Children’s hospitals in Canada are seeing an increase in cases of a common respiratory virus that, in rare cases, can lead to severe illness in infants.
Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It can result in severe infection in some people, including babies under two and older adults with pre-existing conditions.
Cases of RSV dropped dramatically early in the pandemic, but spiked last fall and are now surging in many parts of the country, says Dr. Earl Rubin, director of the infectious diseases division at the Montreal Children’s Hospital.
Rubin says that surge is part of the reason his hospital is struggling with long wait times and a shortage of beds.
“We are overwhelmed,” he said. “We are experiencing in the pediatric hospitals what the adult hospitals were experiencing during the peak of COVID.”
Here’s a look at what’s behind the increase in RSV cases.
What is RSV?
The virus generally leads to cold-like symptoms such as runny nose, cough and fever. It’s the most common cause of lower respiratory tract illness in young children worldwide, and typically leads to outbreaks in Canada from late fall to early spring.
While many infections are simple colds, children less than two years of age are at risk of severe disease such as bronchiolitis — a blockage of small airways in the lungs — or pneumonia and may be hospitalized.
“Almost all babies are infected by two years of age. It’s very common … but some babies can get very sick with it,” said Dr. Anna Banerji, an infectious disease specialist and associate professor at the University of Toronto’s faculty of medicine.
In its most recent update, the Public Health Agency of Canada reported a rise in RSV cases in many parts of the country, though Banerji says testing isn’t widespread enough to get a complete picture. Hospitals in the United States have also reported an increase in cases.
Quebec’s Ministry of Health reported a higher positivity rate than the national average. CHEO, an Ottawa children’s hospital, said in a statement RSV cases were part of the reason it “just had its busiest September ever.”
Why are cases rising now?
Both Banerji and Rubin say there were fewer RSV cases when public health measures were in place because of COVID-19, but there was a spike last autumn and again this year as young children were exposed to more people.
Many of those children don’t have strong immunity because they weren’t exposed previously and, similarly, their birth mothers might not have been exposed and passed immunity on either, Banerji said.
At his Montreal hospital, Rubin says he’s also seeing some slightly older children, between age one and two, that are sicker than usual.
“They have no immunity, and if they have any predisposing conditions, whether it’s asthma or allergies, that will predispose [them to RSV],” he said.
How does it spread?
RSV is predominantly spread by aspirated droplets, says Rubin. He recommends hand washing and, for older children, ensuring they sneeze into their elbow and cover their mouth when they cough.
It can also spread through contact. “If you touch a contaminated surface and then rub your eye, pick your nose, you can infect yourself,” he said.
People infected are usually contagious for three to eight days. Babies and people with weakened immune systems, however, can spread RSV for longer.
Who is most at risk and what can be done?
Those with pre-existing conditions, particularly those born prematurely, can be vulnerable to the most serious infections.
“They have much higher rates of admission than almost any other population in the world,” she said.
During RSV season, injections of an antibody-based medicine are sometimes prescribed to protect premature infants and other very vulnerable babies.
Banerji launched a petition — now with more than 200,000 signatures — calling on the Nunavut government to expand the use of that medicine to make it available to all babies in the territory.
More generally, doctors may also prescribe oral steroids or an inhaler to make breathing easier. In serious cases, patients in the hospital may get oxygen, a breathing tube or a ventilator.
“If a child needs to be admitted to the hospital, it’s because their oxygen levels are low or they’re having a really hard time breathing on their own and may need to be ventilated or they’re not feeding well,” Banerji said.
At home, she said, parents can do their best to manage symptoms with fever medications, and ensure their baby is adequately hydrated.
WATCH | What to expect this winter from COVID:
What's alarming pediatricians about surge in children's respiratory infections, the flu & COVID-19 – Niagara Frontier Publications
Oscar G. Gómez-Duarte, M.D., is chief of the division of infectious diseases, department of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB, and director of the PediUBatric Infectious Diseases Service at John R. Oishei Children’s Hospital. (University at Buffalo photo)
Tue, Nov 29th 2022 01:10 pm
Oscar G. Gómez-Duarte, Jacobs School’s pediatric infectious diseases division chief, discusses why physicians are so concerned – and how to keep kids healthy
Submitted by the University at Buffalo
The request by children’s hospitals nationwide this month that the federal government declare a formal state of emergency given the surge in respiratory syncytial virus (RSV) and flu cases was no surprise to Oscar G. Gómez-Duarte, M.D.
As chief of the division of infectious diseases, department of pediatrics in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, and director of the pediatric infectious diseases service at John R. Oishei Children’s Hospital, Gómez has seen firsthand the jump in cases of both RSV and flu, and the resulting increase in hospitalizations of children.
By September, Oishei Children’s Hospital reported having seen more patients admitted to the hospital with RSV than it had seen during the entire 2019-20 respiratory season, along with higher rates of flu infections, some requiring hospitalization.
Gómez says the surge this early in the season is unusual and especially concerning since there are very low vaccination rates for COVID-19 and flu in children. Cases may rise this winter, especially among unvaccinated children in addition to the rise in RSV cases.
How would you characterize this season so far for RSV and flu in kids?
“What’s concerning to us are not only the number of infections, but the severity of these infections leading to a high number of emergency room visits and hospitalizations. The surge in cases is putting pressure on hospitals nationwide. This is a very dramatic increase over what we normally see, especially at this point in the season. This year, we have been seeing significant increases in cases and this is even before the winter season has begun. We saw RSV cases peak over the summer this year and then another peak was reported in October. This RSV infections pattern is quite different from what we normally saw pre-COVID-19 pandemic.”
How do you think COVID-19 has influenced this increase in other respiratory viruses?
“It’s very possible that this jump in respiratory viruses that we are seeing now is related to the dramatic changes in community behavior during the past two years due to the COVID-19 pandemic.
“Those behaviors significantly limited the normal exchange of viruses that people typically have through interactions with each other. That’s especially true of young children, who exchange different viruses with each other at day care, at school and public gatherings. That exposure allows children to develop a natural immunity to common respiratory viruses at a young age.
“During much of the pandemic, that exchange of viruses wasn’t happening, and there was a gap in natural protective immunity. Now that children are again attending day care and school and other gatherings, getting exposed to these viruses that they haven’t been exposed to in the past two years has resulted in a high peak of infections and an overwhelming number of ER visits and hospital admissions. We are seeing increases especially in RSV, and some of these cases are severe.”
What factors make children especially susceptible to developing RSV?
“RSV tends to affect the very young, those under 2 years of age. Infants at the highest risk are those who were born prematurely or who are immune-compromised.”
Is it mostly children with underlying conditions who are being hospitalized with RSV and/or flu?
“We are seeing hospital admissions for RSV and/or flu among previously healthy children with RSV who have no comorbidities; but we are also seeing it in children with underlying conditions, such as asthma, cardiac conditions, neurological disorders, among other chronic conditions.”
Are you seeing cases where a child gets infected with two viruses at once?
“Yes, some children are getting what we call coinfections, where they become infected with more than one virus at a time. In some instances, a child becomes initially infected with flu, begins to recover and subsequently comes down with rhinovirus (a common cold virus), RSV or any other respiratory virus. These coinfections tend to be more severe than when the child just has one infection. Different viruses can attack different receptors and use different mechanisms to damage respiratory cells, and this can worsen the disease and, in some cases, may require that the child be admitted to the intensive care unit for management.”
What kinds of treatments are available for children hospitalized with either RSV or the flu?
“While we do have specific treatments for flu and COVID-19, there is no specific treatment for RSV or other respiratory viruses. The mainstay management of respiratory infections is supportive care, such as hydration, control of fever and supplemental oxygen if needed. When the child’s breathing is very compromised, we will put the child on oxygen and, depending on the severity of the respiratory compromise, they may even require more intense measures such as mechanical ventilation.”
Can children be immunized against RSV?
“Passive immunity in the form of monoclonal antibodies is available for premature infants during RSV season. This FDA-approved monoclonal antibody named palivizumab has the ability to block RSV and decrease the severity of the RSV infections.
“There is no approved active vaccine against RSV in the U.S. for children or adults. There is evidence, however, that pregnant mothers do transmit antibodies against RSV to their babies. It was recently reported that pregnant mothers who received an experimental vaccine against RSV did pass those antibodies onto their babies and these infants were at lower risk of developing RSV infections. These developments are very good news for the future, so that maybe pregnant women who are immunized can pass this protection to their babies.”
How concerned are you that along with RSV and the flu, children may begin to get sick from COVID-19 this winter?
“COVID-19 will stay among us in the same way as RSV, influenza and any other respiratory virus. Accordingly, we expect to continue to have COVID-19 infections in children, along with RSV and the flu. Current variants of the COVID-19 virus are becoming resistant to preventive measures such as monoclonal antibodies, although vaccines remain protective.
“It is concerning that the vaccine coverage for COVID-19 and flu vaccine among children in our community is low. Nationally, only 4% of children younger than 5 and fewer than a third of children ages 5 to 11 have had any COVID vaccine series. There is strong evidence that vaccines prevent infection, prevent hospitalizations, and prevent deaths due to COVID-19.
What should parents watch for?
“The first and most important way to protect children is to make sure they get vaccinated against the diseases where vaccines are available, among them the flu and COVID-19.
“If a child acquires a respiratory infection, the child will likely experience upper respiratory symptoms, such as fever, sore throat, cough and nasal congestion.
“Parents should be vigilant for more concerning symptoms, such as shortness of breath. If a parent notices that the child’s breathing is labored and difficult, this is an emergency situation that requires immediate attention, such as taking the child to the closest emergency room or calling 911.
“Most respiratory infections in children, though, are self-limited, and are not associated with shortness of breath. In most cases, a call to the pediatrician for advice is the best measure to take.”
The views and opinions expressed in this commentary are based on the opinions and/or research of the faculty member(s) or researcher(s) quoted, and do not represent the official positions of the University at Buffalo or Niagara Frontier Publications.
Monkeypox renamed "mpox" in an effort to combat stigma – News-Medical.Net
As of November 29, 2022, the World Health Organization (WHO) has announced that the monkeypox virus will now be referred to as “mpox” in an effort to reduce the stigmatization of this condition.
Image Credit: Berkay Ataseven / Shutterstock.com
Since the start of the current mpox outbreak in numerous non-endemic regions throughout the world, racist and stigmatizing language and have been widely spread on social media platforms. Following the increasing number of concerns raised by many individuals and countries over this issue, the WHO, under the International Classification of Diseases (CID) and the WHO Family of International Health Related Classifications, recommended the adoption of “mpox” to replace the use of “monkeypox” in WHO communications.
Removing ‘monkey’ removes the stigma that monkeypox comes with and deals with the possible misinformation.”
The current status of the mpox outbreak
Over 81,000 cases of mpox virus infection have been reported worldwide in 110 different locations, 103 of which are non-endemic areas.
The mpox virus, an Orthopoxvirus with manifestations similar to smallpox infection, usually is endemic to central and west African countries. However, in April of this year, several new mpox cases were reported in other areas of the world, many of which were documented in men who have sex with men (MSM).
Mpox symptoms and transmission
Symptoms will begin to develop about three weeks after being infected with the mpox virus. The most common mpox infection symptom is a rash located on or near the genitals and anus and other areas of the body, including the hands, feet, chest, face, or mouth. The pimple/blister-like appearance of the mpox rash will eventually scab before healing.
In addition to a rash, mpox infection may cause fever, chills, swollen lymph nodes, fatigue, muscle aches, headache, and respiratory symptoms, including a cough, sore throat, or nasal congestion.
The most common way mpox is transmitted is through skin-to-skin contact with an infected individual, such as sexual intercourse, hugging, kissing, or prolonged face contact. In addition to this transmission route, the mpox virus can also be transmitted following contact with contaminated objects, fabrics, and surfaces previously used by an infected individual.
Extracellular, brick-shaped mpox virions (colorized pink). Backlighting shows the surface membranes of the virions and the outlines of nucleocapsids. Credit: NIAID.
In the United States, the JYNNEOS and ACAM2000 vaccines have been approved to prevent the spread of the mpox virus due to the structural similarities between the mpox and smallpox viruses. Individuals previously exposed to a mpox-infected individual will likely be exposed to mpox in the future or are immunocompromised and are advised to receive either vaccine to prevent infection.
Importantly, no specific mpox antiviral agents have been approved for use; however, antiviral agents initially developed for treating smallpox infection may also be effective in treating mpox infection. Only those currently experiencing severe forms of mpox infection or are considered high risk for severe disease are eligible to receive these treatments.
Tecovirimat, for example, is considered the first line of therapy for treating at-risk patients with mpox infection. This antiviral medication is typically administered as a prophylactic measure to exposed individuals with severe immunodeficiency in T-cell function and would otherwise not be eligible to receive smallpox/mpox vaccination.
Brincidofovir, otherwise known as Tembex, is another smallpox drug available for treating mpox infections in adults. Only mpox-positive individuals experiencing severe disease or are at risk of severe infection can receive this drug.
In addition to these agents, vaccinia immune globulin intravenous (VIGIV) and cidofovir are other therapeutic modalities that may be employed in treating mpox infection.
We welcome and support the renaming to mpox to reduce stigma and barriers to care for those most impacted. https://t.co/qxRuFWm6cd
— Rochelle Walensky, MD, MPH (@CDCDirector) November 29, 2022
When the #monkeypox outbreak expanded earlier this year, there was sometimes racist and stigmatizing language used around it. After consultation with expert groups, @WHO will use a new term “#mpox”. We recommend others also adopt this name. https://t.co/DDjXBm0UxO
— Tedros Adhanom Ghebreyesus (@DrTedros) November 29, 2022
— Doherty Institute (@TheDohertyInst) November 29, 2022
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“The other aspect of this study that really fascinated us was how patients are getting information about cancer genetic testing,” says Sameer Thakker, MD.
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