Ossian Smyth (Dún Laoghaire, Green Party) | Oireachtas source

I thank Deputy Burke for raising this matter. Both Minister for Health, Deputy Donnelly, and the Chief Medical Officer share these concerns in relation to the high levels of RSV that are circulating in our community.

To begin with, I can confirm that following receipt of NIAC advice on RSV immunisation options in October, and the Office of the Chief Medical Officer having considered that advice, the Department of Health has requested HIQA to undertake a health technology assessment, HTA, in relation to RSV.

RSV is a common winter respiratory virus that generally leads to mild respiratory symptoms. It can, however, lead to severe illness among infants, young children aged less than five years and in people aged 65 years and older. Symptoms of RSV include a cough, wheezing, runny nose, difficulty feeding or decreased appetite as well as a fever and a sore throat. RSV associated deaths among children in Ireland and other high-income countries are thankfully rare.

Since last month, RSV has been circulating at very high levels. The highest rates are in those aged less than one year old, followed by the one to four year age group. In the last two weeks, we have seen the highest number of recorded cases and hospitalisations due to RSV. The majority of hospital cases are in those aged less than one. This surge in the rate of RSV cases is stretching healthcare capacity by placing a significant burden on the hospital system.

The numbers of notified RSV cases and hospitalisations decreased slightly in the last week but remain at very high levels. The number of RSV cases notified to the Health Protection Surveillance Centre in the week ending 9 December is 829. This compares to 985 cases notified during the previous week. The number of hospitalised cases notified to the Health Protection Surveillance Centre in the week ending 9 December is 335. This is a decrease of 9% over the previous week when 370 cases were notified. However, despite the decrease in RSV case numbers it is anticipated that the healthcare system will continue to come under increased strain in the coming weeks due to an expected rise in the transmission and co-circulation of respiratory viruses including Covid-19, influenza and RSV.

It is worth noting that certain infants at high risk of infection are offered a form of immunisation, licensed in Ireland for the prevention of serious lower respiratory tract infection caused by RSV. The NIAC advice notes that in relation to infants, there are two forms of passive immunisation against RSV. First is a long-acting monoclonal antibody which can be administered to the infant directly and second, a maternal vaccine which can provide infant protection through transplacental antibody transfer. Passive immunisation is when a person is given antibodies to a disease rather than producing them through his or her own immune system. Active vaccination involves administration of a vaccine to stimulate the production of an immune response in the form of the production of antibodies. Based on a small number of clinical trials carried out to date, both products have acceptable safety and efficacy profiles.

The NIAC advice also noted that further analysis of cost effectiveness and programmatic considerations is required to determine the most appropriate RSV immunisation strategy for infants. In relation to the over 65 age group, the advice stated that there are two vaccines which NIAC recommends to protect against RSV. The advice also noted that based on clinical trials carried out to date, these products also have similar safety and efficacy profiles and again, further analysis of cost and product availability is needed to determine which product is more suitable for use in Ireland.

As I mentioned earlier, following consideration of the NIAC advice, the Department of Health asked HIQA to carry out a HTA to determine first whether infant or adult immunisation would provide the greatest benefit in reducing healthcare utilisation due to RSV infection and second, what the most cost-effective RSV immunisation strategy for Ireland would be. The outcome, when available, will inform whether or not RSV immunisation will be added to the national immunisation programme.

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