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.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
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.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...

Episode Transcript

Florence (00:00):
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife, maybe birth fascinates
you, or you're simply curiousabout what exactly an
obstetrician is.
You might be pregnant andpreparing for birth.

(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.

(01:01):
Episode 175, the RSV vaccine.
This is a super topical episodebecause we're about to
introduce the RSV, orrespiratory syncytial virus
vaccine in the UK in pregnancy.
I've talked before aboutvaccination in pregnancy and
before you listen to thisepisode, you might like to go
back to episode 64, vaccinationfor a quick recap about

(01:22):
vaccinations in pregnancy,because the RSV vaccine is just
the latest vaccination in anumber of vaccinations that we
recommend during pregnancyeither to protect the pregnant
woman or to protect her baby.
I recorded that originalepisode when there was lots of

(01:46):
controversy and discussion aboutthe COVID vaccine and I
wondered in that episode why wewere so obsessed with the COVID
vaccine but didn't query othervaccines like flu and whooping
cough.
So if you want a well-roundedthink about vaccination in

(02:06):
general in pregnancy, head backto episode 64.
But today I'm going to focus onthe RSV vaccine, and that's
because it's about to beintroduced, in September, to all
pregnant women between 28 and36 weeks in the UK.
Therefore, I thought this mightbe a helpful episode for

(02:32):
pregnant women currentlypregnant at the moment and
assessing and deciding whetherthey want this vaccination, but
also for healthcare staff,midwives and obstetricians who
are suddenly having a newvaccination that they need to be
confident to talk to womenabout.

(02:53):
So what is RSV?
Rsv is short for respiratorysyncytial virus and it's a very
common cause of respiratorytract infections and in adults
mainly causes a mild,self-limiting respiratory
infection.
But in infants, particularlybabies under a year old, and in

(03:19):
older adults who are atincreased risk, it can cause
more severe problems.
It is spread via droplets, sovery similar to what you're
thinking of with Covid, it'sspread through respiratory
secretions, close contact withsomeone else who has the illness

(03:40):
.
So this might be somethingpassed around at work, or
perhaps by small children atnursery or older kids at school.
Globally, data suggests 90% ofchildren will have an RSV
infection in the first two yearsof life.
So if it's a very commonrespiratory illness, why are we

(04:06):
going to think about vaccination?
The issue is that for babiesunder a year old, there is
significant morbidity.
It's a seasonal infection andif you've ever worked in
paediatrics you know there'ssomething called bronchiolitis
season and the wards fill upwith babies with bronchiolitis.

(04:32):
This is respiratory distress,babies needing perhaps
respiratory support andhospitalisation.
And bronchiolitis is the namegiven to the infection caused by
RSV or respiratory syncytialvirus.
The season runs roughly fromOctober to March, with a peak

(04:54):
around December time, andalthough it doesn't cause much
in the way of mortality,thankfully, it can cause
significant numbers of hospitaladmissions.
If you look at the stats thatare behind the discussion around

(05:15):
the introduction of the vaccine, around 20,000 babies a year
are admitted to hospital withbronchiolitis.
That's not only veryfrightening as a new parent to
have a severely unwell babyneeding hospitalisation, but

(05:37):
that's also a significant burdenfor the NHS in terms of beds,
healthcare staff and treatment.
So it makes sense on all frontsif we could prevent this
illness, to try and do so, andthat's where vaccination comes
in.
That's where vaccination comesin.

(06:03):
So in the last few years, somevaccines for RSV have been
developed, and these are what wecall recombinant vaccines.
That means, rather thaninjecting a live or changed
version of the virus itself totrigger immunity, they take some
of the proteins off the virusand create a vaccine so that the

(06:25):
body is reacting to theproteins on the virus but has no
risk of actually being infectedbecause you're not actually
injecting the virus itself,actually being infected because
you're not actually injectingthe virus itself.
So the vaccine developed is arecombinant vaccine and this is

(06:48):
a similar type of vaccine to thevaccine for HSV that's given to
teenagers now to preventcervical cancer, now to prevent
cervical cancer.
So to decide whether or not togo ahead with a new vaccination
programme, they look at theprevalence of the disease, but
then also they have to look atthe efficacy of the vaccine.
Is it going to be helpful inpreventing the illness and also

(07:13):
how safe is the vaccine, becausewe're always cautious giving
things to pregnant women.
So they've looked at data fromclinical trials in a number of
countries and also the usage inthe US analysis of the impact

(07:43):
RSV has on hospital admissionsin some specific areas of the UK
to decide whether or not it'sworth rolling out this programme
and the answer is that thevaccine is pretty effective.
Actually, what the vaccine doesis it boosts your own immune
system.
So you have the vaccine.
During pregnancy, your bodyproduces antibodies and these

(08:05):
antibodies pass to the babythrough the placenta and also
through breast milk.
These antibodies have beenfound to reduce the chance of
severe bronchiolitis, so needinghospital admission, perhaps by
70% in the first six months oflife, which is huge.

(08:28):
That's a really big reduction.
So it's not to say that yourbaby can't get bronchiolitis if
you have been vaccinated.
Your baby can't getbronchiolitis if you have been
vaccinated, but that is a verysignificant reduction.
When they were looking at thedata initially, there were some
possible concerns about thepossibility of giving the

(08:53):
vaccine increasing the chance ofpreterm birth.
However, when they undertookmore detailed analysis, it
appeared that this higher chanceof preterm birth was only
observed in low-income countriesand not high-income countries,
and the UK counts as ahigh-income country, so that

(09:18):
isn't applicable to us and theyfelt that it may be that there
were confounding reasons whythere was an apparent disparity
in pre-term birth.
They did some plotting of thegestational age, so the numbers
of weeks of pregnancy atvaccination stratified against

(09:42):
the weeks of pregnancy whengiving birth and there wasn't a
relationship between the time ofvaccination and prematurity.
So the Joint Committee onVaccination and Immunisation,
who make the decision forvaccination programmes in the UK
, were assured that this was asafe vaccine to give and that

(10:05):
this wasn't going to have anegative impact on pregnancy
outcome or increase the chanceof preterm birth.
And that's obviously a very,very important thing to be sure
of.
And if you look at theinformation sheet for pregnant
women, they've included thatinformation that there were

(10:28):
slightly more premature babiesin the vaccine group 2.1% than
the group that didn't have thevaccine 1.9% but that this
difference is likely to be dueto chance.
But it's important.
We as clinicians are aware ofthat data and can discuss it
with women if they're concernedabout those numbers.

(10:53):
So the next question is if it'sa seasonal illness, much like
flu or COVID, are we going to begiving seasonal vaccination
from about October every yearand the vaccine is updated every

(11:19):
year to the previous year'slatest variant so that it's as
efficacious as possible.
So the months during whichyou're pregnant will vary
whether or not you are offeredand encouraged to have a flu or
COVID vaccination.
So because they're startingthis vaccination programme in

(11:43):
September, I thought this may bea seasonal vaccination
programme that's going to goalong with flu and COVID.
However, looking into it more,they've actually decided that
it's better to have a continuousvaccination programme, that
that's more beneficial, so that,although they're starting in

(12:04):
September, we will be offeringvaccination to women throughout
the year, more similar to thewhooping cough vaccination
programme that's already inexistence.
So you will be offered thevaccine around 28 weeks the data
suggests it's most efficaciousbetween 28 and 36 weeks which

(12:28):
will enable you to build thatimmunity and pass it to your
baby before birth, and thatgives 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 Iimmediately thought people are

(12:50):
going to start asking me in myantenatal clinic is can I have
all these vaccines at the sametime or do I need to have them
separately?
If we're going to be advisingwhooping cough vaccine, rsv
vaccine and then seasonally fluand covid vaccine, that's a lot
of vaccines.
So the current guidance is thatthe whooping cough vaccine is

(13:16):
usually given a bit earlier inpregnancy, so around the 20 week
scan, and the RSV vaccine isgoing to be around 28 weeks.
So those usually would be givenseparately, and the flu vaccine
can be given at any point inpregnancy, because that is the

(13:39):
flu and COVID vaccine are moreprotecting the mother.
I mean, obviously they protectthe 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 tothe mother, but they're for the
benefit of the newborn baby.

(14:02):
The advice and the informationleaflet for women does say,
though, that if you go for yourRSV vaccine and you haven't had
your whooping cough or fluvaccines already, you can
actually have them all at thesame time.
You might not fancy having themall at the same time, but it's

(14:24):
perfectly safe to do so, and Ithink implementing the new RSV
vaccine is going to probably bea lot easier for us as maternity
staff, because we've alreadygot in place, in a lot of units
now, facilities to give vaccines, because this has become a core

(14:47):
part of maternity care in a waythat it really wasn't at the
beginning of my career.
So we have a vaccination nurseor midwife in our antenatal
clinic so that when women comefor scans or appointments, we
can offer them the vaccine as adrop-in basis.
So we're very well set up forthat and so to add in the RSV

(15:13):
vaccine is not a big deal.
So hopefully that's given you alittle bit of information about
the upcoming implementation ofthe RSV vaccine.
I've put some links in the shownotes that you can have a look
at, both information forpregnant women and also
information for professionals.

(15:34):
So in terms of zesty bit, Ithink the important thing to
remember is, just like othervaccinations in pregnancy, we're
recommending this because thereis a significant health benefit
for either you or your baby,and we really would not be

(15:55):
recommending this if it wasn'tsafe.
I think women are very hesitantto take medication or have
vaccination in pregnancy andhopefully by doing a quick
episode on this, it willreassure women that this is the
right thing to do and could beextremely helpful and protective

(16:16):
for their baby and hopefullyhelp health professionals be a
bit more confident in talkingabout it, because when something
new is implemented, it can bedifficult to get up to speed
quickly and know what we'readvising and why we are advising
it.
I very much hope you found thisepisode of the OBS pod

(16:39):
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review on whatever platform youfind your podcasts.
As well as recommending the OBSpod to anyone you think might
find it interesting, there'salso tons of episodes to explore

(16:59):
in my back catalogue fromclinical topics, my career and
journey as an obstetrician andlife in the NHS more generally.
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient

(17:20):
identifiable information unlessI have expressly asked the
permission of the personinvolved on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at

(17:44):
the programme notes where I'veattached some links.
If you want to get in touch tosuggest topics for future
episodes, you can find me atTheObsPod, on Twitter and
Instagram, and you can email metheobspod at gmailcom.

(18:04):
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(18:26):
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