Correspondence

Introduction of new NHS vaccination programmes against respiratory syncytial virus (RSV)

Published 24 June 2024

Applies to England

24 June 2024

To:

Trust:

• chief executives
• chief operating officers
• medical directors
• chief pharmacist
• chief nurses
• head of midwifery

Integrated Care Boards (ICB):

• chief executives
• chief operating officers
• medical directors
• chief pharmacist
• chief nurses
• head of midwifery
• public health directors
• clinical leads
• accountable officers

For onward cascade to:

• general practices
• midwives
• paediatricians
• NHSE regional directors
• NHSE regional chief midwives and heads of midwifery
• NHSE regional medical directors
• NHSE directors of nursing
• NHSE regional directors of commissioning
• NHSE regional directors of primary care and public health commissioning
• NHSE regional heads of public health commissioning
• NHSE regional heads of primary care
• NHSE specialist commissioning teams
• all directors of public health

Stakeholders:

• Nursing and Midwifery Council
• Royal College of Midwives
• Royal College of Paediatrics and Child Health
• Royal College of Physicians
• Royal College of Nursing
• Royal College of General Practitioners
• Royal College of Obstetricians and Gynaecologists
• Faculty of Public Health
• Local Government Association
• Royal Pharmaceutical Society
• Royal College of Emergency Medicine
• Society of acute medicine

Dear Colleagues,

Introduction of new NHS vaccination programmes against respiratory syncytial virus (RSV)

Following guidance from the Joint Committee on Vaccination and Immunisation (JCVI), we are writing to systems to set out next steps for delivery of 2 new respiratory syncytial virus (RSV) vaccination programmes from 1 September 2024, for older adults and during pregnancy for infant protection.

RSV is a common respiratory virus that that can cause serious lung infections. While RSV infection can occur at any age, the risk and severity of RSV and its complications are increased in older adults and in neonates and small babies, and it has a considerable impact on individuals and NHS services during the winter months.

Following successful completion of a competitive tender and with funding approved from the Department of Health and Social Care (DHSC), we are pleased to be able to provide further information about the programme. We ask that you share this with all local partners involved in commissioning and delivering the programme.

Programme for older adults aged 75 to 79 years old

All adults turning 75 years old on or after 1 September 2024 will be eligible for the routine programme and should be offered a single dose of the RSV vaccine on or after their 75th birthday. A one-off catch-up campaign for those already aged 75 to 79 years old on 1 September 2024 should be undertaken at the earliest opportunity with the aim of completing the majority by 31 August 2025. To offer the best protection, we are asking systems and providers to vaccinate as many people as possible during September and October 2024 prior to the expected RSV season. In line with JCVI guidance, individuals will remain eligible until the day before their 80th birthday, with the exception of people who turn 80 in the first year who have until 31 August 2025 to get vaccinated.

This campaign will be commissioned from general practice as an essential service, starting from 1 September 2024. In addition, NHS England (NHSE) will be commissioning a number of community pharmacies to deliver the programme. Further details will be shared in due course.

Programme for pregnant women to protect infants

All women who are at least 28 weeks pregnant (the eligible cohort) on 1 September 2024, should be offered a single dose of the RSV vaccine, through commissioned services. After that, pregnant women will become eligible as they reach 28 weeks gestation and remain eligible up to birth. The ideal opportunity to offer vaccination would be at the 28-week antenatal contact (ANC), following prior discussion at the 20-week ANC. Providers should aim to vaccinate those already eligible on 1 September as soon as possible.

Information provided in the annexes of this letter:

Annexe A: detailed information and guidance for healthcare professionals about the RSV older adult offer.

Annexe B : detailed information and guidance for healthcare professionals about the RSV vaccination offer for pregnant women to protect infants and the high-risk infant offer.

Annexe C: detailed information and guidance for healthcare professionals – both programmes.

For any operational queries, please contact your NHS England Regional Public Health Commissioning Team. For clinical queries or queries about supporting programme resources, please email [email protected].

We would like to take this opportunity to thank everyone involved in commissioning and delivering the national immunisation programme in England.

Yours sincerely

Steve Russell, National Director of Vaccinations and Screening, NHS England

Dr Mary Ramsay CBE, Director of Public Health Programmes (including immunisation), UK Health Security Agency

Annexe A. Detailed information and guidance for healthcare professionals – Older adult programme

The Joint Committee on Vaccination and Immunisation (JCVI)

In June 2023, based on impact and cost effectiveness modelling, the JCVI advised that an RSV immunisation programme, that is cost effective, should be developed for older adults aged 75 years old and above. The JCVI further advised it favoured a one-off campaign as the strategy for this programme with the initial offer covering several age cohorts and then a routine programme for those turning 75 years old, with its delivery and implementation to be determined through further consultation between NHS England, DHSC, UKHSA and the devolved administrations.

Funding and service arrangements

Routine NHS-funded vaccinations and immunisations are delivered as essential services under the GP Contract from the 1 September 2024, the RSV vaccination programme will be included, as set out in this letter. Details of how the service will be commissioned will be shared via an NHS England deployment note and relevant contracting arrangements will be put in place accordingly.

Practices will be required to undertake call/recall for patients as they become eligible for the programme from 1 September. Accurate and timely recording of all vaccines given, and good management of all associated documentation, is essential as per the standards set out in the GMS Regulations and Statement of Financial Entitlement (SFE).

Funding will be part of the Public Health Allocation to regional commissioners annually to disseminate, as required locally.

Vaccine coverage data collection

Single dose coverage of the RSV vaccination will be collected. GP practice-level RSV vaccine coverage will be based on data automatically uploaded via participating GP IT suppliers to the ImmForm website (a website used by UKHSA and NHS to collect data on vaccine coverage and provide vaccine ordering facilities for the NHS). For the maternal programme, data will be collected monthly with an 8 week lag to allow for transfer of records and recording of live births and immunisations in women’s records. For older adults, data will be collected quarterly.

From September 2024 data will be collected on the following:

For older adults:

Denominator: the number of patients in the relevant age bands registered with a participating GP on the data extraction date.

Numerator: the number of patients in the denominator that have received the RSV vaccine between 1 September 2024 and the extraction date.

The data will be validated and analysed by UKHSA to check data completeness, identify and query any anomalous results and describe epidemiological trends. Reports will be available on GOV.UK.

Annexe B. Detailed information and guidance for healthcare professionals – pregnancy vaccination for infant protection programme

The Joint Committee on Vaccination and Immunisation (JCVI)

In June 2023, based on impact and cost effectiveness modelling, the JCVI advised that a RSV immunisation programme, that is cost effective, should be developed for infants. Further details can be found in the JCVI RSV statement.

Women should be offered RSV vaccination in each pregnancy from 28 weeks gestation. Infants at high risk of RSV disease should also receive passive immunisation against RSV in accordance with criteria in the Green Book, chapter 27a regardless of whether the mother was vaccinated during the pregnancy.

Funding and service arrangements

Where appropriate and in accordance with procurement legislation, the service may be provided under a variation to the NHS Standard Contract with current providers as determined by regional commissioners, based on population need and using the nationally provided template schedules. Where a new non-primary care provider is commissioned in accordance with procurement legislation, then the nationally provided standard contract templates must be used.

Opportunistic or on request GP delivery of immunisations will be commissioned as an essential service in the GP contract. Where commissioners may want general practice to routinely provide this service, this will need to be commissioned locally over and above the core opportunistic or on request offer and giving due regard to procurement legislation.

Funding will be provided as part of the Public Health Allocation to regional commissioners annually to disseminate, as required locally.

Vaccination event data recording

Vaccination events should be recorded using nationally agreed applications. Vaccinations provided in a GP setting will be recorded directly onto GPIT systems. Supporting information on vaccine event recording requirements will be provided to regional commissioners and commissioned providers.

Vaccine coverage data collection

Single dose coverage of the RSV vaccination will be collected.

From September 2024 data will be collected on the following:

For the maternal programme:

Denominator: the number of women registered with a participating GP on the data extraction date who delivered in the survey month regardless of gestational age at birth.

Numerator: the number of women in the denominator recorded as having received RSV vaccination between week 28 of pregnancy and delivery.

The data will be validated and analysed by UKHSA to check data completeness, identify and query any anomalous results and describe epidemiological trends.

Annexe C. Detailed information and guidance for healthcare professionals – both programmes

Vaccine supply

The RSV vaccine Abrysvo® will be made available to order online via the ImmForm website. See the ImmForm helpsheet for information on registering for an ImmForm account. The vaccine is expected to be available to order from early August. The same Abrysvo® vaccine will be used for both the older adult and the infant programmes but will be separate items on ImmForm and the product should be managed independently where possible. Ordering controls may be in place to enable UKHSA to balance incoming supply with demand. Details on ordering will be available on ImmForm and in Vaccine Update in due course. Providers should plan to include Abrysvo® with their usual ImmForm vaccine orders rather than placing additional orders and ensure that local stocks of vaccine are rotated in fridges so that wastage is minimised. It is recommended that practices hold no more than 2 weeks’ worth of stock.

Patient Group Directions (PGDs)

A new RSV PGD template will be produced by UKHSA for NHS England areas to authorise for their commissioned services. This will be available from the PGD collection on GOV.UK.

Information and guidance for healthcare practitioners

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

Healthcare practitioner information and guidance to support the RSV programme including an Information for Healthcare Practitioners document and a training slide set will be available from the RSV vaccination programme webpage.

Patient information materials

Patient information materials will be available on the RSV vaccination programme webpage.

All patient facing resources can be ordered free of charge from Health Publications. All users need to register to receive deliveries. If you register as a health professional, you can order 500 to 1,000 copies on the website. For larger quantities, please call 0300 123 1002.

Consent

Guidance on informed consent can be found in chapter 2 of the Green Book.

Black Triangle Scheme and reporting suspected adverse reactions

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.