Respiratory syncytial virus in children: symptoms, treatment, risks

Respiratory syncytial virus in children: symptoms, treatment, risks
Respiratory syncytial virus in children: symptoms, treatment, risks

All you need to know about the respiratory virus that also affected the daughter of Chiara Ferragni and Fedez. The head of pediatrics at San Raffaele in Milan speaks

“Don’t underestimate this virus who is spinning because he is an ugly beast ”: the appeal of Chiara Ferragni after her little Vittoria was hospitalized for respiratory syncytial virus (RSV) infection it had a far greater echo than many alarms issued by experts and doctors. To amplify the echo the fact that, after a year in which the respiratory infections naturally fell due to the reduced sociability and the use of masks dictated by Covid pandemic, many parents have returned to reckon with colds and flus of their young. But how much must the respiratory syncytial virus? Which symptoms, in particular, should they be alarmed? Dr. Graziano Barera, head of pediatrics, neonatology and neonatal pathology at the San Raffaele Hospital in Milan, without diminishing the situation reassures: “The respiratory syncytial virus it is a respiratory virus normally spread in our latitudes during the autumn and winter period, with a peak between December and January ”.

How is respiratory syncytial virus transmitted?
“Like all respiratory viruses, the VRS is transmitted through the goccioline o droplets that we emit when we speak, sneeze or cough, therefore through the sharing of closed spaces in which these droplets can spread. This virus, then, can survive for many hours too on hard surfaces and can therefore, if collected with the hands, infect through a contact mechanism. But the greater diffusivity is for respiratory route“.

What are the symptoms of respiratory syncytial virus?
“The symptomatology varies greatly depending on the age of the patient: in older children and adults the VRS it causes an infection not unlike a trivial one cold syndrome, the symptoms of which are low fever, cough, nasal congestion. When the virus affects younger children, especially under six months of age, it can manifest itself in a severe form with breathing difficulties that requires hospitalization for respiratory support “.

Can respiratory syncytial virus infection be fatal?
“Disease can determine obstructive inflammatory phenomena, breathing difficulties e respiratory failure even severe which may require intensive therapy. But the chances of death are fortunately very low ”.

Who are most at risk of a severe course of RSV infection?
“Are the premature births, especially i large premature babies, under 32 weeks; the children they have fragility of a neurological or respiratory nature (e.g. suffering from broncodisplasia); children who have syndromic pictures that compromise their immune and respiratory response, but also children with severe heart disease. For all these more fragile children, however, there is one prophylaxis ad hoc by the national health system, which consists in the use of a monoclonal antibody, the palivizumab, which provides defense to the child through passive immunity, unlike the vaccine which induces an active immune response. It is administered intramuscularly at intervals of about one month in the period from October to March. This prophylaxis is usually prescribed immediately after the baby is discharged and is able to reduce the risk of serious illness and to resort to intensive care ”.

For children and infants who are not particularly fragile, who therefore do not have the right to the monoclonal drug, what is the therapy used?
“The treatment is supportive, because as it is a viral infection there is no specific therapy. The support includes adequate nutrition and hydration, oxygen administration if necessary, temperature control with antipyretics, secretion control. Medicines such as cortisone o i broncodilatatori have not demonstrated the effectiveness assumed in the past. Also the antibiotic it is not active, being a viral form, and should be chosen with great caution in the suspicion of a possible one bacterial superinfection “.

How can respiratory syncytial virus infection be prevented?
“The prevention it is non-specific and general, valid for all childhood respiratory diseases: certainly l‘hygiene and hand cleaning are essential. Then parents are advised to limit sharing community environments, not to bring the little one too much into very busy closed places, especially in winter. Attention also to humid environments, where there are molds and the presence of smokers “.

Is it true that this year there are more cases than usual?
“What we are observing these days is a perception of us pediatricians. Things are very different from last year, but last year was an atypical year because the interruption of sociability prevented the circulation of the virus. There is no case tracking in previous years. Our perception is that this year, starting in October, we have begun to see a few more cases of bronchiolitis hospital and perhaps a few more cases of bronchiolitis in very young children. But the risk of hospitalization it is higher in young children, so the two may be related. Probably avoided this kind of infections last year, like others viral infections which give cold syndromes, prevented some sort of partial immunity in the pediatric population, which in the sharing of social life in 2021 is found to be much more discovered in terms of infections, offering a terrain of very easy viral spread. However, it should be remembered that the respiratory syncytial virus it does not confer permanent immunity and is very frequent in the winter period. But acquiring an RSV infection in two years is a very different thing than acquiring it in a few months ”.

Is it true that children who get RSV respiratory infection have an increased risk of getting asthma for years to come?
“VRS can prepare children for bronchospasm: up to 4 years, in the presence of other viral forms of respiratory disease, children who have contracted RSV will have one more easily bronchospastic response, that looks likeasthma but that’s not really asthma. In order to speak of asthma, the condition must last over time. So if it is certain that the VRS can favor the appearance of reactive bronchospasm in the first years of life, the less certain is the inducing effect of asthma at a distance from an RSV infection “.

Do you have any advice for parents worried about respiratory syncytial virus?
“There is no reason to be alarmed by this kind of infection, since in the vast majority of cases it occurs fortunately in a benign way. For frail people there is a prophylaxis implemented by the National Health Service. Certainly like all respiratory infections has a margin of cases that can become complicated and require a admission to intensive care. But there are no specific alarms. The criterion of a reasonable management of small children remains valid: they should not be imprisoned but particular attention is always needed, especially in very first months of life “.

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