RSV epidemic. Where did it come from, what is the risk, how to protect children? Important advice from a pediatrician

The RS virus has always been dangerous to the youngest children. Currently, however, the pathogen is sweeping through the world and Poland with doubled force, also infecting older children. – This means for us the overlap of the fourth wave of COVID-19 with the earlier wave of RSV and the starting flu – admits the infectious and pediatrician Dr. Lidia Stopyra. What led to this? What happens to a baby when it becomes infected? How to prevent this from happening? Finally, when should parents consider not sending a healthy child to a nursery or kindergarten? The specialist explained in an interview with Medonetm.

1. The RS virus started attacking children in late fall and ended in spring with a peak in January-February. Currently, the wave of RSV infections has come earlier and has affected not one, but two years of children, the number of hospitalizations is increasing
2. Dr. Stopyra admits that “statistically speaking, nowadays infectious diseases units have more children with the RS virus under oxygen than those with SARS-CoV-2, although we have a fourth wave.” – It has come to the fact that we lack beds intended for the smallest children – says the specialist
3. The doctor emphasizes that most often the pathogen is brought home by a child from kindergarten, nursery or school. Hence the advice to refrain from sending the elder to kindergarten when there are two children at home, including a few weeks old.
4. This does not exhaust the tools to protect your baby from infection. What should a parent remember? And when will the situation start to improve?
5. You can find more important ones on the Onet homepage.

Monika Mikołajska / Medonet: The RS virus has been with us “always”. Moreover, it is known that infection with this pathogen is common – in about 95 percent. children in the second year of life have antibodies indicating contact with the virus. Meanwhile, we currently have an exceptionally high RSV wave. Has the virus become more dangerous, or are the children weaker? Does this have anything to do with the COVID-19 pandemic?

Dr. Lidia Stopyra, specialist in infectious diseases and paediatrics: It can be said that the wave of RSV infections that we are currently observing is a consequence of what COVID-19 has brought, namely lockdowns. Because in fact, RS virus epidemics happened every year, usually between November and February, and many children stayed in hospitals for that reason. Last year turned out to be an exception. The lockdown, introduced at the beginning of the COVID-19 epidemic, also meant that schools, kindergartens, nurseries were closed, everyone else was at home. Consequently, we had neither an influenza epidemic nor the RS virus.

1. The RS virus attacks with doubled force. “Something like that has never happened before”

What you need to remember is that the first time you get RSV is the most severe, then the course of the infection is much milder. Last year, for the reasons already mentioned, the children did not get sick. Now the epidemic has returned and it is doubled. Not one, but two years were infected with RS. That is, children who are now several months old and first came into contact with RSV fell ill, as well as those who were born almost two years ago, but only now came into contact with the pathogen.

Another wave of COVID-19 is added to all of this …

This is. We admit more and more children to the hospital and we have to differentiate whether the infection was caused by SARS-CoV-2 or RSV. Moreover, the flu starts too. Doctors fear that there will again be a situation where, due to the need to create more “covid beds”, scheduled hospital admissions will have to be restricted. We cannot do that in paediatrics. It is impossible not to admit a toddler with RSV or flu-related shortness of breath. This, however, means for us an overlap of the fourth wave of COVID-19 with the earlier RSV wave and the flu starting. We must admit all patients. And we have to reconcile it all.

Dr. Magdalena Okarska-Napierała from the Department of Paediatrics with the Observation Department of the Medical University of Warsaw even says that currently it is not COVID-19 that is our greatest concern, but the wave of RSV cases. The specialist says that the epidemic is alarming … According to your observations, it is so bad?

I agree with this opinion because most children, even the youngest ones, go through a mild process of COVID-19. Meanwhile, the first RSV disease is bronchiolitis / pneumonia accompanied by dyspnea. Statistically speaking, today infectious diseases departments have more children with the RS virus under oxygen than with SARS-CoV-2, although we have a fourth wave.

It has come to the point that we lack cots for the smallest children (cribs with rungs), and we cannot put such a patient in a “normal” bed. Such a situation could lead to the fact that the statistics looked good, because there were free beds. However, the reality turned out to be different and we had to bring more beds to the ward to have a place to put our babies.

Why is RS virus so dangerous for kids? What happens to such a patient?

The child has a specific anatomical structure and his airways are quite narrow. Meanwhile, the RS virus attacks the bronchioles, which are located directly next to the alveolus. Swelling following contact with the pathogen causes the bronchioles to clog, preventing oxygen from reaching the alveolus. The baby is just suffocating. If your toddler does not reach the hospital on time, it may even end in his death. It is comforting that we do not observe complications after suffering from RSV infection.

We should remember that we do not have a drug for RSV and there is no vaccine. Premature infants, who have a very high mortality rate from such an infection, receive immunoglobulins. But that’s actually the only protection we can provide.

What about adults and older children? There are signs that entire families are sick with RSV.

Our observations show that the pathogen most often brings home a child from kindergarten or school. If an infection does occur, the older child and adult will go through it like a cold, greater or less, depending on immunity. The worst thing is if a small child in the family is infected. The most severe course is observed in babies under six months of age. Therefore, their protection is crucial.

A few days ago in “Onet Rano.” You advised families with a preschooler and a toddler who is a few weeks old to keep the older child at home. How long should such a break last?

In such a situation, it is worth refraining from sending the child to kindergarten for about three to four weeks. After this time, we expect the RSV epidemic to fade away. It is worth taking such a step not only to protect the baby from infection. We should also remember about the difficult situation in hospitals. I encourage you to do so, the more that the mother looks after the youngest at home anyway.

It is different if, for example, the youngest child in the family is a 4-year-old. Then there is no threat of severe RS infection and hospitalization. So it makes no sense to give up kindergarten. Much less close these outlets because of RSV. However, it is very important not to send children to kindergarten with the infection, but also in a situation where it only seems “unclear”. If the kindergarten teachers notice that the toddler is starting to feel unwell, they should call the parents immediately.

How else to protect your baby from RSV? It is known that the source of infection can be not only older siblings, but also other family members.

We know from our experience that siblings are the most important link. What is worth remembering is not to take the youngest child to places where there are many people, where masks are not worn, do not travel by public transport if we do not have to, and if we do, remember about the mask. Protecting a tiny child is not complicated and certainly easier than a busy preschooler.

What first symptoms should light up the warning light that an RSV infection may have been present? What to pay attention to?

Most often it starts with a slight cough and runny nose. A slight fever may appear, but this is not always the case. Later, however, breathing difficulties begin, and this is a point that must not be overlooked. The child starts to accelerate breathing, you can see that he is breathing with effort – it can be visible, for example, during a meal: the toddler stops eating, tries to gasp, gasps, gasps. It may also be the case that we hear sounds in the chest when cuddling with the baby. In such a situation, you must immediately make an appointment for a quick consultation with a doctor or go straight to the hospital.

You mentioned the doctor that the RSV epidemic should begin to subside in about a month. But we still have COVID-19, flu season is about to begin. What scenario do you envision?

In fact, in about four weeks, the RSV epidemic should start to improve. However, I am afraid of influenza – the number of cases will probably increase exponentially. We already have cases, and there are still not enough vaccines. Additionally, we have an increase in COVID-19 cases. As for children, the difficult infection situation will probably last until March. Until then, there will be exchange of RSV, influenza, SARS-CoV-2, noroviruses, rotaviruses, adenoviruses …

Can we do something about this?

The most important thing is not to contact us when we are sick. We stay at home from the very beginning. Our mentality is sometimes such that even in the event of a fever, we go to work or send the child to kindergarten. Meanwhile, the greatest contagiousness is precisely at the beginning of the infection. To this, let’s join the still valid, though somewhat forgotten, DDM rules – distance, disinfection, mask. Remember that masks prevent not only the transmission of the coronavirus, but also other pathogens, and even more so. Last year, when we followed the sanitary regime, there was no RSV, no flu, but the COVID-19 waves were.

You may be interested in:

1. The fourth wave in Poland. What restrictions must be introduced? Doctors: the worst scenario comes true
2. The fourth wave is growing stronger, but fewer Poles want to be vaccinated. Why? [POLL]
3. Prof. Pyrć: If a new mutation does not emerge, the pandemic will be under control by spring

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