Syncytial virus bronchiolitis. What do we know about the disease that worries parents (and why we shouldn’t panic)

The respiratory disease due to the syncytial virus, potentially dangerous for the elderly and children, has recently taken the lives of two newborns in the Neapolitan area and in La Spezia. There is no approved vaccine, although some are pending trial on over 60s. Some drugs are known, which must be taken under certain conditions. According to Republic at least 15 children were hospitalized in Tuscany, occupying half of the resuscitation places in the Meyer pediatric hospital. The Rest of the Carlino speaks of eight newborns hospitalized in the province of Rimini. But be careful: we are not facing a new emergency.

What is syncytial virus bronchiolitis

Respiratory syncytial virus bronchiolitis (RSV) is a long-known problem that is particularly challenging in the field of prevention in the pediatric population. In rare cases, the pathogen can cause severe lower respiratory tract diseases in children. It usually causes a very common cold that disappears after two weeks at the latest. Things potentially get more dangerous among the elderly and infants.

According to the American CDCs Approximately 58,000 children under the age of five are hospitalized for RSV each year in the United States. Known since 1956, the syncytial virus is one of the most common causes of childhood diseases, with seasonal outbreaks (usually in autumn), which can affect all age groups. Vaccines, monoclonal antibodies and antiviral therapies are still being studied. Prevention is important not only for children, but also for the elderly and pregnant women.

The current state of research

Two pharmaceutical companies now known for the anti-Covid vaccine are also studying one for the syncytial virus: Moderna in August announced its research on its mRNA vaccine for the over 60s; Pfizer last September announced the start of a third phase study called RENOIR trial. It will involve around 30,000 volunteers over 60.

Unfortunately for children it is still early for a vaccine, while monoclonals have been studied, for example the motavizumab, on children under six months. A third-phase study of over two thousand children showed promising results, but currently the American Academy of Pediatrics (AAP) recommends the palivizumab for children at risk of hospitalization. The monoclonal is also recognized by AIFA, and is the only one currently on the market in our country.

“For ethical reasons, trials are usually done first with adults, as we have seen for Covid – pediatrician Stefano Prandoni, founder of the Facebook group, explains to Open The influence this unknown – When we have more evidence of efficacy and safety then it can also be tried in younger people. We are still a long way from the vaccine for children ».

Another well-known treatment is medication ribavirin (known in Italy as ribavirin). It is a broad spectrum antiviral, which therefore also works against other RNA viruses (for example, Hepatitis C and Zika). It inhibits replication showing significant benefits in children. However, it has two flaws: the high cost and potential toxicity. Therefore it is administered only in children with an already severely compromised immune system.

Too early to talk about an emergency

Can we talk about a new health emergency? “We cannot speak of an emergency yet, but there has been a certain rebound as for many other viruses – continues Prandoni -. In the first bulletin on the trend of flu forms there is a bit of everything, including the syncytial virus, which shows a very high incidence in this period ».

“We pediatricians are working on many children, including those who got sick from this virus. Last year with the lockdowns all these viruses were put a bit ‘at the door. They circulated much less ». This year, however, they are regaining footing “by manifesting themselves in a fairly dense way, not in gravity but in intensity”.

The syncytial virus also goes in periods. “There are years in which it strikes more and others less. This year – explains the pediatrician – we had higher levels than the previous ones, but not at emergency levels. We are talking about a virus that has always been, an important infectious agent in pediatric age, especially in younger children, with severe cases and hospitalizations, even in the elderly, but it has always been so “.

In short, pediatricians are not exactly disarmed in the face of these cases. «In the majority of serious cases respiratory support is given, but 99.9% of the affected children recover – concludes the pediatrician -. Fatal cases are very rare. In particular, premature babies, children with heart disease or diseases of the muscular system are at risk; precisely those who are put on prophylaxis with palivizumab in the winter period. Generally a child goes to hospital for three or four days and then goes home ».

Cover photo: orzalaga | Stock image.

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