Respiratory syncytial virus or RSV: to vaccinate or not?

The NHS is urging people living in London to get the RSV vaccine, but it is only covered by the NHS for pregnant women and older adults (75-79 years).

An urgent pre-Christmas warning to ensure you have had the seasonal flu and COVID-19 vaccines and possibly the respiratory syncytial virus (RSV) vaccine. Unfortunately, the RSV vaccine is only covered nationally for pregnant women and older people (75-79 years of age. If you want the RSV vaccine, you must self-fund and get it via a private vaccine provider.

Please see “Q&A 48 - RSV and other vaccines: to vaccinate or not” (03-Sept-2024).

Severe RSV pneumonia

Immunocompromised individuals are more vulnerable to severe RSV infections. However, the current guidance from the UK Health Security Agency (UKHSA) states that they can still receive the RSV vaccine even though the NHS does not necessarily cover its cost.

It is widely acknowledged that the vaccine's effectiveness might be reduced in immunocompromised individuals, but the benefits generally outweigh the risks. Unlike some vaccines, there's no specific exclusion for immunocompromised people regarding the RSV vaccine. The immune response triggered by the vaccine might be weaker in people with compromised immune systems, particularly people with MS (pwMS) on anti-CD20 therapies (ocrelizumab, ofatumumab, rituximab and ublituximab) and the S1P modulators (fingolimod, siponimod, ozanimod and ponesimod). This is a common issue with most vaccines, and the problems have been well-rehearsed with the COVID-19 vaccines.

In the UK, two RSV vaccines, Abrysvo® (Pfizer RSV pre-F) and Arexvy® (GSK adjuvanted RSV pre-F), are available. Both are given by intramuscular injection. For more vaccine information, please see the green book (Chapter 27a: Respiratory syncytial virus 30 September 2024).

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. However, it can be severe, especially for infants, older adults and the immunocompromised. Typical symptoms are runny nose, cough, sneezing, fever, wheezing and a high fever. In severe cases, RSV can lead to laryngitis (inflammation of the larynx), bronchiolitis (inflammation of the small airways in the lungs) and pneumonia (infection of the lungs). These conditions can cause difficulty breathing, rapid breathing, and a bluish colour to the skin (cyanosis) due to lack of oxygen.

There are two monoclonal antibody treatments (Nirsevimab, Beyfortus® & Palivizumab, Synagis®) licensed for infants and young children at high risk for severe RSV. I am unaware of these being used prophylactically in vulnerable pwMS on immunosuppressive therapies. However, there is no reason why they wouldn’t work.

I have just been told by a friend of mine, a general practitioner in London, that they are currently seeing a surge of RSV, Flu, and COVID-19 infections, with several patients from their practice having to be admitted to the hospital. I suspect this is why the NHS is urging people living in London to get the RSV vaccine (please see: ‘People in London urged to get RSV vaccine’, 27 November 2024). Please be careful and remain vigilant. It may also be worth rehearsing some previous newsletters concerning COVID-19 that apply to Flu and RSV infections. If you are a new subscriber, these are essential readings.

• Prehabilitation the ultimate in self-help (5-Jul-2021)

• Case study: pulse oximetry (20-Nov-2021)

• Do you know how to stack your lungs? (25-Oct-2021)

I would like to know if any of you have had a recent severe lower respiratory tract infection this season and whether or not any of you have had an RSV infection in particular. Are there any learnings you would like to share with the MS-Selfie community?

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Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.