The success of an ongoing pilot programme providing RSV vaccination to new child infants gives hope in tackling the possibly life-threatening illness, writes Michael McHale
The re-opening of society post-pandemic has seen a surge in respiratory situations. Simply 12 months in the past Eire was within the grips of an particularly troublesome winter season for viral infections, with excessive ranges of respiratory syncytial virus (RSV) a selected concern.
That winter, RSV peaked within the week ending December 2, 2023, with 985 instances recorded that week alone. By January 6, 2024, a complete of 6,747 instances of the virus had been reported to Irish well being authorities that winter.
This winter, nevertheless, appears completely different. For starters, the start of the virus season appears to be later this yr in comparison with final.
In response to the Well being Safety Surveillance Centre (HPSC), RSV instances, hospitalisations and intensive care unit (ICU) admissions notified in early winter have been between six and 7 instances decrease than the identical time interval final yr.
Within the 12 weeks to November 16, 2024, there had been a complete of 309 RSV instances, 151 RSV hospitalisations, and 6 RSV ICU admissions notified to well being officers. This compares to 2,027 RSV instances, 989 hospitalisations, and 45 ICU admissions reported throughout the identical interval in 2023.
After quite a few years of heightened virus ranges post-pandemic, illness charges now appear to be extra intently resembling pre-Covid developments.
In a current report on RSV epidemiology, the HPSC famous that the 2024/2025 RSV season is later than the final three seasons, however comparable in timing to the 2019/2020 pre-pandemic RSV season. Evaluating exercise to the identical 12-week interval in 2019, RSV exercise was barely greater then, with 552 RSV instances and 309 hospitalisations notified.
“The earlier two RSV seasons (2022/2023 and 2023/2024) began earlier in comparison with pre-pandemic RSV seasons and have been extreme, with excessive numbers of instances and hospitalisations,” the HPSC report famous.
“This was possible because of an accumulation of inclined people within the inhabitants on account of decreased social mixing throughout the Covid-19 pandemic, lack of circulation of RSV throughout the preliminary waves of the pandemic and likewise elevated testing with using multiplex RT-PCR testing.
“The rebound impact post-pandemic is predicted to be momentary, and we could return to pre-pandemic seasonal patterns this winter. RSV circulation in pre-pandemic RSV seasons began in September-November and peaked in late December/early January.”
Nevertheless, one other main new growth in efforts to handle RSV charges is vaccination. On September 1, the RSV Immunisation Pathfinder Programme commenced. Operating till the tip of February 2025, the provisional initiative sees all infants born inside that interval being supplied a brand new vaccine to assist stop the unfold of the virus.
In December, interim Chief Medical Officer Prof Mary Horgan supplied an replace on the influence the vaccine is already having on conserving RSV at bay.
“We’re already seeing the influence of the RSV immunisation which started on 1 September 2024,” she stated.
“In these infants who’re eligible for the RSV immunisation, now we have been notified of simply 23 instances of RSV this yr, in comparison with 496 for a similar interval final yr, with simply 13 hospitalisations down from 316.
“Most significantly, simply three ICU admissions have to this point resulted from RSV in these infants eligible for the programme, in comparison with 50 for a similar interval in 2023.”
Within the 12 weeks for the reason that vaccine was launched, greater than 9,300 infants have obtained the immunisation, representing round 83 per cent of eligible infants.
Earlier than the provisional programme ends, it’s anticipated that as much as 28,000 infants will likely be supplied the vaccination.
Primarily based on proof from the same programme carried out in Spain, it’s estimated that the toddler RSV vaccination programme in Eire will result in the avoidance of as much as 453 hospitalisations and 48 ICU admissions.
The roll out of the scheme comes after a suggestion from the Nationwide Immunisation Advisory Committee (NIAC) that infants aged underneath 12 months ought to obtain passive immunisation towards RSV throughout their first season of publicity to the virus.
In a follow-on price evaluation, the Well being Info and High quality Authority (HIQA) estimated that the full-year price to the HSE of immunising infants throughout their first RSV season would vary from €3.9 million to €19 million, relying on the strategy taken.
Nevertheless, these prices could be partially offset by the truth that fewer infants would require hospital care.
HIQA is at the moment conducting a bigger evaluation to offer recommendation to tell a longer-term coverage determination about RSV immunisation. This can embrace rising worldwide proof in addition to expertise from the continued RSV Immunisation Pathfinder Programme.
The problem of RSV in older adults will even be rigorously thought of. In its suggestions, NIAC referred to as for an immunisation programme for over-65s to guard these most susceptible.
“Given the excessive burden of RSV in older adults in Eire, each to people and to the healthcare system, the introduction of RSV vaccination for these aged 65 or older has the potential to scale back related morbidity and mortality and relieve strain on the healthcare system throughout the busy winter season,” NIAC’s report on RSV immunisation stated.
HIQA estimated that providing an RSV vaccine to everybody aged 65 years and older was estimated to price €146 million, whereas it will price over €76 million if solely supplied to these aged 75 years and older.
“There could be substantial organisational challenges related to extending RSV immunisation to the final toddler and/or older grownup inhabitants, given the big variety of people concerned and the purpose to maximise uptake inside a short while body earlier than the beginning of the RSV season,” stated HIQA Deputy CEO Dr Máirín Ryan.
“Moreover, given the uncertainty in relation to the price related to the completely different RSV methods, we suggested that the product price ought to be a key consideration in any decision-making.
“Information assortment will likely be essential to help the continued monitoring and analysis of the effectiveness of any programme that’s carried out. A public marketing campaign would even be important to boost consciousness and help knowledgeable decision-making.”
A current survey of over-65s seems to verify the necessity for higher consciousness across the risks of RSV an infection. A nationwide ballot printed in August discovered that 48 per cent of respondents aged 65 and over have little to no data of RSV and its potential dangers.
“RSV poses a big menace to older adults, but consciousness of its influence on this inhabitants stays alarmingly low,” stated Prof Patrick Mitchell, advisor respiratory doctor at Tallaght College Hospital.
“It’s essential for people over 65 or adults with underlying well being situations equivalent to COPD, bronchial asthma or coronary heart failure to talk to their GP or healthcare skilled about RSV and its potential penalties. The pressure that RSV locations on our healthcare system is usually underestimated and never appreciated, highlighting the necessity for elevated consciousness and proactive measures.”
Broadcaster Mary Kennedy has partnered with GSK Eire to launch a brand new public consciousness marketing campaign highlighting the indicators, signs and threat components of Respiratory Syncytial Virus (RSV) for adults over the age of 65. Pic: Julien Behal
Broadcaster and author Mary Kennedy not too long ago partnered with GlaxoSmithKline (GSK) Eire to launch a brand new public consciousness marketing campaign highlighting the indicators and signs of RSV, in addition to threat components for RSV in adults over the age of 65.
The ‘RSV and Me’ marketing campaign encourages over 65s to remain energetic, wholesome and to get winter prepared by studying extra about RSV.
“Like so many others, I wasn’t conscious of the dangers posed by RSV. It doesn’t simply have an effect on infants, however older adults too,” she stated.
“Studying extra about RSV has allowed me to take motion and plan forward for the winter season. Taking proactive steps to take care of my well being means I can keep wholesome and energetic doing the actions I like and spending time with my household.
“For those who expertise signs equivalent to coughing, wheezing and a runny nostril, please speak to your GP – it may very well be RSV. Don’t let RSV interrupt your plans or maintain you again from dwelling life to the fullest.” 
