RSV is responsible for 1 in 50 deaths in children under 5, study estimates

RSV is responsible for 1 in 50 deaths in children under 5, study estimates



CNN

A new study estimates that 1 in 50 deaths of otherwise healthy children under the age of 5 worldwide is due to a common virus currently on the rise in the US: respiratory syncytial virus, or RSV. And in high-income countries, 1 in 56 healthy, full-term babies will be hospitalized with RSV in the first year of life, researchers estimate.

The virus is known to be particularly dangerous for premature and medically sensitive babies, but it causes a “substantial burden of disease in infants worldwide,” wrote the authors of the study, published Thursday in the journal Lancet Respiratory Medicine.

Other studies have looked at the number of children with pre-existing conditions who are hospitalized with RSV, but the new study is one of the first to look at the numbers in otherwise healthy children.

“This is the lowest-risk baby to be hospitalized for this, so really the numbers are a lot higher than I think some people would assume,” said study co-author Dr. Louis Bont, professor of pediatric infectious diseases at Wilhelmina Children’s Hospital in the University School of Medicine. the center of Utrecht in the Netherlands. Bont is also the founder and president of the ReSViNET Foundation, a non-profit organization dedicated to reducing the global burden of RSV infection.

The estimates are based on a study that looked at the number of RSV cases in 9,154 infants born between July 2017 and April 2020 who were followed during the first year of life. The babies received care in health centers across Europe.

About 1 in 1,000 children in the study were placed in the intensive care unit to be helped to breathe using a mechanical ventilator. This care is vital: In parts of the world where there is a lack of hospital care, the risk of death is significant.

“The vast majority of RSV deaths occur in developing countries,” Bont said. “In the developed world, mortality is really rare, and if it does happen, it is practically only in those who have serious co-morbidities. But most places in the world don’t have an intensive care unit.”

Globally, RSV is the second leading cause of death during the first year of a child’s life, after malaria. Between 100,000 and 200,000 babies die from the virus each year, Bont said.

There are fewer deaths from RSV in high-income countries, but the virus still causes significant morbidity, and even hospitalization can have serious consequences, said Dr. Kristina Deeter, chief of pediatrics at the University of Nevada, Reno and a pediatric intensive care specialist. care at Pediatrix Medical Group.

“Whether it’s just traumatic psychosocial, emotional issues after hospitalization, or even more vulnerable lungs — you can develop asthma later, for example, if you had a really bad infection when you were young — it can permanently damage your lungs,” said Deeter, who was not included in the new study. “It’s still an important virus in our world and something we’re really focused on. It’s kind of the bread and butter of pediatric intensive care.”

Healthcare providers know that November through March is the traditional “virus season” and must plan accordingly for RSV and other respiratory problems.

dr. Nicholas Holmes, senior vice president and chief operating officer at Rady Children’s Hospital in San Diego, said officials there always have enough respiratory therapists and doctors to manage the influx of cases.

Even then, at the largest pediatric hospital on the West Coast, officials had to get creative to keep up with the patient load, Holmes said.

“One thing we’ve implemented recently to help is to have a lot of clinicians who are licensed nurses or therapists, or physicians like myself, who are in non-clinical roles in the organization. So we are re-engaging that licensed staff to help support and bridge that gap in supporting our nurses, physicians who are in the direct line of patient care,” Holmes said.

Holmes said Wednesday that through the hospital’s Helping Hands program, he spent an hour and a half in the emergency room instead of doing his normal job. He checked on families and patients, handing out blankets and fruit. This gave him the opportunity to observe problems and alert the nurses if the child was getting sicker and needed medical attention right away.

“It allows the medical team in the triage area to really focus on the sickest of the sick kids,” Holmes said.

While there is no specific treatment for RSV in healthy babies, recent developments in vaccines and therapies mean help may be on the way for busy hospitals.

There is only one treatment with monoclonal antibodies for patients who have pre-existing diseases or were born prematurely. It’s been available since 1998 and has made a significant difference, Deeter said.

“When premature babies started receiving it, the numbers dropped dramatically,” she said. “It’s incredibly rare at this point that we put a baby on a respirator for RSV. This tiny, fragile group is so well protected by these injections; however, we still receive thousands of babies who have not received these injections and who still need supportive care, and are often managed without a respiratory support system.”

There are things parents of infants can do to prevent RSV, said Dr. Priya Soni, assistant professor of pediatric infectious diseases at Cedars Sinai Medical Center. These are simple behaviors that everyone knows from the Covid-19 pandemic: wash your hands thoroughly, stay home if you’re sick and keep surfaces clean.

“The virus is a little more resistant on hard surfaces, so really cleaning those surfaces and washing your hands goes a long way against RSV, as does limiting a child’s exposure to infected respiratory secretions and droplets in general,” said Soni, who was involved in the new research.

The study’s findings on the number of children who get RSV in the first months of life show how important it will be to have an immunization strategy for pregnant women, she said.

“Whatever we can do to bridge that gap for those young infants in the first six months of life who may be really prone to RSV infection will help,” Soni said.

In the US, four RSV vaccines may be nearing FDA review. More than ten of them are undergoing trials in the world. Preventive treatment of lower respiratory tract infections caused by RSV has been given the green light by the European Commission last week.

This development can change the situation, experts say.

“Every pediatrician I know has always worked very, very hard during Christmas. We are always overwhelmed with RSV patients every year,” Bont said. “This year or next year might be the last time we actually see that, because it could really prevent most of the severe infections.”

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