This case study is based on Baby Kuda, a male infant born 31+4 gestational age with a birthweight of 540 grams. He was discharged from the neonatal unit at 64+2 weeks gestational age and with a discharge weight of 2230 grams. During his neonatal stay Baby Kuda was diagnosed with prematurity, gastro-oesophageal reflux, hypothyroidism and chronic lung disease at 36 weeks gestational age. He was discharged from the neonatal unit to home on 0.1l/min of low flow home oxygen therapy. This case study will discuss how RSV infection increases the risks of mortality for high-risk children under the age of 2 years. Furthermore, it will highlight key principles of health promotion in support of RSV immunization in high-risk infants.

1. To discuss the risks of RSV infection in infants under the age of 2 years

2. To discuss the importance of RSV passive immunization during winter months

3. To discuss the importance of early identification of high-risk infants to reduce mortality and morbidity

4. To discuss the role of health professionals in educating parents of high-risk infants about the importance of immunizing their infants

Over the past 20 years there have been many changes within the UK National Health Service (NHS) regarding who should pay for RSV immunization for vulnerable children. Baby Kuda was the second child to parents who lived in an area of England where RSV immunization was not funded due to debates about the vaccine’s effectiveness. After seven months as an inpatient on the neonatal unit Baby Kuda was discharged home on low flow oxygen therapy. Baby Kuda subsequently developed a cough and cold. His home oxygen was increased and a referral was made to his General Practitioner for his review. A flu jab was given to Baby Kuda and his whole family. In less than 24 hours Baby Kuda’s breathing had worsened and he had a wheeze. His mum was advised to call the emergency services immediately and, on their arrival to the Emergency Department, Baby Kuda stopped breathing and sadly died.

Evidently, at the onset of the RSV season, at least 80% of children are infected with the virus before the age of 2 years (Goddard et al., 2007). The RSV infection is known to survive on surfaces or objects for about 4 to 7 hours, and is transmitted by large droplets and secretions from contact with an infected person (Public Health England, 2008). The RSV incubation period is short, about 3 to 8 days, this being the time span from infection to the appearance of symptoms (Public Health England, 2008). Recently there has been a demand for clear pathways for identifying high-risk infants who may have co-morbidities such as Trisomy 21, immunodeficiency, pulmonary hypertension, heart failure and chronic lung disease. These are public health functions that are exercised by the NHS Commissioning Board 2012. The RSV infection has been found to be one of the main causes of serious respiratory infections such as pneumonia and bronchiolitis (Vaccine Knowledge Project, 2016). Evidently, at least 3% of infants that have RSV bronchiolitis would need to be hospitalized. Globally RSV has been identified as the second largest cause of death in children under the age of one year (Vaccine Knowledge Project, 2016). In the UK RSV infection is known to be a winter epidemic that is responsible for the deaths of around 30 babies in a year (Vaccine Knowledge Project, 2016). The UK Joint Committee on Vaccination and Immunization recommends that the RSV monoclonal antibody Palivizumab should be offered prophylactically to high-risk infants under the age of 2 years (UK Government, 2015).

Accordingly, the UK Government and Public Health England considers the role of the health professional leading RSV immunization clinics to have understanding of the disease and the use of passive immunizations. This would ensure that health professional are able to identify all eligible infants early and that parents are given up to date information about the importance of RSV immunization.

Health can be promoted through immunization which is a type of illness prevention that falls under the medical approach to health promotion (Naidoo & Wills, 2016). Whilst this is more closely aligned to a medical model of health the importance of preventative measures such as immunization cannot be under-emphasized. Primary prevention is defined by Green et al. (2015: 71) as being ‘concerned with preventing the development of disease by reducing exposure to risk factors’. Rose (1981) defines the link between the quantification of risk and the targeting of health promotion interventions as the ‘prevention paradox’. ‘Rose’s prevention paradox occurs when a population-based preventative heath measure that brings large benefits to the community offers little to each participating individual’ (Beckett et al., 2017: 1).

Synagis solution for injection (Palivizumab) is a humanized monoclonal antibody produced using recombinant DNA techniques in mouse myeloma host cells (UK Government, 2015). The use of Palivizumab in RSV immunization can be identified as a ‘high-risk approach’ strategy in health promotion. RSV immunization should be given as a maximum of five doses every 28 days starting from week 40 of the calendar year (the beginning of the winter season in the UK) (UK Government, 2015). The ‘high-risk approach‘ in relation to RSV immunization is that the strategy is costly however appropriate for individual infection prevention. In Baby Kuda’s case study, the prevention paradox was important to avoid a similar case recurring within any community setting. Currently, all funding for RSV immunization is released from NHS England via a blue-tag system. This resulted in higher health professional motivation and the benefit to the patient is also higher.

This case study highlights the importance of access to health care services and provision as crucial to health. It also demonstrates the centrality of health education as an approach to promoting health.

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