sections of our website are “free access” to all to support the national response to this pandemic.

 

 

 

PHE and NHS England urge eligible people to get free flu vaccine

Parents of 2 and 3-year olds are urged to protect their children against flu, which can be a serious and fatal illness.

Those aged 65 and over, children and adults with underlying medical conditions and pregnant women are also urged to get their free vaccine in the next few weeks, before flu begins to circulate widely.

The primary schools-based flu vaccination programme is once again underway. This follows a temporary pause in the ordering of the nasal vaccine, which was caused by delays from the manufacturer.

Primary school clinics will be rescheduled as soon as possible and children in high risk groups should visit their GP if their school session has been delayed, to ensure that they are protected early. GPs have now been advised to call in all eligible children for vaccination by early December.

Read more here

In addition, England’s chief nursing officer has issued a new appeal to NHS staff urging them to fulfil their “duty” to get vaccinated against influenza this winter. Dr Ruth May has written an open letter to frontline nurses and other health professionals working in the health system to urge them to work together to achieve a high level of coverage this season.

Also read our guest blog from the National Infection Service, Public Health England: Help us help you this winter by getting your flu vaccination

MMR vaccination call following high numbers of measles cases

Public Health England (PHE) is calling for all parents to get their children vaccinated against measles, mumps and rubella (MMR) when the vaccine is offered, or for them to take it up now if they didn’t have it at the scheduled time.

In the first quarter of 2019, there were 231 confirmed cases of measles. This figure is slightly lower compared to the same quarter last year. As measles is highly infectious, anyone who has not received two doses of MMR vaccine is at risk, particularly unvaccinated people travelling to countries where there are currently large outbreaks of measles. The recent measles cases are mainly occurring in under-vaccinated communities, particularly those with links to other countries with ongoing measles outbreaks. There has also been some spread into the wider population, such as those who may have missed out on the MMR vaccine when they were younger.

In the final quarter of 2018 94.9% of eligible children aged five received the first dose of MMR. To achieve herd immunity for measles at least 90-95% of the population need to be fully protected. One dose of the MMR vaccine is about 90-95% effective at preventing measles. After a second dose the level of protection is around 99%. Coverage of the second dose is at 87.4% for children aged five. PHE is therefore urging those who have only had one dose to ensure they are fully vaccinated with two doses.

This quarter, 795 cases of mumps have also been confirmed. No new cases of rubella were reported.

The MMR vaccine is given on the NHS as a single injection to babies as part of their routine vaccination schedule, usually within a month of their first birthday. A second injection of the vaccine is given just before starting school, usually at 3 years and 4 months. The vaccine is also available to all adults and children who are not up to date with their two doses. Anyone who is not sure if they are fully vaccinated should check with their GP and those planning to travel to Europe should check NaTHNaC travel health advice.

iHV welcomes immunisation training standards for healthcare practitioners

iHV welcomes the National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners which have just been published.

The National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners sets the standards and lists the essential topics which should be incorporated into immunisation training for registered healthcare practitioners.

The aim of the national standards is to describe the training that should be given to all practitioners engaging in any aspect of immunisation so that they are able to confidently, competently and effectively promote and administer vaccinations.

Dr Cheryll Adams CBE, executive director, iHV, said:

“iHV welcomes this new guidance from Public Health England on the training and standards required to support a high quality, safe and effective immunisation programme that achieves high uptake.  It is important that HVs, who visit every baby and family, have a good knowledge of immunisation and are confident to advise parents. Comprehensive training and regular updates combined with supervision and support as laid out in the guidance will help support HVs to achieve this.”

Go to PHE - Immunisation training standards for healthcare practitioners