BarcelonaBetween November and March, pediatric emergencies tend to be crowded with families as their children suffer from bronchiolitis. With the outbreak of the Corona virus, the typical behavior of the respiratory syncytial virus (RSV), which causes this disease, changed in such a way that either cases practically disappeared, or there was a peak in transmission outside the season. In 2021, for example, the wave began at the gates of summer. The virus had already begun to show signs of normalcy before the pandemic by causing an initial surge of cases at the end of October, resulting in 1,000 people being hospitalized, 400 of them seriously. Indicators now indicate that the spread of the disease has completely returned to normal, but neither pediatric surgeries nor hospitals have witnessed a massive influx of patients yet. The experts consulted attribute this, although cautious, to the vaccination campaign that began in October. According to the ARA, 80% of children have already received the injection.
The latest report from the Catalonia Infection Surveillance Information System (CIVIC) indicates that respiratory syncytial virus is the virus that has grown the most in the past week. Between November 27 and December 3, health detected 13 cases per 100,000 inhabitants, indicating that the pathogen had already reached a moderate transmission threshold. In other words, the wave has begun. Data indicate that the surge in cases began four weeks ago and that respiratory syncytial virus (RSV) samples have doubled since then. “Respiratory syncytial virus cases are delayed by a few weeks compared to a normal year, but we believe that is due to lower temperatures, which has not started to happen yet. However, the trends in terms of severity, they are similar,” assesses the Deputy Director General for Surveillance and Response. For public health emergencies, Jacobo Mendioros.
Last week, the health system announced 1,020 cases of respiratory syncytial disease in Catalonia; 474 in subjects younger than 1 year of age and 415 in children aged 1 to 2 years. “We are heading towards a peak in cases, but the health care impact is much lower than in other years in the same period,” says pediatrician and researcher at the Institute for Global Health Barcelona (ISGlobal), Kiki Bassat. The epidemiologist is also decisive: the reason is the immunization campaign that began in October and targets all children born after April 1, 2023 (and premature babies or those with severe pneumonia under one year of age). “This year will be very different: there are hospitalizations, but much fewer admissions to intensive care units (ICU) because there are many children under six months who are immune,” he says.
Protecting these children from severe pneumonia, the ultimate nightmare for parents of infants, comes from neresivimab, a monoclonal antibody that promises 75% effectiveness in preventing complications associated with the virus that causes bronchiolitis. It is not quite a vaccine, because there is no vaccination against any virus, but antibodies are given that make it difficult for the respiratory syncytial virus to enter cells. A single dose has an almost immediate effect: the child generates defenses at the time of receiving the prick and they last for five months.
Most of the children indicated to receive the antibody have already received it, according to informed sources. “The confidence of parents of children under six months of age is very high, and the profile of those infected is changing: unvaccinated children arrive or children who have not received the vaccine appropriate for their age and are therefore less serious cases,” says Bassat Radiography. The expert points out that last year, at a similar point on the infection curve, children’s hospitals received many cases. Now, in contrast, the emergency room is not currently experiencing a collapse due to bronchiolitis.
65,000 doses
In this first campaign, the Ministry of Health gives priority to children born during this season [a l’octubre] Families are offered the vaccine within the first 24 to 48 hours after birth. As for children born between May and October, they receive protection during pediatric examinations at their primary care centers (CAP). According to Bsat, the fact that it is not a vaccine per se, that it is only aimed at children, and that in recent years serious complications that can result from infection of a newborn with RSV have been reported, have raised the confidence of families in this vaccine. New preventive tool.
However, for Mendioros, it is still too early to fully assess the impact that immunization may have on health centres, considering that cases are not yet increasing. He adds: “However, expectations are that if the most at-risk children are immunized, it is logical that the number of serious cases will decrease. This is the hypothesis and what we hope will happen.” Respiratory syncytial virus (RSV) is a highly contagious virus that causes the common cold, but it can cause bronchiolitis, pneumonia and other complications. It mainly affects children under the age of one year, and can be especially dangerous in infants, young children, and premature or severely ill children. They may require intensive care if they become infected.
Since there is no specific treatment, the department is confident that the €14.1 million cost of these monoclonal antibodies will be clearly offset by lightening of cases and desaturation of the system. In total, Slot obtained 65,000 doses, taking into account that the estimated number of births during the period of the spread of the respiratory syncytial virus is about 55,000 children. Although it does not prevent infection, immunization reduces the chance of complications if a respiratory infection develops.
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