RSV is responsible for 1 in 50 deaths in children under 5, study estimates
A new study estimates that 1 in 50 deaths of otherwise healthy children under the age of 5 worldwide is caused by a common virus currently on the rise in the U.S.: respiratory syncytial virus, or RSV. And in high-income countries, 1 in 56 babies born on time and healthy will be hospitalized with RSV in the first year of life, researchers estimate.
The virus is known to be particularly dangerous to premature and medically fragile 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 much higher than I think some people would assume,” said study co-author Dr. Louis Bont, Professor of Pediatric Infectious Diseases at the Wilhelmina Children’s Hospital at the University Medical Center Utrecht in the Netherlands. Bont is also the founder 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 receive help breathing from 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’s practically only in those who have severe comorbidities. But most places in the world don’t have an intensive care unit.”
Globally, RSV is the second leading cause of death in 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 Kristina Deeter, Ph.D., chair of pediatrics at the University of Nevada, Reno and a pediatric critical care specialist. 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,” Deeter said. who was not included in the new study. “It’s still an important virus in our world and something we’re really focusing on. It’s kind of the bread and butter of pediatric intensive care.”
Healthcare professionals 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 always make sure there are enough respiratory therapists and doctors to handle 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 number of patients, 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 did reengaging that licensed staff to help support and bridge that gap to support 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, distributed blankets and fruit. This gave him a chance to keep an eye out for problems and alert the nurses if the child became sicker and needed immediate medical attention.
“This allows the medical team in the triage area to really focus on the sickest of the sick children,” Holmes said.
Although 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 conditions or who were born prematurely. It’s been available since 1998 and has made a significant difference, Deeter said.
“When premature babies started receiving it, the number dropped dramatically,” she said. “It’s incredibly rare at this point to put a baby on a ventilator for RSV. This small, fragile group is so well protected by those injections; however, there are still thousands of babies who have not received these injections who still need support, and are often managed without a respiratory support system.”
There are things parents of newborns can do to help prevent RSV, said Dr. Priya Soni, assistant professor of pediatric infectious diseases at Cedars Sinai Medical Center. These are simple behaviors that everyone has been familiar with since 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 cleaning those surfaces and washing hands goes a long way with 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 about 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 close that gap for those little babies who are in the first six months of life, who are really prone to that RSV infection, will help,” Soni said.
In the United States, four RSV vaccines may be close to FDA review. Globally, more than ten are undergoing trials. Preventive treatment of lower respiratory tract infections caused by RSV has received the green light from the European Commission last week.
Experts say these events can be game-changers.
“Every pediatrician I know has always worked very, very hard at Christmas time. We are always overwhelmed with RSV patients every year,” said Bont. “This year or next could be the last time we really see that, because it could really prevent most of the severe infections.”
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