Respiratory syncytial virus in infants (Rsv), in 2021 it arrived earlier, there are more cases and they are more serious. “The relaxation of anti-Covid measures – hand washing, use of masks – associated with the return to school of older children has greatly favored the spread of the respiratory syncytial virus, which occurred earlier than the usual period (December- January), and actually it seems that even more serious cases are being recorded, but we do not yet have precise data “. Annamaria Staiano, president of the Italian Society of Pediatrics (Sip) explains this to Adnkronos Salute, commenting on the alarm for the many hospitalizations in pediatric wards and intensive care of newborns and babies with bronchiolitis and pneumonia caused by the virus.
“Last year, anti-Covid measures limited the circulation of the virus. But this probably also reduced the antibody response to the pathogen,” added the pediatrician. “The respiratory syncytial virus is a very common virus, which circulates among the adult population and among older children, giving, in most cases, mild respiratory symptoms such as those of a common ‘cold’ (nasopharyngitis, cough, sometimes fever) .
However, “adults and older children represent a vehicle for transmission for younger children, who may instead experience severe lower respiratory tract infections and bronchiolitis. The signs of infection, especially the first months of life, are those of respiratory distress. (shortness of breath and shallow breathing, increased respiratory rate, subcostal retractions). As regards prevention, all standard precautions are valid such as hand washing, disposable handkerchiefs to always throw in the garbage, masks (to wear if you is cold and a small child must be looked after), and especially the spacing if there is an older brother who is sick “.
“We were alarmed because the epidemic of” respiratory syncytial virus in newborns “started early this year. Usually this type of respiratory virus arrives in mid-November and lasts until February, and in some cases of premature babies it can activate a prophylaxis with a monoclonal antibody. The early arrival of the virus is making these premature babies sick for whom it would have been possible to have ‘preventive’ therapy “. So at Adnkronos Salute Luigi Orfeo, president of the Italian Society of Neonatology (Sin) and director of the neonatal intensive care of the Fatebenefratelli Isola Tiberina hospital in Rome. “Recently – he reports – we have brought together, in Lazio, neonatology precisely on this topic to activate an immediate response”.
“Every year in Italy 30 thousand premature babies are born – recalls Orfeo – and a good percentage may be affected by the risk of bronchiolitis. Prophylaxis, which has a high cost and is reserved only for some particular cases indicated by the guidelines, does not give immunity but allows a cover for the winter season – Orfeo recalls – For five months every 30 days an injection is made which helps protect the little patient from the risk of developing a serious or very serious problem that can lead to severe respiratory failure from respiratory syncytial virus “.
“In addition to pharmacological prophylaxis, there is also the primary one, especially linked to hygiene, which last year was strengthened by anti-Covid measures and countered the onset of many cases – warns President Sin – the mask, the Hand washing and the isolation of lockdowns with closed schools have avoided many cases. Today, however, with the relaxation of these anti-Covid measures, the respiratory syncytial virus is back in charge and hits. It is the younger siblings who bring it home and infect newborns. This is why it is important for mothers to continue with protective measures at home. This virus can often be confused with Sars-CoV-2 and vice versa, you need to be careful and alert immediately “.
Lancet
He has been in hiding for an abundant year, sent into ‘exile’ from masks, lockdowns and social distances. Today the respiratory syncytial virus (RSV) returns to be felt earlier and with a higher intensity than would be expected in a normal winter season. And while in Italy there are several hospitalizations among the smallest, a theory is emerging: that of the immunity debt accumulated thanks to the measures adopted in times of pandemic, which we now “pay with interest”. It is discussed in the scientific journal ‘Lancet Child & Adolescent Health’. To report this possible ‘boomerang’ effect is a group of researchers from the Medical Research Institute of New Zealand who are currently writing a correspondence on the subject.
The RSV virus causes seasonal winter epidemics and accounts for 60-80% of hospitalizations for bronchiolitis, the most common cause of hospitalization for newborns in high-income countries. “Globally, Rsv and bronchiolitis infection rates have been remarkably low since early 2020,” note the authors, Lee Hatter and colleagues. “This success has been attributed to the implementation of rigorous non-pharmacological public health interventions aimed at Covid-19”, in short, to anti-contagion measures. “However, concerns have been raised about the potential for more severe RSV outbreaks” at a later time “due to so-called immunity debt, a proposed term to describe the scarcity of protective immunity resulting from long periods of low exposure to a given. pathogenic “, situations that leave the” majority of the population susceptible to the disease “.
A peak of cases of bronchiolitis – caused by the respiratory syncytial virus – 5 times higher than in previous years. It is the post lockdown rebound experienced by New Zealand this year. At the peak, reached in the 28th week of 2021, in New Zealand the numbers were “5 times higher” than the average of the peaks reached between 2015 and 2019, the researchers of the ‘Medical Research Institute of New Zealand’ report. Provisional national data for children between the ages of 0 and 4 – the group most at risk of severe manifestations from this infection – show that in 2021 there were 866 hospital discharges for bronchiolitis during the peak week; the incidence rate was 284 cases per 100,000 children in this age group, 3 times higher than the average of the 2015-2019 peaks.
A similar increase was observed in ICU discharge for bronchiolitis, with an incidence rate of 15 per 100,000 0-4 year olds, 2.8 times higher than the 2015-19 peak average. These similar increases in the various items suggest that there has been more disease, but not more severe than in previous years, experts point out. “The pressure on the New Zealand health system due to bronchiolitis has been considerable”, report the authors of the correspondence, who warn: “In countries with a higher Covid burden, especially those in the Northern Hemisphere that are entering their third winter since the start of this pandemic, the pressures resulting from RSV outbreaks could be even greater than those seen in New Zealand. “
This immune debt “is a particular concern for RSV, for which temporary immunity is achieved through exposure to the virus and maternal antibodies vanish rapidly; without seasonal exposure, therefore, immunity decreases and susceptibility to infections future, and potentially more serious, increases, “experts explain bringing the case of New Zealand, which had very low levels of Rsv infection in 2020, with no seasonal outbreak of hospitalizations for bronchiolitis. The partial relaxation of the strict border closure policy in April 2021 was followed “by a rapid increase in cases and therefore by an increase in hospitalizations for bronchiolitis”.
For experts, in countries where the season of colder temperatures is approaching, “preventive measures must be planned. Infection control measures will be needed, such as keeping babies and children with respiratory symptoms at home, and hospitals should prepare for it. to more hospitalizations than historical data suggest. “
Milan
Cases of respiratory virus “are on the increase compared to previous years and hardly such numbers have been seen”. Luca Bernardo, head of pediatrics at the Fatebenefratelli hospital in Milan, told Adnkronos, commenting on the respiratory syncytial virus (RSV) epidemic that is affecting newborns and babies throughout Italy, with pediatric intensive care units and full of affected children from bronchiolitis and pneumonia from Rsv.
Padua
Not only Covid, the syncytial virus is also alarming the health workers of the Padua hospital. “It is a virus that we know very well, and that affects children in particular, but it can become a serious disease in children with a few more fragile months of life, with immunodeficiencies and cardiorespiratory problems. The peculiarity of this year is that the the epidemic started earlier than the past, already in September we had some cases, and in October they hospitalized 21 children, of which 4 needed intensive care. To date we have 5 hospitalized, and there is no day that we do not both a hospitalization and a discharge “. The director of the Pediatric Department of the Hospital of Padua, Lisiana Da Dalt, explains this to Adnkronos.
“The difference, compared to past years, is the higher number of cases: last year throughout the winter season we had a total of 50 hospitalizations this year in the month of October alone, we reached 21- underlines prof. Da Dalt- In any case, we started prophylaxis, which involves the use of monoclonal antibodies, since there is currently no vaccine for the syncytial virus: And, in any case, the course is very fast, after two to three days in which the child is very ill, there is improvement and there is no danger of a serious relapse “.
Palermo
An increase of 25-30 percent of cases and, above all, an “anticipation” of the epidemic season with a trend that “if confirmed in the numbers” risks making “the number of beds available” with the consequence of “not being able to cope urgent care needs “. Also in Palermo, the epidemic of respiratory syncytial virus which is affecting very young children throughout Italy, with intensive therapies filling up again, is worrying. In numbers and in perspective. “In part it was an expected situation – says Professor Giovanni Corsello, director of the complex operational unit of Neonatology and Neonatal Intensive Care of the Palermo Polyclinic – told Adnkronos. Last year, with the lockdown and the closure of schools, the circulation of these respiratory viruses has almost disappeared to resume now with the return to sociability “.
“In Palermo we have recorded not only a greater number of children, including preschoolers, who fall ill – he explains -, but above all an anticipation of these infections that normally appear later, in late winter, in the months of January-February. ‘year, however, already in September we had cases, including newborns, with severe respiratory infections who needed hospitalization in intensive or semi-intensive care “. A national trend that is fully confirmed in the Sicilian capital and that worries pediatricians. “We are alarmed because the current numbers suggest that there will be an increase in cases and, consequently, also in potentially serious ones”, underlines Corsello. The risk? “That the hospital system is unable to meet the hospitalization needs of infants and children in intensive and semi-intensive care”. A very real risk. At least judging by the numbers.
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