A new vaccination programme to help protect infants against respiratory syncytial virus (RSV) has commenced. Greta Hayward, Consultant Midwife, Immunisation Division, UKHSA, explains the programme and the role of midwives in supporting women to make informed decisions and access the vaccine
________________________________________
Most of you will have heard about the year-round RSV (respiratory syncytial virus) vaccination programme for pregnant women to protect infants, which was launched nationally on 1 September 2024. This programme is designed to protect infants by vaccinating women during pregnancy, thereby temporarily boosting maternal immunity and enabling the mother to transfer a high level of antibodies across the placenta to their unborn child, providing passive immunity to the infant.
The primary aim of the maternal vaccination programme is to protect young babies from RSV disease. Research by Kampmann et al., 2023 indicates that the protection infants receive against RSV disease lasts for at least the first 6 months of life. Babies are particularly vulnerable to severe RSV infection, which often necessitates hospital treatment and, sadly, can lead to death. While most RSV infections typically cause mild illness, infants under 6 months are at the highest risk of developing severe conditions like bronchiolitis and pneumonia, which can lead to hospitalisation. By vaccinating pregnant women, we can significantly reduce the likelihood of these severe outcomes and help ensure the safety of the youngest members of our community.
Maternal RSV vaccination is an effective way to protect infants from RSV disease during the critical first few months of life. Midwives play a key role in ensuring the success of this programme by optimising vaccine uptake among pregnant women. This includes making the vaccine easily accessible to all pregnant women, ensuring that midwives are well-informed and confident in addressing any questions or concerns pregnant women and their partners may have, and providing women with information resources. For example, offering leaflets and displaying posters can help women access further information if they wish. Information resources to support you in this can be found on the UKHSA Health Publications website. Taking these steps help empower pregnant women to make informed decisions that protect their babies from RSV during their most vulnerable months.
Women can be vaccinated against RSV from 28 weeks gestation until they give birth, but it is most effective when administered on or as soon after 28 weeks as possible. Vaccinating at this time allows the mother’s immune system to optimally respond to the vaccine, ensuring that a sufficient level of antibodies is transferred to the baby across the placenta. This timing is particularly crucial because it increases the likelihood that, even if a baby is born prematurely, they will still receive some protection against RSV.
If the vaccine is administered just days before birth, it is likely to be less effective in protecting the baby since the maternal antibodies may not have had enough time to be transferred. However, vaccinating late in pregnancy can still help protect the mother from RSV infection, which in turn reduces the risk of exposing the newborn to the virus. Importantly, the RSV vaccine should be given during every pregnancy to ensure that each child receives the best possible protection.
Midwives play a crucial role in discussing vaccinations with parents and caregivers. National surveys on attitudes to vaccination consistently show that healthcare professionals are the most trusted source of information on this topic. Receiving guidance on vaccination from a healthcare professional is particularly effective in supporting pregnant women in making informed decisions.
Through the trusting relationships midwives build with pregnant women, they play a vital role in boosting vaccine confidence. This trust allows midwives to effectively communicate the importance of vaccinations, thereby contributing significantly to the success of maternal vaccination programmes. By providing accurate information and reassurance, midwives help ensure that pregnant women feel confident in their choices, ultimately protecting both their health and the health of their babies.
As a midwife you might be asked about the safety of the vaccine. It has been approved by the medicines regulator MHRA and is recommended by the JCVI, the independent scientific committee that advises government on immunisation programmes. The most common reactions are injection site pain, headache, and muscle ache. There are no major safety concerns for babies or mothers. You can read more about the vaccine’s safety in the adverse reactions section of the Green Book chapter on RSV.
The programme is an effective way of helping to protect infants from respiratory illnesses caused by RSV and has been shown to reduce the risk of severe bronchiolitis by 70% in the first six months of life. Midwives can confidently support its use in maternal immunisation programmes, helping to protect infants from RSV complications. UKHSA provides a range of valuable resources to support healthcare professionals in discussing vaccinations with pregnant women. For midwives administering or advising on the maternal RSV programme, the information for healthcare practitioners section on GOV.UK is essential reading. This guidance includes detailed recommendations for the vaccination programme, information on contraindications and precautions, and examples of scenarios or questions that may arise when vaccinating pregnant women.
Additionally, midwives can access resources to share with pregnant women on the Health Publications page. These materials are designed to help support and inform women about the benefits and details of the maternal vaccination, further enhancing their confidence and understanding.
Midwives are pivotal in ensuring that pregnant women feel informed and confident about receiving the maternal RSV vaccination. Your trusted relationship with pregnant mothers allows you to effectively communicate the importance of this vaccination, and other vaccines given in pregnancy, not only for the mother’s health but also for the longer-term protection of their baby against respiratory diseases like RSV, influenza, and pertussis (whooping cough). It is very important that healthcare practitioners encourage and enable vaccination of pregnant women against RSV in every pregnancy, from 28 weeks.
If you would like to learn more about RSV the maternal RSV vaccine webinar for health professionals is available to view.
Greta Hayward, RN, RM, MPH
Consultant Midwife, Immunisation Division, UKHSA
October 2024