Unexpected flare of bronchiolitis in children

“Since May 15 there has been a significant increase in cases of bronchiolitis. There were already some sporadic in March, but since mid-May they have increased a lot and the most normal thing is that it continues to do so for at least the next eight weeks. “These are statements to the SER by Dr. Paula Vázquez, president of the Spanish Society of Pediatric Emergencies.

“Every day we are seeing how increase progressively throughout the Spanish territory, although there are differences by communities. There are many more cases, for example, in Catalonia and the Community of Madrid than in Andalusia or the Canary Islands, where they are still very specific. “

Theories of the rebound

Experts have several theories to explain this totally unexpected increase in bronchiolitis caused by the respiratory syncytial virus (RSV). Some point to the displacement theory. COVID-19 has occupied all space during the winter and has displaced the rest of the viruses including VRS. “The only virus that came with the coronavirus was the rhinovirus, what is the cold virus and it has been to begin to decrease the incidence of COVID in the last month when it has given way, it has allowed RSV and other viruses such as parainfluenza to take hold, adenovirus virus, bocavirus, etc. “

Another theory bets because this increase in cases is due to the fact that, with the low circulation of RSV in winter, older children in kindergartens have not acquired protective immunity, and now – although they are normally infected in a milder way – if they transmit it to their little brothers. Bronchiolitis is really serious, especially in babies under six months and, mainly, in under three months.

Relaxation of measures

The last hypothesis bases the emergence of this virus on a possible relaxation of protection measures: use of masks, hand washing, or social distancing.

The difference between a catarrhal picture and a bronchiolitis picture, says Dr. Vázquez, “is that the second presents respiratory distress. By definition, bronchiolitis is the first episode of respiratory distress presented by a child under 2 years of age. Generally it begins with a catarrhal picture and, after two or three days, fatigue appears when breathing, may have wheezing (wheezing in the chest), rhonchi in the chest and may eat poorly, have a fever but, the most of course, it’s that fatigue and that shortness of breath.

Concern in pediatricians

The bronchiolitis It is one of the pathologies that most worries pediatricians because it has a high rate of hospitalization. “Children who require admission are usually younger than three months, children with underlying disease, with previous heart disease, premature children or children with some pulmonary disease.”

Normally, these children at risk, especially premature infants or heart disease, are given, in the month of October before the epidemic begins, a monoclonal antibody to prevent disease or make it milder, “But last year as there was no circulation of RSV because this monoclonal antibody was not put on them. Now seeing that there is a rebound or epidemic outbreak, it will start to start again to avoid income in these pathologies “.

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