Few of us may have heard of this virus, but now leading scientists warn that RSV (respiratory syncytial virus) poses a significant threat to some people’s health.
Until now, RSV, a common respiratory winter illness, has mainly been associated with young children.
Nearly all children will have it by the time they turn two, and for many it is mistaken for a cold. However, for some infants it can cause inflammation of the small airways and significant breathing difficulties, and it results in 20 to 30 deaths a year in the under-fives.
But another group of patients is also at risk from the virus, according to UK scientists. RSV is increasingly identified as causing serious and sometimes lethal respiratory illness in older people, particularly those with heart or lung problems or who are physically frail.
It is estimated to be responsible for more than 29,000 hospitalisations in over-65s in the UK each year. The majority, 70 per cent, are in adults aged over 75.
Harish Nair, a professor of paediatric diseases and global health at Edinburgh University, says some mathematical studies even estimate that in the UK, RSV may cause the same annual increase in hospitalisations and deaths as flu.
Experts are recommending that 5.5 million over-75s in Britain should be inoculated against RSV as part of a national vaccination campaign
Yet the viral infection is under-diagnosed and undertreated, not least because its symptoms are not fully recognised and can be mistaken for colds, flu or even neurological conditions.
Such is the concern that the Joint Committee on Vaccination and Immunisation (JCVI), an independent expert committee that advises the Government on immunisation jabs, is recommending that 5.5 million over-75s in Britain should be inoculated against RSV as part of a national vaccination campaign, using newly-developed jabs.
Sir Andrew Pollard, chair of the JCVI and a professor of infection and immunity at Oxford University, told Good Health that the risk from repeat RSV infections increases with age and can make chronic conditions worse.
‘In adulthood, every three or four years we catch a “cold” that is actually RSV,’ he explains. ‘And as we get older, we’re at increased chance of getting other conditions that make us more vulnerable to RSV.
‘Once we’re over 65, an increasing proportion of the population has medical conditions that can worsen with an RSV infection.
‘If you have heart failure and you get a respiratory infection, then it makes your heart failure symptoms much worse. It’s the same for people with chronic lung disease.’
Typically, the RSV season in the UK starts in October, peaking in December and dropping off by March. The majority of people infected have only mild illness, usually showing symptoms within four to six days of becoming infected: a runny nose, a drop in appetite, coughing, sneezing, wheezing and fever.
But some estimate that it may cause as many hospitalisations and deaths per year as flu, because it can cause life-threatening symptoms in people who are frail or vulnerable, particularly older people.
A 2012 study by the UK Health Protection Agency concluded that the virus causes 1,200 deaths a year in those aged 45 to 74, and 4,000 deaths in over-75s in England and Wales alone.
But the JCVI says these figures may be an underestimate — and better surveillance is needed.
Professor Nair told Good Health that these figures may be at least 250 per cent too low.
The NHS normally diagnoses RSV using samples of nasal mucus. But Professor Nair says thanks to immune defences dwindling with advancing years, ‘older people shed very little RSV in their nasal mucus — so their results often come back negative. You need to test their lung sputum [mucus samples from the lung] and their spit.
‘When you combine nasal mucus, lung sputum and spit tests, you get at least two-and-a-half times more positive results. You should get even more positive results if you test people’s blood as well.’
Another reason why so many RSV infections are missed, he says, is because ‘we still don’t understand the full range of symptoms’.
As he explains, although RSV is known as a respiratory tract infection, it can affect older people in other much less obvious ways.
For some infants it can cause inflammation of the small airways and significant breathing difficulties, and it results in 20 to 30 deaths a year in the under-fives
If you’re older and worried about contracting RSV, those aged 60 and above can have the GSK vaccine privately at pharmacies at a cost of around £180 to £200 per jab
‘They may come into hospital suffering from confusion, from lethargy and falls. They get tested for neurological problems, but in fact their problems are caused by RSV infection.’
This is because the infection can cause weakness in older people, raising the risk of falls; it can also cause fever, which can make them confused.
‘Only after we implement the vaccination programme will we understand the true burden of this infection, by comparing hospitalisations and deaths before and after the programme’s introduction,’ says Professor Nair.
Another reason why RSV cases are undercounted is that there was, until now, no preventive treatment for it, says Christopher Chiu, a professor of infectious diseases at Imperial College London, so testing for it wasn’t considered important.
Ministers are now considering the JCVI’s recommendation of a national immunisation campaign for the over-75s.
This follows the launch last year of RSV vaccines — the first to be developed against the virus — by GSK and Pfizer.
GSK’s vaccine, Arexvy, was approved for use in older adults by the Medicines and Healthcare products Regulatory Agency in July. Pfizer’s jab, Abrysvo, was approved at the end of November.
The JCVI says either jab could be used in a vaccination campaign as their effectiveness ‘is broadly comparable’. (The new jabs are effective for at least two years.)
‘I think we’re going to be quite surprised by how much RSV infection there is in older adults,’ says Professor Pollard.
‘The virus is a really cheeky one. It has ways of switching off our immune system’s defence systems so that we never get complete immunity from it.’
He believes that a vaccination campaign will prove highly cost-effective if it helps to keep older people out of hospitals during winter.
‘The NHS suffers huge winter pressures which are driven by the seasonal increase in respiratory viruses,’ he says. ‘As well as flu, other respiratory infections hospitalise older and frail people — and RSV is top of the list.’
To older people concerned at the prospect of another jab on top of Covid, flu and shingles, Professor Pollard says: ‘There is no concern about over-vaccinating older immune systems. Our immune defences are under a daily onslaught of viruses and bacteria. The RSV vaccine gives a most trivial dose compared with that.’ He’s also reassuring about potential side-effects: headache, pain at the injection site, tiredness and joint or muscle aches or pain.
‘The regulators have no concerns from the trial evidence and there is very robust safety monitoring,’ he says.
Dr Mary Ramsay, director of immunisation at the UK Health Security Agency, told Good Health: ‘We are fully supportive of RSV vaccination being introduced as a routine NHS programme, following the recommendations by the JCVI and subject to the vaccine being cost-effective.’
A spokesperson for the Department of Health and Social Care added: ‘We are developing plans for delivering infant and adult RSV programmes.’
In the meantime, if you’re older and worried about contracting RSV, those aged 60 and above can have the GSK vaccine privately at pharmacies at a cost of around £180 to £200 per jab.
Professor Chiu advises: ‘If you’re between 65 and 75 and in robust health, with no lung or heart problems, then it’s not critical. But you should consider getting vaccinated if you’re in that age bracket and have heart or chest problems that are smoking-related, or have asthma or chronic lung diseases.
‘If you are aged 75 or older, then it makes sense to get vaccinated regardless of how healthy you are — though you may want to wait to get it free through the NHS.’
