The epidemic season of respiratory syncytial virus (RSV) is an old torment in Spanish hospitals. Stressed pediatric floors, postponed surgeries and crowded ICUs are the usual trend when this infection, the main cause of bronchiolitis, reached the respiratory tracts of the little ones every year. At the threshold of key weeks, different scientific associations and hospitals are optimistic. Since October, the communities have been immunizing, for the first time, those born on or after April 1, and the scenario at this moment has nothing to do with that of 2022 around the same dates.
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If in the last week of November of last year at the Sant Joan de Déu Pediatric Hospital, a reference in Catalonia, the pediatric intensive care beds were dedicated almost exclusively to RSV, sources from the center assure that, at the threshold of the time Of higher incidence, immunization has been noted in the relief of these spaces. “There are fewer cases of children under six months old, especially due to bronchiolitis, thanks to vaccination,” they indicate.
“It is still early, but where we have started with the antibody at the beginning of October, admissions are occurring in more than six months,” explains the coordinator of the Vaccine Advisory Committee of the Spanish Pediatric Association, Francisco Álvarez. In September, the Vaccine Presentation of the Ministry of Health recommended that communities administer the monoclonal antibody to babies under that age. nirsevi food. Although it has been assimilated with a vaccine, instead of causing the body itself to generate antibodies, this drug is injected directly to generate protection for babies.
The general indication was to begin vaccinating newborns from April 1 at the beginning of the season of greatest circulation of respiratory viruses, in October, and newborns until March 31. With this, the population under six months of age is covered, in whom the virus has a greater impact and who usually present more serious symptoms of bronchiolitis, which, furthermore, has no treatment. In fact, in Spain it is estimated that one in every 56 healthy babies is admitted during the first 12 months of life for this reason.
“Excellent” coverage data
According to the information collected by the Spanish Association of Pediatrics, With data from Andalusia, Murcia, Valencia and Galicia, immunization coverage against this virus is around 90%. In Asturias, according to data from the Ministry of Health, vaccination has reached 98.7% of babies. In Madrid, the rate is “quite high.” In the absence of coverage data, 26,000 doses have been given and, although the Department of Health clarifies that it is too early to make conjectures, the data for 2023 are notably better than those for 2022. According to the latest epidemiological report, while the incidence of one to four years old remains the same, that of those under one year old has fallen by half. From other communities they say that if there is no news of tensions in the hospitals it is because the measure works.
Ana Grande Tejada is second vice president of the Spanish Association of Vaccinology and a pediatrician at a hospital in Extremadura. “Here the doses arrived on October 30 and immunization began that same week. The impact on hospitalizations is being very important: infants under six months are not admitted for RSV and, of course, they are not admitted to the ICU even with serious conditions,” she explains. The scenario is totally different from other years and, although the evolution of the incidence will have to be monitored, other seasons recorded “seven or eight new admissions a day.”
According to the Acute Respiratory Infection Sentinel Surveillance System of the Carlos III Health Institute, Last week there were 81.5 cases of hospitalizations in children under one year old due to RSV per 100,000 inhabitants and around 30 cases among children from one to four years old. The same week in 2022 There were 105 cases between both groups, more in any range.
Less income for babies, more for those over two years old
Last season was already particular, due to the coincidence of three respiratory viruses, RSV itself, the flu and covid-19. In addition, high temperatures can influence acute respiratory infections to appear at a later time. However, in a comparison of non-epidemic seasons by the Spanish Society of Pediatric Emergencies (SEUP) it has been observed that, despite the fact that the overall admission rate of emergency patients remains the same, “the number of bronchiolitis seen per day is lower and the number of admissions for bronchiolitis and RSV-positive bronchiolitis is also lower,” explains its president, Paula Vázquez.
If there are fewer admissions for bronchiolitis, why do overall hospitalizations remain the same? The answer lies in the ecological niche. “The peak is similar because the virus has moved to older children. Since there is no room for the little ones, because they are immunized, they ‘look for’ their two or three-year-old brother,” explains Vázquez. In any case, what these patients present is not the bronchiolitis that affects the little ones, but rather bronchospasm, which usually has a favorable evolution, fewer complications and fewer days of hospitalization.
While waiting for the peak season of the virus, the experts consulted venture to predict a calmer winter. At least, in line with what has already been seen in France, the United Kingdom and Germany. In May, the European Society for Paediatric Infectious Disease presented the preliminary results of a study that analyzed the impact of nirsevimad on hospitalizations of healthy children under one year of age in these countries. The data were really encouraging: the research showed that the income of immunized children was reduced by 58% compared to those who did not receive the antibody.
The definitive data left by this season and the new advances will make a new evaluation of the situation necessary. “When we can compare the endemic seasons we will have very interesting data. There we will see if nirsevimad is effective, which clearly it will be, but we still need to go further and expand it to those older children, who are entering,” says Vázquez. In addition, this December 1, the effective marketing of Abrysvo, a new vaccine against RSV for the passive protection of infants. That is, for maternal immunization during pregnancy, which opens a new window. “It will have to be Public Health that decides,” says Álvarez.
“Regular” flu coverage
According to the available data, the AEP considers that immunization coverage against RSV is “excellent”, but Spain is weak in flu. This year, Health has included this vaccine for the first time for children between 6 and 59 months (almost five years), but the result, for the moment, is “regular.” In Andalusia it reached 32%; in Galicia, 40%; in Murcia, 42.7%; and in Madrid it did not even reach 10%.
“The population considers the flu to be a banal disease, because they confuse it with a cold, but in the case of children under five years of age it is a significant cause of hospitalization and has associated complications, such as a higher incidence of otitis, pneumonia and meningitis,” explains Grande Tejada.
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