Medics gear up for a rise in respiratory infections in children

Doctors and children’s hospitals across the country are gearing up for a bumper season of respiratory syncytial virus (RSV).

The National Institute for Communicable Diseases (NICD) said while there had been fewer cases of RSV in the past two years during the Covid-19 pandemic, this year hospital admissions among children younger than five are expected to skyrocket.

In a communiqué to healthcare workers, the institute warned medics and intensive care units to anticipate a spike in cases, predicting that the rise could surpass the average of RSV cases between 2015 and 2019.

RSV infection causes bronchiolitis and lower respiratory tract infections in children.

The NICD said so far the virus has been detected in at least 19% of children younger than five who are hospitalised with lower respiratory tract infections at sentinel pneumonia surveillance sites.

RSV cases started to spike as early as the beginning of February.

Prof Heather Zar, a child health specialist with an interest in respiratory diseases and the chair of the department of paediatrics and child health at the University of Cape Town, said there is definitely an increase of RSV cases among young children. She said the Western Cape had fewer cases so far than Gauteng, and its spike is expected to come later.

She said the early transmission of RSV cases seem to be encouraged by the less stringent use of the Covid-19 nonpharmaceutical interventions.

“Nonpharmaceutical measures are not nearly as stringent as they were last year. Masks are quite erratically worn and social distancing is much less intense — and schools are back. So the potential for RSV transmission is greater compared to last year. Also there’s a vulnerable group of young children who were infants last year and weren’t exposed to RSV and may be susceptible to the virus this year,” Zar said. 

According to the NICD, the number of RSV-positive tests among children younger than five started to climb early February and continues to increase, with 35% and 32% of children hospitalised with lower respiratory illnesses testing positive for RSV subtype A and B respectively. The institute said by February 20 the RSV detection had already breached the low threshold level.

Predictions show that RSV monthly hospitalisation will rise as much as 32% compared with 2015-2019. The RSV infections are predicted to be the largest among older children.

Prof Heloise Buys, head of paediatric medical emergency unit at Red Cross Children’s Hospital, said RSV “appears to be taking off”.

While interventions such as wearing masks has slowed down the transmission of respiratory infections, in children this is not always possible.

“RSV affects mainly the under-two-year-olds who have not been part of the masking age group. Also crèches have been running so there has been easy mixing and cross-infections happening there. The main illness that RSV is associated with is bronchiolitis — mostly mild but some of the very young children, especially premature babies, end up in hospital needing oxygen and sometimes more respiratory support.”

Buys said as there is no affordable effective vaccine available for RSV, the message about prevention is very much along the lines of what is encouraged for Covid-19.

“Distancing and keeping children at home when they have respiratory infections, seeing as they can’t mask, and handwashing is very important. Avoiding exposure to tobacco smoke does not prevent RSV but helps prevent the infection from becoming too severe,” she said.

The NICD reported that sporadic detections of influenza have been made since mid-February after a low number of cases over the past two years of the pandemic.

Individuals at risk of severe influenza include pregnant women and those with chronic illnesses such as diabetes, chronic lung conditions and immunosuppression. The institute noted that the national health department has since updated its guidelines for influenza vaccination, and co-administration of the flu and Covid-19 vaccines is now allowed.

“Clinicians are to give both vaccines during the same visit when an eligible patient presents to the health facility. A different limb should be used for injection of Covid-19 vaccine when delivered during the same visit.”

TimesLIVE

Support independent journalism by subscribing to the Sunday Times. Just R20 for the first month.