Hospitalization due to respiratory syncytial virus (RSV) is being higher than in pre-pandemic seasons. There are 11 European countries that have seen infections increase since October, with Spain in one of the leading places. This is what the European Center for Disease Control warns: the high number of admissions is generating tension in health systems. And the peak of cases has not yet been reached.
“We do not know very well what we are facing, if it is an early sprint or a plateau,” he muses. Pedro Jesus Alcala Minagorre, president of the Spanish Society of Internal Hospital Pediatrics (Sepih). “We don’t know what will happen at Christmas [cuando el VRS suele alcanzar su pico] but many hospitals are already preparing contingency plans.”
According to the latest report from the National Epidemiological Surveillance Network, the incidence of the virus in primary care is 75.7 cases per 100,000 inhabitants in the last week, but it skyrockets in children under 5 years of age: 945.7 patients. The next most affected group are children between 5 and 14 years of age, with an incidence of 195 cases per week.
[Los hospitales, ante la peor ola de bronquiolitis que se recuerda: “Hay más niños que nunca y más graves”]
In the hospital, positivity for the virus has risen to 31.3%, while so far this season (that is, since mid-October) it is 20.2%, higher than that of the flu and Covid. In children between 0 and 4 years old, 79.4 admissions per 100,000 inhabitants have been reported.
Although 90% of bronchiolitis – respiratory infections in infants, mainly caused by RSV – are not amenable to hospital admission, the intensity of the current wave is putting pediatric hospitalization units in trouble.
“The figures are well above what we have seen to date, even exceeding those of the harshest winters“, acknowledges the pediatrician. And this taking into account that the child population has decreased in Spain in recent years. “Without wanting to give an apocalyptic image, we are very committed at the level of assistance.”
However, guessing an occupation figure is more complicated than it seems, since there are no national records. Emergency pediatricians warn of a 40% increase compared to pre-pandemic years, but Alcalá Minagorre points out that in his hospital, San Juan de Alicante, it is even higher.
“We have not had to suspend surgeries, but we did group them,” he points out. “But in other centers they have had problems and have had to suspend them.” It is not just about occupation: in a vulnerable population such as infants or children with chronic diseases, it is crucial to avoid infections acquired within the hospital environment.
“Children must be separated: bronchiolitis with bronchiolitis, flu with flu, etc. to avoid cross infection. This blocks beds, blocks procedures and conditions that the programmed activity is altered”. Thus, children who are admitted to undergo a test or intervention and are expected to spend time on the floor are reorganized.
[La carrera por la vacuna para salvar de la muerte a 100.000 niños al año]
There are three classes of children who are being admitted to hospitals in the midst of a wave of respiratory infections caused by RSV. Infants, that is, those experiencing bronchiolitis itself, are the most common profile. However, they are also seeing a fair number of cases of healthy older children who have been hit hard by the disease, and infants with chronic conditions likely to be made worse by infection.
The latter, comments the president of Sepih, usually come in greater numbers a few weeks after the former. Many times they are cared for at home and an infection forces them to be admitted. “They are the most delicate and the ones with the longest admissions.”
Although the average stay is one week, the pediatrician warns that it is “a very unreal photo”. Cases without special concerns can be at home 48 or 72 hours later, “and intubated children can spend two or three weeks in the ICU and then enter the ward.”
The usual treatment is supportive: provide oxygen and maintain an adequate nutritional and hydration level. There is nothing to fear in the face of shortages of amoxicillin: it is an antibiotic, aimed at infections of bacterial origin, while RSV is, as its name suggests, a virus.
Alcalá Minagorre plays it down: “Infections are treated, not avoided. Some complications of bronchiolitis are treated with antibiotics, but the basis is supportive treatment.”
VRS is not new. Before the pandemic, it collapsed the pediatric units of hospitals every winter, between the end of December and February, and, globally, it is the cause of 1% of infant mortality: about 100,000 children annually.
However, there is no specific treatment beyond support. There are two monoclonal antibodies that are administered intravenously and offered preventively in children with chronic diseases.. There are no approved vaccines at the moment, although several candidates are in the last phase of clinical trials. If everything goes well, they could be available for the next season.
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