RSV immunisation recommended for infants and older people as case numbers rise

All infants and older people should be immunised against the respiratory syncytial virus (RSV), according to advice provided to the Government.

Babies aged under one should receive passive immunisation against RSV during their first season of exposure to the virus, the National Immunisation Advisory Committee (Niac) has recommended.

It said people aged 65 years and older should also be vaccinated with one of the two available products.

The committee says newly-available products to protect against RSV could “dramatically reduce” the burden it imposes on the health service, particularly in winter. An immunisation programme should be put in place “as soon as is feasible”, it added.

RSV: Infants prioritised for new respiratory virus vaccine ahead of older adults

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The advice, though likely to be accepted by Government, comes too late to have a major impact on trends this winter. More than 400 RSV cases were reported in the first week of November, with outbreaks increasing pressure on intensive care units in children’s hospitals.

As a result, children with less serious illnesses are experiencing long waiting times, the HSE said last week.

Similar trends are occurring across Europe. RSV outbreaks this winter may prove as widespread as they were last winter, the European Centre for Disease Control warned last week. Last year’s RSV season was one of the most severe on record and also began earlier than usual, with cases reported in August.

RSV is the main cause of respiratory infections in children under five, and tends to be most severe in babies under six months, premature babies and children born with heart or other serious diseases. For most children, it is equivalent to a cold, but it can progress to bronchiolitis and pneumonia, requiring hospitalisation.

The administration of RSV vaccines should take place before the start of the season “where possible”, according to the recommendation from Niac. Where supplies are limited, priorities should be given to “those of more advanced age, those with significant comorbidities and those living in long term care facilities for older adults as they are at the highest risk of severe RSV disease”.

Two forms of passive immunisation for infants against RSV have recently been authorised in the EU. One is a long-acting monoclonal antibody, nirsevimab, which is given to the child directly. The other is a maternal prophylactic, RSVpreF (also known by Abrysvo), which protects the child but is given to the mother in pregnancy.

Niac says both options have acceptable safety and efficacy profiles but further analysis is needed to see which is the more cost effective and a better fit with the vaccine programme. It says nirsevimab should replace another drug, palivizumab, which is currently given to high-risk infants.

For older adults, it recommends either RSVpreF/Abrysvo, made by Pfizer, or RSVpreF3/Arexvy, made by GSK. “Further analysis of cost and product availability is needed to determine which product is more suitable for use in Ireland.” Since October, Arexvy has been available privately through GPs.