“I have great confidence” to combat respiratory syncytial virus (RSV) infection in the next season, “because we have the” effective tools. “But I also have great concern, because not all the Regions have yet taken action to prepare a campaign that can count on an effective universal immunization tool such as the new generation of monoclonal antibodies”, which must be done by October. “All Italian newborns have the right to have the same type of care, the same prevention opportunities, especially for such a serious disease that has a significant impact on the health of young children and their families. It is unacceptable that only some Italian children can benefit from this formidable opportunity for prophylaxis for the infection, but unfortunately we have 20 different regional health systems”. This is how Luigi Orfeo, president of the Italian Society of Neonatology (SIN), describes the “patchy” national situation on prevention to Adnkronos Salute, which could drastically reduce the “15-20 thousand hospitalizations of newborns per year” caused by bronchiolitis.
“As Sin and with the Italian Society of Pediatrics and Hygienists (Siti), we participated in the ‘Calendar for Life’ which – explains Orfeo – already last year asked to include RSV prophylaxis in the National Prevention Plan, on a par with vaccinations, therefore not something to be delegated to the Regions. This is not yet possible, but we hope it can become reality. We then sent an open letter to the Ministry of Health and the presidents of the Regions, because time is running out and it is not possible for there to be differences in access to prophylaxis. At this moment we do not know exactly how the Regions are moving: we cannot make a division between North and South, because Puglia and Campania have become active like Veneto, but we know that only a few have made the resolutions yet. Time is very tight: the epidemic season begins in October and the antibody must be purchased and distributed in the birth points”.
Every year, “during the epidemic season – explains the Sin president – 60% of newborns are infected with RSV. Not all of them show the disease, but about 4%, therefore 15-20 thousand, are hospitalized for this infection and a quota, 3-4 thousand, in pediatric and neonatal intensive care. It is, every year, a real emergency and we neonatologists are particularly involved because those most at risk are children in the first months of life. The disease from respiratory syncytial virus manifests itself as bronchiolitis, that is, as an infection of the lower respiratory tract. By reducing the caliber of the airways, it can lead, in a non-negligible percentage of cases, to respiratory failure, therefore the need for oxygen supplementation, even respiratory assistance”.
Even though neonatal intensive care units are “well-established, pediatric intensive care units are lacking by at least a third – adds the expert – It happens that the facilities dedicated to premature babies make up for the lack of those for older children and this situation can create problems especially for the youngest”.
The tools to reduce infections and hospitalizations exist. “For twenty years – Orfeo points out – we have been using monoclonal antibodies in newborns most at risk, such as premature babies, but we are witnessing a paradox: in intensive care there are not the children most at risk, but those who are born healthy and full-term for whom, until today, at least in Italy, it was not possible to avoid this infection. Today everything has changed. For some months we have had powerful tools – the expert underlines – In addition to the vaccination of the mother during pregnancy, a new antibody has been added to be administered to the little ones. As Sin we are fighting for the long-acting monoclonal antibody, already approved by the European Medicines Agency (EMA) and the Italian Medicines Agency (AIFA), to be administered to all newborns during the RSV epidemic season. It is convenient because an intramuscular injection is enough and it provides coverage for months: administered once to all newborns they can be protected for the season” which is most dangerous for them.
“The history of the disease could be changed – observes the president of the Sin – by drastically reducing hospitalizations, as demonstrated not only by experimental studies, but also by the experience of what has already been done in other countries where immunization has been available for a year. In Italy the antibody has been used in Valle D’Aosta with excellent results. In Spain, France and Germany we already have observational studies”, therefore on the real population. “In Galicia, therefore in Spain, we see that the reduction in hospitalizations is more than 90%. And this – he concludes – is particularly important because RSV is dangerous not only in the very young, but also in the elderly: by eliminating the circulation of the virus, even the most fragile are protected”.
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