Respiratory syncytial virus (RSV) infections in children: new weapons to prevent them

Respiratory syncytial virus (RSV) infections in children: new weapons to prevent them

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OfMaria Giovanna Faiella

The virus, the main cause of bronchiolitis, can cause serious consequences among children in the first months of life. Every year 15 thousand children are hospitalized (1 in 5 in intensive care), 16 lose their lives. The Manifesto «Breathe to grow – Allies for a childhood free from RSV» presented in Rome

It is estimated that the respiratory syncytial virus (RSV), main cause of bronchiolitisis responsible Of respiratory tract infections more than 60 percent of children in the first year of life, with approximately 230 thousand children (out of 400 thousand born per year) requiring medical care. In most cases the RSV infections they are mild or moderate, but they can also be very serious, so much so that every year or so 16 children lose their lives and it becomes necessary hospitalization for over 15 thousand children less than a year old; among the latter, according to data from the Italian Society of Neonatology, one in five must be hospitalized in intensive care. Thanks to scientific advances they are available today new options for prevention theRespiratory syncytial virus and its complications in the first months of life.
Hence the appeal to ensure that this opportunity is offered to all children, regardless of their place of residence, starting from the next epidemic season 2024/25. It was launched by the newly formed «Alliance for a RSV-free childhood», made up of scientific societies, patient associations, representatives of the economic world and institutions, which presented the Manifesto «Breathe to grow – Allies for a childhood free from RSV».

What is RSV, possible complications, how is it treated

Respiratory syncytial virus is a pathogen that circulates mainly between October/November and March/April and affects the lower respiratory tract in the little ones. In most cases the infections are mild or moderate and the virus tends to disappear on its own. However, this year too there was a epidemic peakparticularly between December and January, with theincrease in access to the emergency room of children who had developed pneumonia and other severe forms of infection from RSV (we talked about it here And here).
Furthermore, unlike other pathogens, once contracted the syncytial virusthere is no lasting immunity, so you can get infected more than once in your life. There are no specific antiviral treatments for RSV. The vice-president of the Italian Society of Paediatrics (Sip), Rino Agostiniani, explains: «Not having an effective therapeutic modalitythe strategy to be implemented is preventive type with effective and safe tools that are proving to drastically reduce the burden of the disease by changing its natural course.”

How to prevent it

The best weapon against RSVTherefore, prevention remainswhich also passes by the good ones hygiene rules that we learned about during the pandemic, such as wearing a mask if you have a cold without touching the child, washing your hands carefully, ventilating the rooms, avoiding crowded environments.
The virus can be particularly dangerous for very young children especially those born premature or with malformations or pathologies.
So far yesonly for the most fragile childrenat high risk if they become infected, a specific monoclonal antibody was used to prevent RSV, which requires 5 administrations per season.
Today also in Italy you can count on forms of passive immunoprophylaxis with new generation monoclonal antibodies. Last year the AIFA, the Italian medicines agency, approved a new monoclonal antibody for prevention of lower respiratory tract pathologies caused by the syncytial virus in infants and children during their first epidemic season. The medicine, which has one long half-life and is able with a single administration Of protect the child for at least 5 months, based on scientific evidence it reduces RSV respiratory infections by 77%. hospitalizations and the risk of hospitalization was 86%. Intensive care.
Hence the invitation, as early as February 2023, to adopt one universal prevention strategy of respiratory syncytial virus diseases for all newborns, by the board of the Vaccination Calendar for Life, SItI – Italian Society of Hygiene, Preventive Medicine and Public Health, Sin – Italian Society of Neonatology, SIP – Italian Society of Paediatrics, FIMP -Italian Federation of Pediatric Doctors and FIMMG-Italian Federation of General Practitioners.

Hospitalizations reduced by 80%

In the wake of the demonstrated results, some European countries – such as Spain and Germany and, in Italy, the Valle d’Aosta Region – have introduced, as early as the 2023 epidemic season, there universal prevention of RSV diseases with the new monoclonal antibody.
Fabio Midulla, past president of the Italian Society of Infantile Respiratory Diseases (Simri), reports: «Where the monoclonal antibody has already been used, as in Spain, there has been a approximately 80% reduction in hospital admissions due to RSV infection in the first year of life, as well as visits to the family paediatricians. Scientific data is demonstrating that Prevention also reduced the number of recurrent asthmatic bronchitis in children immunized in the first year of life. In Italy, unfortunately, we have been able to use this new prevention weapon only in Val d’Aostawith results identical to those recorded in other countries.”
The suggestion is to administer the monoclonal antibody directly in the hospital, as Dr. Agostiniani explains: «It should be used, before discharge from the maternity ward, for all children born between October and March (epidemic period), while children born in the period between April and September they could be immunized in October (year of birth) in local vaccination centers or by a pediatrician of free choice”.

Same opportunities for all children in every Region

Underlines Luigi Orfeo, president of Sin, the Italian Society of Neonatology, who in recent days wrote an open letter to the ministers of Health, family, birth rate and equal opportunities, to the presidents of the Regions and to the regional councilors for Health and Health, asking that all the children who are born in Italy have the same health opportunities in each Region and compared to European peers: «We neonatologists ask equity: we are worried because in Italy there are notable differences between one region and another, so much so that the risk of neonatal mortality in a southern region is almost three times higher than in the north; we also know that for the monoclonal antibody against RSV some regions in the north and center are Already equipping to purchase the drugWhile to the south I am still backwards». The problem is also economic, even if prevention could save money, for example by reducing the costs caused by hospital admissions: based on Sin data, at least 4,000 euros are spent for each admission to the ward and 14 thousand euros for each hospitalization in intensive care. In terms of economic impact on the Health Service, according to Alliance calculations, the expenditure associated with the management of care related to respiratory syncytial virus infections as well as its complications is approximately 64 million euros per year for direct costs alone .

The poster “Breathe to grow»

The poster «Breathe to grow – Allies for a childhood free from RSV” – signed by scientific societies, patient associations, federations, economists, institutions -, the result of multidisciplinary work carried out in recent months and supported by Sanofi, suggests some necessary actions to deal with the weapons available today a public health need still unmetamong which: inform immediately Regions and health workers availability of new prevention tools that allow protect all children in the first year of life; update the Vaccination calendar and expand itwith the introduction of the monoclonal antibody, with a National Immunization Calendarin time to effectively implement the RSV immunization strategy in the 2024/2025 season; organize information and awareness campaigns, aimed at parents and healthcare workers, on the importance of reducing the risks of RSV infection; guarantee the protection of the right to health to all children thanks to passive RSV immunoprophylaxis uniformly, throughout the national territory.
Concludes Ignazio Zullo, doctor and member of the Social Affairs, Health, Public and Private Work Commission of the Senate, promoter of the initiative to present the Manifesto: «The integration of monoclonal antibodies intended for the entire cohort of children, an innovative and indispensable tool for preventing RSV bronchiolitis can reduce not only the number of visits to healthcare facilities and, therefore, the number of medium-serious infections, but also the costs associated with hospital admissions and the therapies adopted”.

March 6, 2024

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