Introduction of RSV vaccination programme 2024 (WHC/2024/032)

Issue date:

24 June 2024.

Status:

Action.

Category:

Public health.

Title:

Introduction of new NHS Wales vaccination programmes against Respiratory Syncytial Virus (RSV).

Date of expiry / review:

Not applicable.

For action by:

• Chief executives, health boards / trusts.
• Immunisation leads, health boards / trusts.
• Immunisation coordinators, health boards.
• Vaccination operational leads, health boards / trusts.
• COVID-19 vaccination leads, health boards / trusts.
• Medical directors, health boards / trusts.
• Directors of primary care, health boards / trusts.
• Nurse executive directors, health boards / trusts.
• Chief pharmacists, health boards / trusts.
• Directors of public health, health boards / trusts.
• Executive Director of Public Health, Public Health Wales.
• Head Vaccine Preventable Disease Programme, Public Health Wales.
• Director of Planning, Vaccination Programme Wales, NHS Executive.
• Community Pharmacy Wales.
• General Practitioner Committee, Wales.
• General practitioners.
• Community pharmacists.

Sender:

Dr Keith Reid, Deputy Chief Medical Officer (Public Health).

Health Social Services and Early Years Group Welsh Government contacts:

Vaccination Division,
Welsh Government,
Cathays Park,
Cardiff.
CF10 3NQ.

Email:

wg.vaccinationsprogrammeteam@gov.wales

Dear Colleagues,

The Welsh Government has accepted advice from the Joint Committee on Vaccination and Immunisation (JCVI) that two Respiratory Syncytial Virus (RSV) immunisation programmes will commence in Wales from September 2024 to protect both infants and older adults.

RSV is one of the common viruses that cause coughs and colds in autumn. Globally, RSV infects up to 90% of children within the first 2 years of life and frequently reinfects older children and adults. Babies under one year of age and the elderly are at the greatest risk of being hospitalised.

The Oxford Vaccine Project states:

In the UK RSV accounts for approximately 450,000 GP appointments, 29,000 hospitalisations and 83 deaths per year in children and adolescents, the majority in infants. It also has a major impact on elderly adults; 175,000 GP appointments, 14,000 hospitalisations and 8,000 deaths per year in the UK.

As such, implementing the RSV vaccination programme will help protect the most vulnerable whilst also reducing the pressure felt by the NHS during the winter months.

I am pleased to be writing, therefore, with instructions regarding the standing up of the RSV vaccination programmes from this autumn. A ministerial announcement will follow, once it is possible for the 4 UK health ministers to make an aligned announcement. Additional professional guidance materials are being prepared by PHW to assist with the implementation of the programme and these will be shared shortly.

This letter is aimed at health professionals who are responsible for commissioning and delivering the RSV vaccination programme in Wales. I encourage you to share this guidance with all those involved in delivering the programme in your area.

Core principles

The new routine RSV vaccination programme will be offered year-round to the following groups:

• older adults, as they turn 75 years old
• pregnant women, who will be offered vaccination at 28 weeks gestation, with a catch-up programme for those already past 28 weeks gestation, but that have not yet given birth ^{[footnote 1]}

A one-off campaign for older adults will also target those individuals aged between 75 and 79 years (+364 days) old ^{[footnote 2]}. This campaign will run for 12 months from the start of the programme on 1 September 2024.

The offer of maternal vaccination will be available with each pregnancy to protect each infant against RSV.

Programme expectations

Health boards are expected to maximise vaccine uptake, minimise vaccine waste, retain their focus on reaching the most vulnerable, and understand and address inequity by ensuring access for all eligible people.

With this in mind, we expect:

• all those eligible to receive an invite for an RSV vaccination in a timely manner:
  • for older adults, the aim should be for invitations for vaccination to be made within 12 weeks of individuals turning 75
  • for pregnant women, vaccination should be offered at their 28 week antenatal appointment, with vaccination available until discharge from midwifery services
• health boards should make every effort to maximise uptake across all groups, with a particular focus on ensuring vaccination equity, for example by seeking to ensure uptake rates are similar in the least and most deprived areas of the health board

Implementation of the programme will be reviewed at the end of the first year. Expectations for the next phase of the programme will be considered and engaged upon as part of that review. Further advice and instructions will be communicated subsequently.

Programme start date

Older adult routine programme

The routine adult vaccination programme, for those turning 75 years, will commence from 1 September 2024, with those eligible invited within 12 weeks of their 75th birthday.

Older adult one-off campaign

The formal launch of the one-off campaign for those aged 75 to 79 ^{[footnote 3]} begins in February 2025. There is operational flexibility to start from 1 September 2024, if there is capacity or vaccination is requested by eligible persons and can be accommodated. The one-off campaign will run for 12 months from the start of the programme, therefore starting from 1 September 2024 and concluding by 31 August 2025. Operational flexibility is provided for the start date of the one-off campaign for older adults in recognition of the pace at which we are standing up the RSV programme this autumn and that there will be other pressures on services at this time. The RSV programme must not disrupt the delivery of the winter respiratory vaccination programme 2024 to 2025.

Maternal programme

The routine programme offering vaccination to all pregnant women at 28 weeks gestation, to protect infants, will commence on 1 September 2024. Vaccination at the 28 week appointment, ideally, should follow a conversation with pregnant women about RSV and the benefits of RSV vaccination at their 20 week antenatal appointment.

A catch-up programme must be undertaken for women past 28 weeks gestation up to discharge from midwifery services, starting from 1 September 2024, at or near their next antenatal appointment.

Existing RSV selective antibody programme

The existing selective RSV monoclonal antibody treatment programme for high-risk neonates will remain in place. Health boards should continue to follow all current guidance as set out in the 'Green book'.

Financial support

Funding has been agreed to support the deployment of an RSV vaccination programme, the details of which will be sent to health board finance directors in due course.

Service arrangements

Engagement with General Practitioners Committee (GPC) (Wales) is underway to agree the General Medical Services (GMS) role in delivering vaccination to those eligible, including discussions around a service specification. Further details will be shared in due course.

I am very conscious that planning for these programmes will be undertaken by teams at pace, and alongside preparations for the 2024 to 2025 winter respiratory vaccination programme. Your hard work and commitment in making these programmes a success and protecting those most vulnerable to RSV is very much appreciated.

Yours sincerely,
Dr Keith Reid.
Deputy Chief Medical Officer (Public Health).

RSV vaccination programmes for 2024 to 2025

Further information:

RSV vaccine ordering, storage and waste

RSV vaccine for the NHS vaccination programme will be supplied by United Kingdom Health Security Agency (UKHSA) in line with other routine vaccination programmes (excluding flu and COVID-19) and ordering will be via the Immform platform. The vaccine will be available to order from 1 August 2024 and deliveries made in line with other routine vaccines.

Both the older adult programme including catch up and maternal programme will be implemented with Abrysvo® supplied by Pfizer. As the vaccine is the same for both programmes but will be ordered via separate codes on Immform, due care should be given to ensure volumes of vaccine used for each cohort are correct.

Abrysvo® is part of the Medicines and Healthcare products Regulatory Agency’s (MHRA) black triangle scheme for new medicines and vaccines to allow rapid identification of new safety information. Health professionals and those vaccinated are asked to report suspected adverse reactions through the online Yellow Card scheme, by downloading the Yellow Card app or by calling the Yellow Card scheme on 0800 731 6789 9am to 5pm Monday to Friday.

Detailed clinical guidance on RSV and RSV vaccination is contained in chapter 27a of Immunisation Against Infectious Disease (the 'Green book').

Vaccine orders should be reviewed to ensure that sufficient supplies of appropriate vaccines have been ordered to meet the needs of eligible groups without hold stock in excess of 2 weeks demand.

GPs and health boards must ensure that all vaccines are received, stored, prepared and subsequently transported (where appropriate) in accordance with the relevant manufacturer’s, Public Health Wales' and local health boards' guidance and all associated standard operating procedures.

Patient Group Directions (PGDs)

PGD links and supporting content will be available prior to the commencement of the programme, and should be reviewed, ratified, and authorised locally by the health board/trust for local use.

Patient Group Directions (PGD) - Welsh Medicines Advice Service (wales.nhs.uk)

Communications

The importance of public communications is fully recognised. Public Health Wales will lead the RSV immunisation programme communications and marketing campaign. Information will be available at Public Health Wales' RSV page.

Surveillance and reporting

Public Health Wales will lead surveillance and monitoring of RSV and the RSV immunisation programme in Wales. To support delivery of the programme, Public Health Wales will provide surveillance reports and will work closely with Digital Health and Care Wales to access data from appropriate national data systems, scoping potential for centrally reconciling uptake data where appropriate.

Work is being undertaken at pace to provide a national digital solution for the recording of and payment for RSV vaccinations. Further information will be communicated when possible.

[1] Pregnant women will remain eligible until discharge from maternity services and should be actively offered vaccination at each opportunity.

[2] All individuals aged between 75 and 79 years with a date of birth between 2 September 1944 and 1 September 1949 (inclusive) will be eligible for the catch-up programme between 1 September 2024 and 31 August 2025, after which point, eligibility is retained until their 80th birthday. Those turning 80 years of age between 2 September 2024 and 31 August 2025 will remain eligible up to and including 31 August 2024 (that is only for the first year of the programme).

[3] All individuals aged between 75 and 79 years with a date of birth between 2 September 1944 and 1 September 1949 (inclusive) will be eligible for the catch-up programme between 1 September 2024 and 31 August 2025, after which eligibility is retained until their 80th birthday.