• Sat. Nov 27th, 2021

Respiratory virus in newborns, more and more serious cases in 2021

Byeditorial

Oct 27, 2021

Respiratory syncytial virus in newborns (Rsv), in 2021 came earlier, there are more cases and they are more severe. “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 in intensive care infants and babies with bronchiolitis and pneumonia caused by the virus. Read also “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 are a vehicle of transmission for younger children, who may instead experience lower respiratory tract infections and severe bronchiolitis. The signs of infection, especially the first months of life, are those of respiratory difficulty (shortness of breath and shallow breathing, increased respiratory rate, subcostal retractions). As far as prevention is concerned, all standard precautions are valid such as hand washing, disposable handkerchiefs to always throw in the garbage, masks (to wear if you are cold and you have to look after a small child), and above all spacing if there is an older brother who is sick. “” We were alarmed because the “respiratory syncytial virus in newborns” epidemic 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 a prophylaxis with a monoclonal antibody can be activated. The early arrival of the virus is making these premature babies sick for whom it would have been possible to undergo ‘preventive’ therapy. “Thus 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 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 can 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 coverage for the winter season – recalls Orfeo – For five months every 30 days an injection is made that helps to protect the small patient at risk of developing a serious or very serious problem that can lead to severe respiratory insufficiency from respiratory syncytial virus “.” In addition to pharmacological prophylaxis there is also the primary one, especially linked to hygiene, which last year was been strengthened by anti-Covid measures and has countered the onset of many cases – President Sin warns – the mask, the washing of hands 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 returns to the charge and strikes. 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 as well. This virus can often be confused with Sars-CoV-2 and vice versa, you need to be careful and alert immediately. “Lancet Held in hiding for an abundant year, sent into ‘exile’ from masks, lockdowns and social distances. Today the respiratory syncytial virus ( Rsv) returns to be heard earlier and with a higher intensity than would be expected in a normal winter season. And while in Italy there are several admissions among the little ones, a theory is emerging: that of immunity debt accumulated thanks to the measures adopted in times of pandemic, which we now “pay with interest.” This is mentioned in the scientific journal ‘Lancet Child & Adolescent Health’. Medical Research Institute of New Zealand which in these days signs a correspondence on the topic.The Rsv virus causes seasonal winter epidemics and represents 60-80% of hospitalizations for bronchiolitis, the cau sa more common than 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 15 per 100,000 children aged 0-4, 2.8 times higher than the average of the 2015-19 peaks. 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, pressures from RSV outbreaks may be even greater than those seen in New Zealand “. This immune debt” is a particular concern for RSV, for which temporary immunity is obtained through exposure to the virus and maternal antibodies vanish rapidly; without seasonal exposure, therefore, immunity decreases and susceptibility to future and potentially more serious infections increases “, explain the experts bringing the case of New Zealand, which has 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 an increase in hospitalizations for bronchiolitis.” For experts, in countries where the season is approaching of colder temperatures, “preventative measures need to be planned. Infection control measures will be needed, such as keeping babies and children with respiratory symptoms at home, and hospitals should prepare for more hospitalizations than historical data suggests.” . Milan Cases of respiratory virus “are on the increase compared to previous years and such numbers have hardly 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 alarms 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 in total 50 hospitalizations this year in the month of October alone we have reached 21- underlines Prof. Da Dalt- In any case, we have started prophylaxis, which involves the use of monoclonal antibodies, given that to date there is no a vaccine for the syncytial virus: And, in any case, the course is very fast, after two or 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 “advance” 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 make to address the needs of assistance in urgency “. Also in Palermo, the respiratory syncytial virus epidemic that 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, even of 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 respond to the hospitalization needs of infants and children in intensive and semi-intensive care”. A very real risk. At least judging by the numbers.