Respiratory syncytial virus, or RSV, gets the “S” in its name for large cells known as syncytia that form when infected cells fuse. Syncytia are prone to dying and clogging the airways, leading to respiratory distress, said Dr. Clement Lee, a pediatrician at Newton-Wellesley Hospital in Newton, Massachusetts. thread on Twitter. However, for most healthy people, the highly contagious virus looks like a common cold. Dr Rod Lim, medical director for the pediatric emergency department at the London Children’s Hospital, said that while many infants get through RSV just fine, the virus tends to present little children almost like asthma, with wheezing. Before the COVID-19 pandemic, children were typically exposed to RSV between November and March. By the age of two, an estimated 90 percent of us have been infected. But this year, RSV arrived early in parts of Canada and the U.S., based on swabs from those in the hospital — even circulating in the summer. “We see viruses circulating at different times than we do,” Lim said in a virtual briefing hosted by the Ontario Medical Association. “It’s a bit of a perfect storm right now.” Dr Rod Lim, who heads the pediatric emergency department at the Children’s Hospital at London Health Sciences Centre, says higher patient numbers, staffing challenges and supply chain issues have combined to make the hospital busier. (Submitted by Rod Lim)
Protecting babies
Lim’s emergency department was built for about 100 visits a day, and on Tuesday there were 280 visits, forcing staff to look for alternative places to care for people, he said. Staffing challenges and supply chain issues for medicines to reduce pain and fever they add to the burden, he added. WATCHES | Relieving anxiety about children’s pain relievers:
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Parents across Canada are growing concerned as the shortage of painkillers for children that began this summer shows no signs of easing. “If I had an ideal world, [it] it certainly wouldn’t allow babies to get RSV and get any kind of infections for the first two to three months,” Lim said. Eram Chhogala, a registered nurse who works in emergency rooms in the greater Toronto area, said she sees families show up with many children who need treatment. “We’re talking about entire families of four, maybe even six,” Chhogala recalled in an interview. “You have, for example, three children all with coughs and fevers. Three patients who need treatment for fever.” When parents are asked if they gave Tylenol or Advil, they say, “I’m sorry, we couldn’t because there was nothing left and we tried to go everywhere,” the nurse said. In addition, RSV circulates at the same time as the flu, COVID-19, and common cold viruses such as rhinovirus and enterovirus also cause people to have fever, cough, and other symptoms. The risk of RSV getting into the lower respiratory tract is always greatest during the first infection, says Dr. Jesse Papenburg. (Submitted by Owen Egan)
Because babies are more vulnerable
Dr. Jesse Papenburg, a pediatric infectious disease specialist at McGill University Health Center Montreal Children’s Hospital, said infants are particularly vulnerable to respiratory infections. In part, this is because the airway and bronchial muscles get stronger as they get older. “The risk of the virus entering the lower respiratory tract is always greater during the first infection” with RSV, Papenburg said in an interview. “The way your body can handle this lower respiratory infection is very different when you’re … two years old than when you’re two weeks old.” Papenburg said his hospital is also extremely busy increasing admissions respiratory viruses, which adds wait times. Also, elective surgeries are being canceled to free up staffed beds in intensive care and elsewhere. The positivity rate for RSV was over 25 percent last month, which he called highly unusual.
The processing pipeline opens
Infants are born susceptible to RSV because they lack antibodies to fight the infection, Papenburg said. Drugmaker GSK is developing a vaccine program for pregnant women as well as older adults, an age group Papenburg said is now also considered at risk for complications from RSV. Modern said it is planning a Phase 3 clinical trial of an mRNA vaccine for adults age 60 and older. Possible RSV vaccines from other companies are also in the works. Vaccinating pregnant people could help protect infants, Papenburg said. This is why pertussis or whooping cough vaccines are given in pregnancy and the antibodies cross the placenta. Currently, those hospitalized for RSV receive supportive care for what caused it, such as dehydration or oxygen through a mask to help them breathe. Babies at high risk of RSV complications can receive monthly doses of an expensive treatment called palivizumab during the normal RSV season. Some provinces and lands started rolling it out early this year. Last week, pharmaceutical companies Sanofi and AstraZeneca announced that the authorized by the European Commission a single-dose RSV drug called nirsevimab. It is a laboratory-developed antibody designed to protect infants during their first exposure to RSV. “You can do that one dose and the baby has protective antibody levels for the entire RSV season,” Papenburg said. “What the studies have shown is that it is as protective as palivizumab in terms of preventing hospitalizations” in both high-risk patients and otherwise healthy infants. The potential catch? Price. “I think one of the big questions will be, what will the cost be?” Papenburg said. “How much are we willing to pay to prevent these RSV hospitalizations?” Immunization advisory committees such as NACI will likely review the use of nirsevimab in all infants, said Papenburg, who cites potential conflicts of interest over the past 36 months from various drugmakers, including AstraZeneca.
