Let’s put an end to ‘Bronch season’

For many people, Respiratory Syncytial Virus (RSV) is nothing to worry about. It feels like a cold and they recover relatively quickly. But RSV is particularly dangerous for infants and the elderly. It’s highly infectious and can lead to pneumonia and infant bronchiolitis, requiring hospitalisation and intensive care in severe cases.

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 staff in helping parents decide.

A Hospital Case of Bronchiolitis

I remember the first baby with bronchiolitis I cared for on a ward.

She was wrapped in her mum’s arms, six months old, crying and couldn’t get her breath. She had runny eyes, runny nose and mouth, slobbering all over the place. And she had that cry, not a high-pitched cry because a baby with bronchiolitis is too exhausted for that. And I remember mum, looking me in the face as if to say, “What can I do?”

Like me, anyone who’s worked on a paediatric medical ward knows what to expect in a case of bronchiolitis, which is mostly caused by respiratory syncytial virus, or RSV.

They’ll have the knowledge of a babe in arms, nought to 1 years old. They’ll know they’re 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. So, they’re on a form of ventilation because they get exhausted quickly; it’s hard to breathe, cough and feed when they’re under this type of distress.

They’ll also see extremely anxious parents, because they can’t pacify their baby. They’ll know the baby’s hungry but to feed them makes them worse. And they’re watching their baby physically struggling, and it’s really hard.

I’m painting the worst-case scenario, and of course it’s a spectrum. Some cases are mild, some severe. But there are so many, cot after cot in a ward which is why hospitals prepare early for ‘Bronch season’.

Prevention in Primary Care

And if you understand the 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 but for babies what we’re really talking about is its 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 sitting by this parent’s side, holding her baby in my arms, trying to feed and suction, trying to reassure them 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.

Chronic Illness

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 1st 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 not 100% preventable, you give your baby a better chance with vaccination. We as healthcare professionals need to be armed with information to help them do that.

A Health Visitor’s Toolkit     

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 XY 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 info, tailoring it to meet their needs; and 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.

Not everyone has had the experience of nursing a baby with bronchiolitis. But I’d estimate 90% of children’s nurses have at some point nursed a baby in a distressed state because of it. So, let’s use that shared experience, let’s get the information out there and put an end to Bronch season.

RSV vaccination Fact Box

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. Pregnant women who are 28 weeks or later and haven’t been offered vaccination, should speak with their maternity service or GP practice.

More than 1.5 million people have so far been vaccinated. Over 158,000 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.

Further information:

• nhs.uk/rsv-vaccine
• nhs.uk/vaccines-in-pregnancy
• Translated resources to support your engagement