2 PAEDS IN A POD

Episode 88 | The RSV Jab Proves Itself

Released: 19th July 2026 | Runtime: ~20 minutes

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EPISODE SUMMARY

This episode leads with the first national effectiveness data on the UK's maternal RSV vaccination programme — a thirty-seven-hospital study finding that vaccination in pregnancy cut RSV hospital admissions by 61% to six months of age and 76% to three months, while also revealing that a third of mothers still aren't taking it up. The second main story asks whether the paediatric asthma scores now appearing in UK pathways can actually predict who needs admitting after a bronchodilator burst; across ten scores and over twelve hundred children, none reached the accuracy needed to be used that way. What's Caught My Eye covers the near-zero yield of retinal examinations in suspected abuse when head imaging is clear, a study showing that CT use in low-risk head injury is predicted by the clinician rather than the child, and data showing that one in ten children with a CNS infection had been seen and discharged in the preceding week.

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MAIN STORY 1: Does the maternal RSV vaccine work in the real world?

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The UK began offering bivalent RSVpreF vaccination to all pregnant people from 28 weeks in late summer 2024, moving to year-round delivery after an initial catch-up phase; nirsevimab replaced palivizumab for high-risk infants in late summer 2025. Trial efficacy is one thing — this is the first look at what the programme delivers once uptake, timing and ordinary life are in the mix. Note that Episode 85 covered a French cohort comparing nirsevimab against maternal vaccination head-to-head; this is a different question, asked of our own population.

Key findings:

• Prospective, test-negative case-control study across 37 BronchStop hospital sites in the UK; parents contributed to protocol design.
• 1,356 infants aged ≤6 months admitted with acute lower respiratory tract infection were screened; 694 entered the primary analysis (429 RSV-positive, 265 RSV-negative).
• Median age at admission 2.2 months for RSV-positive infants, 1.7 months for RSV-negative infants; 57% male.
• 38% of mothers of RSV-positive infants had received RSVpreF before delivery, against 66% of mothers of RSV-negative infants.
• Adjusted vaccine effectiveness against hospital admission: 61% (95% CI 38–75) to age 6 months, and 76% (95% CI 54–87) to age 3 months.
• Overall effectiveness of the UK RSV prevention programme: 61% (95% CI 39–75) through to 6 months.

The effect is largest exactly where the disease is most dangerous — the first three months of life. Equally important is the control group: with two-thirds uptake among mothers of RSV-negative infants, this is a story about a vaccine that works and a programme that hasn't yet reached everyone, and those are separate problems.

The design is observational, covers a single season, and deliberately excluded infants born before 28 weeks and those who received nirsevimab, so it measures the maternal vaccine in the population it was designed for rather than at the margins.

Reference: O'Hagan S, Cunningham S, Drysdale SB, et al. The Lancet Child & Adolescent Health. Published July 2026.

DOI: https://doi.org/10.1016/S2352-4642(26)00134-3

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MAIN STORY 2: Can an asthma score tell you who needs admitting?

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Deciding whether a wheezy child goes home or upstairs after the first bronchodilator burst is one of the commonest judgements in paediatric emergency medicine, and structured asthma scores have been quietly appearing in UK departmental pathways as objective disposition aids. The CASPER study, from the PREDICT network, tested whether ten of the most widely used scores are actually good enough for that job.

Key findings:

• Multicentre prospective observational study across four Australian emergency departments; 1,238 children aged 2–18 who received at least one bronchodilator dose. Median age 3 years (IQR 2–6); 64% male; 41.4% met admission criteria.
• Trained research nurses took observations before and after initial treatment to calculate ten scores: PRAM, SiCAS, CAS, AAIRS, MPIS, PIS, PAS, PASS, Woods and Downs, and the Pulmonary Score.
• No score reached the prespecified AUC ROC of ≥0.80 for discriminating admission from discharge. The four best performers (MPIS, SiCAS, PIS, PAS) scored between 0.70 and 0.73.
• No score achieved a Youden index of ≥50%, meaning none struck an adequate balance between sensitivity and specificity.
• Every one of the ten scores did show that each one-point increase was associated with higher odds of admission (p<0.001).

The clinical bottom line is that these scores measure severity but do not make the disposition decision. They are reasonable for tracking a child over time, structuring a handover or triggering senior review; they are not a threshold to discharge on.

This is Australian data with different admission thresholds to ours, and the median age of 3 means a substantial proportion of the cohort is preschool wheeze rather than established asthma. If your department has a score embedded as a disposition rule, this is a reason to review it against current joint BTS/NICE/SIGN guidance.

Reference: Gray C, Armit L, Babl FE, et al. Archives of Disease in Childhood. Published July 2026.

DOI: https://doi.org/10.1136/archdischild-2026-330613

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WHAT'S CAUGHT MY EYE

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1. The retinal examination you probably don't need

A multicentre retrospective study of 2,591 US children under two undergoing child protection evaluation with no intracranial injury on neuroimaging. Retinal examinations were performed in just 10.5% (272 children), and of those only four (1.5%) had retinal haemorrhages — all with a plausible alternative explanation. Worth your time because it makes a reasonable case that the examination can be safely deferred when head imaging is clear, sparing the infant, the family and your ophthalmology colleague, with the authors carving out suspected strangulation and signs of ocular trauma as the exceptions.

Reference: Hamlin I, Breeden-Carino K, Christian CW, et al. Pediatric Emergency Care. Published July 2026.

DOI: https://doi.org/10.1097/PEC.0000000000003655

2. Why we scan the head injuries the rule says not to

A prospective multicentre study that surveyed 421 emergency clinicians on their experience and risk tolerance, then linked each to the 8,957 PECARN-negative children they had enrolled. 7.3% of these very-low-risk children were scanned anyway, and the predictors were clinician-level rather than patient-level: more years in practice (aOR 1.02), caring for fewer children in one's own practice (aOR 1.55), and self-reported avoidance of uncertain outcomes (aOR 1.31). Worth your time because it is a rare, honest look at the fact that we override a rule we know and trust for reasons that sit in us rather than in the child.

Reference: Chaudhari PP, Ugalde IT, Badawy M, et al. Emergency Medicine Journal. Published July 2026.

DOI: https://doi.org/10.1136/emermed-2025-215859

3. The meningitis that went home

A cross-sectional study across five US states of 2,686 children admitted with meningitis, encephalitis or craniospinal abscess, asking how many had a prior emergency department visit within seven days. 10.6% did, at a median interval of two days; in children over 90 days, more than three-quarters of those visits were coded as isolated flu-like symptoms and only 6% had red flags such as altered mental status or neck pain. Worth your time for two numbers: in bacterial cases, a missed visit carried 2.49-fold adjusted odds of neurological complications, and the risk of a missed diagnosis was 3.7 times higher at the lowest paediatric-volume emergency departments — the closest analogue we have to the DGH and the urgent treatment centre.

Reference: Jafari K, Fatemi Y, Gupta A, et al. Pediatric Emergency Care. Published July 2026.

DOI: https://doi.org/10.1097/PEC.0000000000003648

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KEY TAKEAWAYS

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• The UK maternal RSV vaccine cut hospital admission with RSV by 61% to six months of age and 76% to three months — British data from 37 hospitals, usable in a conversation with a parent.
• Uptake, not efficacy, is now the limiting factor: a third of mothers in the control group had not been vaccinated.
• No paediatric asthma score reached an AUC of 0.80 for predicting admission. Use them to measure severity and structure handover, not to decide disposition.
• If head imaging shows no intracranial injury, the yield of a retinal examination in suspected physical abuse is around 1.5%, and every positive in this cohort had another explanation.
• CT use in PECARN-negative head injury is driven by clinician experience and personal risk tolerance rather than by anything about the child.
• One in ten children admitted with a CNS infection had been seen and discharged in the previous week, usually looking like a virus — and missed diagnosis was commonest where children are seen least often.

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FULL REFERENCE LIST

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All articles retrieved from PubMed.

1. O'Hagan S, Cunningham S, Drysdale SB, Groves HE, Hunt S, Iskander D, Liu X, Lyttle MD, Mpamhanga CD, Waterfield T, Williams TC, Marlow R, Roland D. A national programme of bivalent prefusion F vaccination in pregnancy and protection against respiratory syncytial virus hospitalisation in infants until age 6 months in the UK: a multicentre, prospective, test-negative, case-control study. The Lancet Child & Adolescent Health. 2026 (advance online publication).
2. https://doi.org/10.1016/S2352-4642(26)00134-3
3. Gray C, Armit L, Babl FE, Dalziel S, Borland ML, O'Brien S, Tham D, Asghari-Jafarabadi M, Craig S. Diagnostic accuracy study assessing the ability of paediatric asthma scores to predict admission following initial emergency department bronchodilator therapy: a Clinical Asthma Scoring systems in Paediatric Emergency (CASPER) study. Archives of Disease in Childhood. 2026 (advance online publication).
4. https://doi.org/10.1136/archdischild-2026-330613
5. Hamlin I, Breeden-Carino K, Christian CW, Wood JN, Binenbaum G, Campbell KA, Lindberg DM, Bachim A, Frasier L, George CLS, Horton D, Laub N, Letson MM, Valente M, Leonard J, Kiely J, Henry MK. Performance and Yield of Retinal Examinations in Cases of Suspected Physical Abuse Without Intracranial Injury. Pediatric Emergency Care. 2026 (advance online publication).
6. https://doi.org/10.1097/PEC.0000000000003655
7. Chaudhari PP, Ugalde IT, Badawy M, Ishmine P, Yen K, McCarten-Gibbs KA, Nielsen D, Atigapramoj N, Tancredi DJ, Holmes JF, Kuppermann N. Clinician characteristics associated with CT use in children with minor blunt head trauma at very low risk for clinically important traumatic brain injuries. Emergency Medicine Journal. 2026 (advance online publication).
8. https://doi.org/10.1136/emermed-2025-215859
9. Jafari K, Fatemi Y, Gupta A, Klein EJ, Mahajan P. Epidemiology of Potential Missed Diagnosis of Pediatric Central Nervous System Infections in the Emergency Department. Pediatric Emergency Care. 2026 (advance online publication).
10. https://doi.org/10.1097/PEC.0000000000003648

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About 2 Paeds in a Pod

2 Paeds in a Pod is a paediatric medical education podcast hosted by Dr Ian Lewins, Clinical Lead for Paediatric Urgent and Emergency Care at University Hospitals of Derby and Burton NHS Foundation Trust. New episodes fortnightly.

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The content of this podcast is intended for educational purposes only. It does not constitute clinical advice. Always refer to current national guidelines and local protocols when making clinical decisions.