“Without immunization, we probably would have faced a major wave of bronchiolitis.”

“Without immunization, we probably would have faced a major wave of bronchiolitis.”

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Everyone has noticed this holiday season: trade Respiratory viruses It's grown, and we're not just talking about coronavirus, but also influenza, the common cold, and respiratory syncytial virus (RSV). This last virus is the main cause of BronchiolitisIt is an inflammation of the small airways, mainly affecting children under the age of two years. the doctor Tony SorianoThis year the virus has spread a lot, although it reached its peak a few weeks ago, explains the pediatrician and epidemiologist at the Val d'Hebron Hospital and member of the Board of Directors of the Catalan Pediatric Society. But the spread of the virus in this way did not result in many serious cases or hospitalizations, because immunization with nercevimab, a monoclonal antibody, seemed to prevent this. We talk about all this with the pediatrician, who also emphasizes the importance of influenza vaccination among young people.

What situation are we in at the moment regarding bronchiolitis?
—Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis, and the incidence of RSV in primary care is very high compared to last season. On the other hand, its impact on hospitalization was less compared to the years before the epidemic because the range of its youngest, especially those under six months of age, was protected by the prophylactic procedure of immunization with the monoclonal antibody nercevimab.

How has this impact on hospitals been reduced?
—We have preliminary data that hospital admissions are down 60% compared to last year in the same time period. Bronchiolitis is mainly associated with the first episode of respiratory syncytial virus infection and generally occurs in children under six months of age. This has been avoided by measuring a monoclonal antibody, which prevents the entry of respiratory syncytial virus into the respiratory cell and avoids this consequence in bronchodilator effect. Without immunization, we would have faced a massive epidemic of respiratory syncytial virus and bronchiolitis, which would have overwhelmed the hospital system. There was income, but he needed less support.

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But the spread of the virus was high.
Vaccination with this monoclonal antibody does not prevent the spread of the virus, but it prevents it from replicating, affecting the bronchioles and causing serious illness. He came out to New England this week [Journal of Medicine] As a result of the last clinical trial conducted on this antibody, a decrease of more than 80% was observed in the cases that received it.

Why did the virus spread more?
We have returned to normal, which is not a superior transition to what we had in some seasons before the pandemic. We see that influenza A is increasing a lot, we are at a moderate level of infection, and here we also have a measure that has started this season: vaccinating children between six months and five years of age, who can also end up in hospital. There are seasons when the strain of influenza virus circulating and the vaccine don't match, but this year they do. Therefore, vaccinated people are likely to be very protected from dangerous formations.

But it has not reached VRS-like coverage yet.
— Currently, influenza vaccination coverage in this age group does not reach 25%. In contrast, RSV antibody coverage is greater than 84%. We now have a very important tool in primary care, which is the ability to make a rapid diagnosis. Before, your pediatrician would tell you, “This is a virus,” in the face of a viral condition that you didn't know the cause of. Now we have rapid methods that allow us to diagnose the virus. There are bacteria associated with these infections, especially in the case of influenza and respiratory syncytial virus, and this is useful to be more vigilant in the following months or weeks.

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What explains the return to pre-Covid-style transmission data?
-In the winter, more viruses spread due to factors such as the cold or the fact that we stay at home more. There are weather and social factors, and this is not out of the ordinary. We have returned to normal and this is good news. We have passed the tsunami of epidemics that disturbed the epidemiology of respiratory viruses, and we usually do not remember what happened at this time. We must learn how to protect ourselves and live with viruses, but some do more harm than others.

And Covid was added.
– Yes, and coronavirus vaccination for the elderly and those at risk must be ongoing and continuous. The influenza virus or RSV is one of the most harmful viruses, so preventive measures must be taken. With other viruses, we probably don't need a preventive measure to protect ourselves because in this way we stimulate our immune system, it's a way to generate a strong defense against re-infection. Some serve us as triggers and reminders for our immune memory, and others are better left unseen. But if we see them, we better have an extra layer of protection.

Returning exclusively to bronchiolitis, how can we distinguish between symptoms?
—First you need to know that 70% of RSV infections are upper respiratory infections, and they do not always cause bronchiolitis. There are a lot of respiratory syncytial viruses circulating, but for young children, who end up with severe bronchiolitis, immunization protects them. Respiratory syncytial virus can mainly cause cough, phlegm and fever when it remains in a cold, but if there is difficulty breathing then we should ring alarm bells. This means that the virus affects the bronchioles and that the child, because he does not have the lung capacity of an adult, could fall into respiratory failure. We have to consult a doctor when there are difficulties in breathing, when he stops eating, he is very careless, he vomits… but most of the time he still has nasal congestion and a cough that disappears immediately.

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What do you recommend to prevent assignment?
– Respiratory syncytial virus is transmitted not only by droplets that we emit when we talk, cough or sing, but also by indirect contact: if we lie on a table, we run our hand over it and put it in our mouth. Good personal hygiene, surface hygiene and ventilation are essential, but above all we should avoid contact with vulnerable people if we feel cold and sick. For older adults, RSV is not as important as influenza, but it may eventually lead to decompensated conditions such as chronic obstructive pulmonary disease and decreased lung capacity.

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