The RSV virus has returned – and experts say – with redoubled strength. It even seems that the pathogen in children poses a greater risk than COVID-19 and PIMS. Dr. Magdalena Okarska-Napierała from the Department of Paediatrics with the Observation Department of the Medical University of Warsaw talked about what the RSV virus is and how it manifests itself.
Currently, it is not COVID-19 and PIMS (Multiple Systemic Inflammatory Syndrome occurring in children following coronavirus infection) that are the challenge for us, but the wave of infections caused by the RSV virus. There are more and more infections among children, some of them get sick, very hard. They fill hospital wards – said Dr. Magdalena Okarska-Napierała from the Department of Paediatrics with the Observation Department of the Medical University of Warsaw in an interview with the Polish Press Agency.
The RSV virus started to be talked about because of the 4.5-year-old Mikołaj. The boy suffered from pocovid syndrome – his lungs stopped working. The child was saved thanks to extracorporeal blood oxygenation (ECMO). Dr. Okarska-Napierała noted that such a case should be treated as an isolated case.
As long as COVID-19 is in the world, there will also be PIMS cases among children, but this is a rare complication. If millions of people get sick during the wave, a certain group of children with PIMS will be found and we will treat them again, while in the US it has been estimated that the risk of a child developing PIMS is one in three thousand, ‘she said.
PIMS in Poland and in the world
The expert is co-creating the national register of inflammatory diseases in children. As she mentioned, the documentation was created to capture the appearance of PIMS in the youngest patients.
– We recorded the first cases in May 2020. In October-December, after the fall wave of COVID cases, another came – PIMS cases. Many children have been affected, [mieliśmy – przyp. red.] several hundred cases nationwide. Children were hospitalized in large numbers, which was a challenge for us. In the second winter-spring wave, there were definitely fewer PIMS cases – she said.
A similar pattern was to prevail in the United States – the waves of PIMS disease are lower and lower than the COVID-19 wave. As the expert pointed out, there are currently about 5-10 cases a week in the entire United States. It is not clear yet why this is so, although there are many theories.
Our country is currently facing the fourth wave of cases during the COVID-19 pandemic. Dr. Okarska-Napierała said that an increased number of PIMS infections will have to be expected about a month after the COVID-19 wave.
– So far, about 500 cases have been collected in the PIMS register, which we have been running since May 2020 last year. At the moment, the incidence does not appear to have increased dramatically. Most cases of children with PIMS from the Mazowieckie voivodship go to the hospital where I work, and at the moment we have no problem with this disease – she said.
According to the data cited by the pediatrician, the data of the Polish registry are more favorable than those from Western countries, as less than 10 percent of children with PIMS were admitted to intensive care units. In the USA and Great Britain it was about 40-60 percent.
– The overall survival prognosis for PIMS is still good, even improving. The death rate in the US was up to two percent at the beginning, now it has fallen below one percent, she said.
What is PIMS manifested?
She added that the data show that during the Delta wave, children get statistically the same as with previous waves. The difference is that this variant seems more contagious to them. There are also more and more cases in younger age groups.
– Americans have published two reports which show that these infections are still mild, most children suffer from asymptomatic or mildly symptomatic disease, and only a small percentage develops a severe course, which still most often affects children with comorbidities, e.g. obesity, asthma, immunosuppression . Despite the fact that the absolute number of seriously ill children is higher, still when the statistical child comes into contact with the virus, it poses little threat to him – said the expert.
The symptoms of the disease are similar to those of adults, but they are less likely to develop in children. There is fever, cough, shortness of breath, they have symptoms from the digestive system relatively more often – diarrhea, vomiting, and they often have skin changes, including rash. However, the course of this disease does not differ from other seasonal infections.
“ The British compared large groups with other infections and found that the average duration of symptoms is slightly longer for COVID-19, but it’s still a matter of days. For patients, however, this is not a discernible difference. Currently, however, it is not COVID-19 that is our biggest concern, but the RSV virus wave. The epidemic is alarming – said Okarska-Napierała. – We have an intensified wave of other seasonal infections, and one such virus that is sweeping the world on an incomparable scale than before is the RSV virus. There are more and more infections among children, some – especially the youngest – get very seriously ill – she added.
RSV – Why is it Dangerous?
RSV usually started attacking children in late fall and ended in spring, peaking in January / February. During the pandemic restrictions, both influenza and RSV have almost completely disappeared. Now, however, the dangerous virus has returned and struck twice as hard.
– There are many infections in nurseries and kindergartens. We never had RSV patients during this period, and now there are plenty of them. The ward is full of children with RSV, and the same is true in other hospitals. They are not overcrowded yet, but in Western literature it is described that ICUs, SORs are at the limits of efficiency – she said.
RSV infection manifests itself through runny nose and coughing in older children. The younger ones also have a runny nose at first, but then a suffocating cough appears, often requiring oxygen therapy and fluid therapy in the hospital. Worse, now entire families have started to get sick with RSV all at once.
Vaccination for children
The Ministry of Health announced that vaccination against COVID-19 for children aged 5-11 will begin in November. The pediatrician said that I should be glad that clinical trials are being conducted on the effectiveness of the preparations also in younger children. She added that “vaccination will be beneficial” for children from higher risk groups.
– There is also no doubt that vaccination of adolescents is justified, because – especially if they have comorbidities – the risk that they will be ill like adults is high. In the USA, it was also observed that in states with the highest immunization coverage in society, children – including the youngest ones – fell ill less often, she said. – The virus “looks” for niches in a society that is already largely immune, and children constitute such a niche. Will there be new variants that will be more dangerous for children as a result? It’s hard to say, if so, then our perspective will change. But I am definitely waiting for vaccinations to be registered for children of all ages so that we can vaccinate those with risk factors. There is no doubt here that infection is more dangerous for them than vaccination, she concluded.
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