BUFFALO, NY – The demand from children’s hospitals across the country this month that the federal government officially declare a state of emergency in light of the increase in cases of respiratory syncytial virus (RSV) and influenza no didn’t surprise Oscar G. Gómez-Duarte, MD.
As Chief of the Division of Infectious Diseases in the Department of Pediatrics at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences and Director of the Pediatric Infectious Diseases Service at John R. Oishei Children’s Hospital, Gómez has witnessed firsthand the increase in the number of cases. both RSV and influenza, and the resulting increase in childhood hospitalizations.
In September, Oishei Children’s Hospital reported seeing more patients admitted to hospital with RSV than it had seen in the entire 2019-2020 respiratory season, as well as higher rates of flu infections, some requiring hospitalization.
Gómez says the surge so early in the season is unusual and particularly concerning because vaccination rates for COVID-19 and influenza among children are very low; cases could increase this winter, especially in unvaccinated children, in addition to the increase in RSV cases.
How would you characterize this season so far for RSV and influenza in children?
“What concerns us is not just the number of infections, but the severity of those infections leading to a high number of emergency room visits and hospitalizations. The spike in cases is putting pressure on hospitals across the country. This is a very dramatic increase from what we normally see, especially at this stage of the season. This year, we have seen a significant increase in cases and this even before the start of the winter season. We saw RSV cases peak in the summer of this year and then another peak was reported in October. This pattern of RSV infections is quite different from what we normally saw before the COVID-19 pandemic. »
How do you think COVID-19 influenced this increase in other respiratory viruses?
“It is very possible that this increase in respiratory viruses that we are currently seeing is linked to the dramatic changes in community behavior over the past two years due to the COVID-19 pandemic.
“These behaviors have significantly limited the normal exchange of viruses that people typically have through interactions with each other. This is especially true for young children, who exchange different viruses with each other at daycare, at school and at public gatherings.This exposure allows children to develop natural immunity to common respiratory viruses at a young age.
“For much of the pandemic, this exchange of viruses was not occurring and there was a gap in natural protective immunity. Now that children are once again attending daycare, school and other gatherings, exposure to these viruses to which they have not been exposed for the past two years has resulted in a high spike in infections and a number overwhelming number of emergency room visits and hospital admissions. . We are seeing increases, especially in RSV, and some of those cases are severe. »
What factors make children particularly susceptible to developing RSV?
“RSV tends to affect the very young, those under 2 years old. Infants most at risk are those born prematurely or who are immunocompromised.
Are these primarily children with underlying conditions who are hospitalized with RSV and/or influenza?
“We are seeing hospital admissions for RSV and/or influenza in previously healthy children with RSV who do not have comorbidities; but we also see it in children with underlying conditions, such as asthma, heart disease, neurological disorders, among other chronic conditions.
Do you see cases where a child is infected with two viruses at the same time?
“Yes, some children get what we call co-infections, where they are infected with more than one virus at a time. In some cases, a child is initially infected with the flu, begins to recover, and then contracts rhinovirus (a cold virus), RSV, or any other respiratory virus. These co-infections tend to be more serious than when the child has only one infection. Different viruses can attack different receptors and use different mechanisms to damage respiratory cells, which can make the disease worse and, in some cases, may require the child to be admitted to the intensive care unit for treatment.
What types of treatments are available for children hospitalized with RSV or influenza?
“Although we have specific treatments for influenza and COVID-19, there is no specific treatment for RSV or other respiratory viruses. The primary management of respiratory infections is supportive care, such as hydration, fever control, and supplemental oxygen if needed. When the child’s breathing is very compromised, we will put the child on oxygen and, depending on the severity of the respiratory impairment, he may even require more intense measures such as mechanical ventilation.
Can children be vaccinated against RSV?
“Passive immunity in the form of monoclonal antibodies is available to premature babies during RSV season. This FDA-approved monoclonal antibody named palivizumab has the ability to block RSV and decrease the severity of RSV infections.
“There is no approved active vaccine against RSV in the United States for children or adults. There is, however, evidence that pregnant women pass antibodies against RSV to their babies. It has recently been reported that pregnant mothers who received an experimental RSV vaccine were passing these antibodies on to their babies and that these infants were less at risk of developing RSV infections.These developments are very good news for the future, so that maybe vaccinated pregnant women can transmit this protection to their babies.
How worried are you that in addition to RSV and flu, children may start getting sick from COVID-19 this winter?
“COVID-19 will stay with us like RSV, influenza and any other respiratory virus. As a result, we expect to continue to have COVID-19 infections in children, as well as RSV and influenza. Current variants of the COVID-19 virus are becoming resistant to preventive measures such as monoclonal antibodies, although vaccines remain protective.
“It is concerning that the vaccination coverage against COVID-19 and the influenza vaccine among children in our community is low. Nationally, only 4% of children under 5 and less than a third of children ages 5-11 have received a series of COVID vaccines. There is strong evidence that vaccines prevent infection, prevent hospitalizations and prevent deaths from COVID-19.
What should parents pay attention to?
“The first and most important way to protect children is to make sure they get vaccinated against diseases for which vaccines are available, including influenza and COVID-19.
“If a child gets a respiratory infection, they will likely have upper respiratory symptoms, such as fever, sore throat, cough and stuffy nose.
“Parents should be alert for the most concerning symptoms, such as shortness of breath. If a parent notices that the child’s breathing is labored and labored, this is an emergency situation that requires attention. immediate, such as taking the child to the nearest emergency room or calling 911.
“Most respiratory infections in children, however, are self-limiting and not associated with shortness of breath. In most cases, a call to the pediatrician for advice is the best course of action.
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