By Sophie Hardach September 14, 2021 Doctors were aware of RSV as a seasonal virus that emerged in winter, but in recent months in the northern hemisphere there has been a surprising increase in case.I
In early 2021, hospital staff for thThe Maimonides children in Brooklyn, New York, were beginning to feel some relief. Cases of Covid-19 in the city were on the decline. As a side effect of social distancing, wearing masks, and washing hands, they had also seen far fewer other viral infections, like the flu . But in March, an increasing number of coughing children and babies arrived at the hospital, some of them having trouble breathing.
They had been infected with RSV, short for respiratory syncytial virus, a common winter virus. which can cause lung problems. By this time of year, RSV cases should have been decreasing. Instead, they were skyrocketing .
In the months that followed, peaks in RSVs outside of the seasonits would disrupt summers in places as far away as southern United States , Switzerland , Japan and United Kingdom . The virus 's strange behavior appears to be a side effect of the Covid-19 micro pandemic, doctors say. Last year, lockdowns and hygiene measures suppressed the spread of the coronavirus, but also others virus like RSV . As a result, children did not have the opportunity to build immunity against them.
Once the measures were relaxed, the RSV found a large number of babies and children who may be infected, causing flare-ups at unexpected times. A previously fairly predictable bug has turned into one that could surprise hospitals and families at any time of the year. Non-seasonal epidemics have pushed services to their limits, putting families on alert , and showed how Covid-19 and related measures have reshaped the world.
For staff in the field, the experience has dramatic summer.
Respiratory syncytial virus (RSV) is a common single-stranded RNA virus that causes fusion of infected cells (Credit: BSIP / UIG /)
"Our intensive care unit (intensive care unit) was again overwhelmed, this time not by the Covid, but by another virus " recalls Rabia Agha, the director of pision of pediatric infectious diseases at the hospital for maimonid children. at the height of the epidemic in early April, the majority of those admitted to intensive care were vrs.
Around the world, the virus ravaged populations of young children who had been protected from infectious diseases for months and now suddenly exposed to it.
"It surprised us. We knew it was something to watch out for, but we didn't think it would be that much," says Christoph Berger, head of the infectious diseases and hospital epidemiology departmente at the Zurich University Children's Hospital. .
In his hospital, RSV cases typically peak in January and hover around zero during the summer months of June through August. This year there were no cases in winter. Instead, they started to increase sharply in June, then climbed to 183 infections in July, higher than in previous winter seasons.
"We were full, every bed was occupied, and it 'sa challenge, "Berger remembers of the height of the outbreak in July. His hospital had to transfer sick babies and children with RSV to other hospitals. There was still room. Several other Swiss hospitals have experienced the same.
RSV was a bigger problem for them than coronavirus during the summer in Switzerland. "We have had almost no cases of Covid during this period ", explainsShepherd. The few children who came to the hospital with the Covid recovered fairly quickly. "Those with RSV stayed longer, " he says.
An RSV infection in and of itself is not a cause for alarm. According to the Centers for Disease Control and Prevention , most children will have had one by the age of two. Most will experience it as a cold-like illness, with a runny nose and cough , and will recover on their own. But in some babies and young children, it can cause bronchiolitis , an inflammation of the lower parts of the lung. They may have difficulty breathing and feeding themselves.
About 1 to 2% of babies under 6 months of age with RSV should bere transported to hospital and receive a supplemental oxygen through a mask or tubes in the nose to help them recover. Some may also require a tube d ' food . With this support, most will get better within days.
Before the coronavirus pandemic, hospitals regularly prepared for RSV outbreaks before winter. The most at-ri Sk patients, such as premature babies and those with existing lung and heart problems, can be protected with the target palivizumab , a dose of antibodies that help fight the virus. The vaccine should be given every month during the months when the RSV is active, another reason why thePreparing for power surges is so crucial.
LChildren sickest with RSV can often be treated with oxygen and most improve within days (Credit:)
The pandemic has disrupted this seasonal rhythm and its role in the disease. usual development of immunity in children.
"With the measures we had for Covid, people weren't getting together, people weren't traveling, and people were very careful with masking and distancing " says Agha. "And that really helped keep Covid along with all the other viruses at bay. So a season of this RSV was completely missed. And if you skip a season then you're not producing antibodies against it, and mothers do not produce antibodies that can then be passed on to babies. "
As a result, these babies may then be particularly vulnerable to RSV when the world reopens. Data from different countries support this idea of immune deficiency due to a skipped season. "The largest relative increase in cases is in one-year-old children, who 'missed a season of RSV last fall / winter, " officials from Public Health England said in a report. e-mail to Hfrance.fr, describing the surges seen in parts of England during the summer there.
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A skipped season increases the number of sensitive babies and children because it includes those who were protected during the winter, because as well as those born since then. This can make viral outbreaks more powerful when they do eventually strike. In Tokyo, research has reported the largest annual increase in RSV cases since surveillance began in 2003. They suggest that the build-up of susceptible people during the pandemic may have contributed to the 'unusually large outbreak this year.
Other aspects of the new viral landscape are still unclear, such as why RSV increased after anti-Covid measures were relaxed, but not flu , which has remained fairly contained.RSV outbreaks out of season have also varied somewhat from country to country. Agha and her team in Brooklyn observed that their push was unusually severe, affecting a lot younger children than usual and sending a higher proportion to intensive care. But in Australia , by example, it affected an older age group than before. Berger says that the summer outbreaks in Switzerland had not been more severe than the typical winter outbreaks.
Children with health problems that expose them to the more at risk of contracting RSV may receive a protective injection of antibodies (Credit: Jeff Gritchen / Orange County Register /)
A big question is what this new model means for the months to A summer flare doesn't necessarily mean there won't be more cases when the weather turns cold. And in some areas, cases don't start to increase until now, in early fall.
"The VRS, and thebronchiolitis that it causes is definitely the key thing that children's hospitals are planning, waiting, starting to see and care for right now, "says Sophia Varadkar, assistant medical director and consultant pediatric neurologist. at the Great Ormond Street Hospital for Children in London.
In her hospital, cases have started to increase and she expects to see more in the coming weeks. of babies, RSV may be of greater concern than Covid-19, Varadkar says. "Covid for children, in general, was not a significant illness. It didn't make a lot of the kids really sick. RSV is a potentially more serious disease, [affecting] many more children, and we certainly know it can make these little babies sick, "she says.
With the reopening in schools, viruses, including RSV, will have more opportunities to spread. But adult behavior canbe even more crucial. In Switzerland, nurseries and day care centers remained open all winter and young children did not wear masks. Yet hardly any child got off with viral infections such as RSV and the flu that winter, likely because adult hygiene measures helped protect them.
"People always say that children infect adults, but if you think about it that wasn 't the case here at all, it was the other way around," Berger says. "When adults and older children wear masks, observe social distancing and wash their hands, we don't see the flu or RSV. And when they relax their measures, the virus circulates again, and more and more young children end up in the hospital. "
Even after the summer wave, his hospital remains on its feet. guards. "I have no idea how this will continue, and if this is all the case, or if we will see another vague in winter - i don't know. "
Washing hands, and keeping vulnerable babies away from people with runny noses and coughs, can promote the spread of the disease. infection. It can also smooth out the peak of an RSV outbreak, ensuring that hospitals have the capacity to care for every child who needs help.
"For most children will be a mild illness, they can be cured by their parents, they just need comfort, more frequent feedings, a quiet time, paracetamol if they have a temperature, and that 's all they need, "says Varadkar in London. But if the baby has difficulty breathing or sucking, or if the parents feel something is wrong , they should ask for help, she said.
At the Maimonides Children's Hospital in Brooklyn, the peak of the wave of RSV has passed. But Agha seesa broader lesson for hospitals adjusting to a post-Covid-19 world.
"What this has taught us is to be prepared " , said Agha. "These are not the same times as two years ago. Life has changed, the world has changed and these viruses evolve and behave in unexpected ways.
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