The importance of prevention in managing winter respiratory viruses

The public, NHS and economy face significant pressures annually from winter respiratory viruses, which can require substantial resources to manage.^1,2,3 With covid-19 now also included within the seasonal illnesses being tackled, this winter could be even more challenging for the UK population and the NHS.

The pandemic has highlighted vulnerabilities of the health care system when placed under significant and prolonged strain and has reinforced the need for preventative health strategies to protect patients, the NHS, and ensure wider economic resilience.⁴ This year, the epidemiology of seasonal viruses is out of sync with the usual patterns due to measures that were implemented to try to control covid-19.⁵

Periods of lockdown and social distancing resulted in a decrease in population immunity, raising concerns about the impact of influenza and Respiratory Syncytial Virus this winter, particularly given emerging evidence of a rise in hospital admissions from RSV. ⁶ The Academy of Medical Sciences has predicted that hospital admissions and deaths from flu and RSV this winter could be twice that of a “normal” year.⁷

To put this prediction against the context of a “normal”, pre-pandemic year, RSV, a leading cause of infant hospitalisation in the UK, is responsible for around 30,000 hospitalisations in children under five each year. ^8,9 It affects approximately 90 per cent of children at least once before the age of two, with most infections producing mild symptoms. ^10,11

Despite its widespread impact, awareness of the virus is low amongst pregnant women and midwives which, alongside a lack of routine testing for RSV, means that our understanding of its full burden on society and the NHS remains limited.^{12,13,14,15,16,17} Recent experience of protecting against seasonal infections such as covid-19 and rotavirus has shown the benefits of prevention strategies.

Seasonal rotavirus infection in the under-fives used to be responsible for over 14,000 hospitalisations and 140,000 GP visits every year, however following the successful introduction of prophylactic measures, laboratory confirmed cases significantly dropped.^18,19

In much the same way, whilst measures over the past 18 months have been drastic, implementing social distancing and promoting methods to avoid covid-19 transmission such as mask-wearing and handwashing have been clear demonstrations of the value of prevention in healthcare.

Though measures of this calibre are not always necessary, they have shown what is possible in managing circulating viral infections, helping to manage the burden of winter viruses on the NHS.²⁰ Successful strategies for prevention against seasonal viruses ensure that the public, the NHS and the economy are prepared to face both the known and unknown risks that threaten public health.

Learning from past experiences and from public health interventions that were utilised during the pandemic, it is paramount that we strengthen planning and forward-looking investment in preventative strategies to ensure that we are not caught off guard again. Taking action to limit the impact of respiratory viruses with the aim to protect patients could help to ease winter pressures on the NHS this coming season and into the future. 

This article has been written and funded by Sanofi Pasteur.

References:

¹ NHS Providers, (2021) Winter pressures. Accessed November 2021

² GOV.UK UK Health Security Agency, (2021) Why we are preparing for a worst-case scenario winter season. Accessed November 2021

³ NHS Providers, (2017) Winter warning: Managing risk in health and care this winter. Accessed November 2021

⁴ The New Statesman, (2021), How NHS waiting times were at a record high even before COVID-19. Accessed November 2021

⁵ Nature, (2020) How COVID-19 is changing the cold and flu season. Accessed November 2021

⁶ The Academy of Medical Sciences, (2021), COVID-19: Preparing for the future. Looking ahead to winter 2021/22 and beyond. Accessed November 2021

⁷ The Academy of Medical Sciences, (2021), COVID-19: Preparing for the future. Looking ahead to winter 2021/22 and beyond. Accessed November 2021

⁸ Taylor, S et al. (2016), Modelling estimates of the burden of respiratory syncytial virus infection in children in the UK. BMJ Open, 2, 6

⁹ Reeves RM, et al. (2017) Estimating the burden of respiratory syncytial virus (RSV) on respiratory hospital admissions in children less than five years of age in England, 2007- 2012. Influenza and other respiratory viruses; 11:122–129

¹⁰ Webbergren G, et al, (2001), Relationship between respiratory syncytial virus bronchiolitis and future obstructive airway diseases. European Respiratory Journal, 18:1044- 1058. Accessed November 2021

¹¹ NHS England, Bronchiolitis: Overview. Accessed November 2021

¹² Wilcox, Christopher R. MBBCh et al, (2019), Attitudes of Pregnant Women and Healthcare Professionals Toward Clinical Trials and Routine Implementation of Antenatal Vaccination Against Respiratory Syncytial Virus: A Multicenter Questionnaire Study. The Paediatric Infectious Disease Journal 38(9): 944-951. Accessed November 2021

¹³ Barr, R et al. (2019) Respiratory syncytial virus: diagnosis, prevention and management, Therapeutic Advances in Infectious Disease. Accessed November 2021

¹⁴ Drysdale S.B et al. (2016), RSV Vaccine use – the missing data, Expert Review of Vaccines, Oxford Vaccine Group, UK, 15, 2, 149-152

¹⁵ Krilov, L.r et al. (2019) Respiratory Syncytial Virus Infection, Medscape. Accessed November 2021

¹⁶ World Health Organisation, (2021) Respiratory Syncytial Virus Surveillance. Accessed November 2021

¹⁷ Nunes M, Verwey C. (2020) RSV lower respiratory tract infection and lung health in the first 2 years of life. Accessed November 2021

¹⁸ UK Health Security Agency, (2014), Why vaccinate? Accessed November 2021

¹⁹ Atchison, C.J et al. (2015), Rapid declines in age group-specific rotavirus infection and acute gastroenteritis among vaccinated and unvaccinated individuals within 1 year of rotavirus vaccine introduction in England and Wales, The Journal of Infectious Diseases, 213, 2, 243-249. Accessed November 2021

²⁰ Oraby, T et al, (2021), Modelling the effect of lockdown timing as a COVID-19 control measure in countries with differing social contracts, Nature Scientific Reports, (11), 3354