The number of cases of bronchiolitis who are registering in the Argentina Health systems are on alert. The disease usually affects mainly children under two years of age, but also older adults. The causant? He respiratory syncytial virus (VSR), whose transmission during the covid-19 pandemic it had been self-limited due to non-pharmacological prevention measures, such as the use of masks, social distance, isolation and the emphasis placed on ventilating closed environments (schools, public transport, places with constant movement of people).
Now that the worst part of the pandemic has eased, specialists are referring to the existence of a tripledemia: influenza, pictures caused by RSV such as bronchiolitis, and Covid-19. “Bronchiolitis is a respiratory condition that affects girls and boys under the age of two, and especially babies under the age of six months,” he explains. Gabriela Bauer neonatologist and president of the Board of Directors of the Pedro Garrahan Pediatric Hospital-. It is a self-limited disease, that is, it resolves in seven to 10 days. It causes obstruction of the small airways, called bronchioles. It causes respiratory distress, difficulty eating and falling asleep, among other problems.”
Bauer adds: “After the pandemic, the RSV outbreak presents itself differently than usual. He beak which used to arrive in mid-June, around epidemiological week 24, he was ahead to week 20, between May 14 and 20. This had happened in the Northern HemisphereThat is why we were, in some way, prepared for this situation. If we take the period from the end of April to the end of May, before the pandemic, in 2019 we had around 400 hospitalizations by respiratory syncytial virus. This year, we have around 1,700 hospitalizations, that is, 3.5 times more”.
The biggest problem is that, if you look at the time of the year that Argentina is going through, the coldest months of winter have yet to pass. From the Ministry of Health of the province of Buenos Aires They agree with Bauer, and warn that “this phenomenon of increased cases, early season and their virulence, could be seen in the northern hemisphere in its last winter. here it We started detecting at the end of April, beginning of May and for that the system was prepared ”, they explain.
The health minister of that district, Nicholas Kreplakexplain to NEWS that “the current situation of the peak of bronchiolitis cases is serious, because it comes with many cases and with an advance of several weeks. It is a situation that is happening throughout the territory, it is not something that occurs only in the Province of Buenos Aires We can see that for the epidemiological week 19, which corresponds to the second week of May, the cases are already above the first week of July of the year 2022, that is, the 27th. What does this imply? In epidemiological terms, in the week 27 temperatures are considerably lower.”
health prevention
This warned the National Institute of Communicable Diseases of South Africa last February: “The RSV season began in week 6 of 2023, which began on February 6, 2023. Among children under 5 years of age, the RSV detection rate is currently at moderate levels and continues to increase significantly. Compared to the median RSV circulation between 2014 and 2019, the RSV detection rate appears to be increasing more sharply in recent weeks.”
In March, reports made in the USA also alerted to an unusual number of cases of RSV bronchiolitis: “On average, Centers for Disease Control (CDC) report that there have been approximately 43.4 RSV-associated hospitalizations per 100,000 people thus far in the 2022-2023 season. Typically, the majority of RSV-associated hospitalizations are in children younger than 1 year of age, according to previous studies. It is too early to say that the RSV transmission season is closed for the arrival of the warm seasons, the weekly case totals reported by the CDC signify a significant jump in the first cases compared to previous years.
Was anything done to anticipate a situation with so many signs? Since Kreplak’s management, they affirm that contingency scholarships were increased to add more personnel, the health promoters of the territory were redirected to hospital guards, spaces were adapted and beds were added and Emergency Operations Centers were formed district and hospital as the case may be to form situation rooms at the regional level. The objective is to have information in real time to be able to attend, refer and avoid delays in care.
Meanwhile the alarm grows. The fear is that the hospital guards will reach their limit. Kreplak goes around the media explaining that the outbreak can last another six to eight weeks. Therefore, prevention is essential.
what to watch
“The symptoms from RSV infection usually appear within four to six days, and there is no specific treatmentalthough there are antivirals and a monoclonal antibody is also used”, describes Daniela Hozborexpert in vaccinology, researcher at the CONICET and Konex Award 2023. “The virus can cause more serious infections such as bronchiolitis, an inflammation of the small airways of the lung and also pneumoniaparticularly in children under one year of age”, he adds.
“It usually starts as a cold that lasts two or three days. Then coughing and shortness of breath increase. In some cases it can cause fever, but it is not the predominant symptom. The warning signs are: respiratory distress, complications to breastfeed or feed, sinking of the chest or use of the muscles of the neck or belly to breathe”, Bauer points out.
Hozbor clarifies what is the higher risk population: “The youngest children, those under three months, premature babies and those who have chronic health problems such as heart disease, chronic lung diseases or who are compromised in the development of immunity have a higher risk of presenting more serious forms of the disease . You have to be vigilant and go to the doctor at the slightest respiratory symptom.
Is there a way to prevent infections, at times of rising cases? “To prevent respiratory diseases, it is necessary to reinforce care, carry out pediatric controls and vaccinate children between six and 24 months of age against influenza. It is also important to ventilate the environments, because the cold does not make you sick. What is sick is the overcrowding. Ventilate, clean surfaces and do not send children to the garden when they are sick to reduce the circulation of people and viruses”, emphasizes Gabriela Bauer.
In addition, the experts agree, it is necessary to maintain breastfeeding, wash your hands more frequently, avoid crowding people, not smoke in closed spaces and always away from children and adolescents. “If adults or caregivers have respiratory symptoms, it is essential that they use a chinstrap,” emphasizes the Garrahan specialist.
Vaccines
The United States FDA (similar in functions to what our ANMAT is) approved the first vaccine a month ago that protects against respiratory syncytial virus and that is applied in a single dose to people 60 years and older. A recommendation for its use is still pending from the US Centers for Disease Control and Prevention’s Committee on Immunization Practices, which is meeting this month. Already at the end of March the vaccine (whose trade name is Arexvy) had obtained the recommendation of the EMA, the medicines agency of the European Union.
Although RSV is mostly linked to children under the age of two, It also affects older adults.. Especially those who have risk factors or diseases, such as lung disorders or weakened immune systems. Phase 3 clinical trials, which were conducted in approximately 25,000 older adults from 17 countries and were published in the specialized journal New England Journal of Medicine, show that the vaccine developed by the GSK laboratory is 83% effective in preventing lower respiratory tract disease caused by the virus. And 94% effective in preventing severe disease.
There is three other vaccines that are in the clinical trial stagesome for older adults and another one that could also be applied to pregnant women to protect newborn babies.
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