Experts warn of respiratory syncytial virus infection and call for universal prevention

A group of specialists from different areas warned, this Monday, of the high burden of infection by Respiratory Syncytial Virus (RSV) in Portugal, which causes bronchiolitis, arguing that it is necessary to define a universal preventive method for all children.

In a document to which Lusa had access and which will be handed over to the guardianship, the experts recall that respiratory infections by RSV force 5.6 children out of every 1,000 under five years of age to be hospitalized per year.

“At 12 months of age, approximately half of children have already had an infection by the respiratory syncytial virus. (…) And studies say that by the age of three, all children have already had the respiratory syncytial virus at least once”, he tells the Lusa agency the pediatrician Manuel Magalhães, from the Centro Materno-Infantil do Norte, who participated in this work.

The doctor explains that the infection can range from a simple cold to “serious acute bronchiolitis or viral pneumonia”, with the need for hospitalization in intensive care, warning that depending on some factors (premature babies, with low weight or who have pathology chronic), the risk of mortality increases.

In the document, experts stress that most hospitalizations (95%) “occur in healthy children” and recalling that the real impact of RSV in Portugal is “significantly underestimated”, pointing to the need to improve the combat strategy, which they consider ineffective.

The now known recommendations came as a result of the RSV Think Tank – Inspire change, a Sanofi initiative conducted in partnership with XXS – Portuguese Association for the Support of Premature Babies and APES – Portuguese Association for Health Economics. The expert panel included pediatricians and neonatologists, public health physicians, nurses, economists, parent associations, health authorities and decision-makers.

In addition to pointing out the need to know the real impact of these infections in Portugal – remembering that only the weight of cases arriving at hospitals is known -, they insist on the importance of defining measures at three levels: literacy, pharmacological and non-pharmacological.

In order to overcome barriers in terms of literacy, they recommend that the topic becomes a mandatory approach in consultations with the pediatrician for certain age groups. To this end, they suggest changing the individual child and youth health bulletin.

In order to reduce the spread of RSV, in addition to the usual protective measures used in the covid-19 pandemic (masks and frequent hand washing), they ask that the bureaucratic process of parents’ absence from work be facilitated.

If not, the parents, not being able to miss it, end up having to take their children to day care centers and increase the chances of other children being contaminated, they say.

Manuel Magalhães recalls that these children “are transmission vectors of the respiratory syncytial virus to adults and grandparents”, who, if they are more fragile, “also have an increased risk of serious illness and, eventually, mortality”.

As for pharmacological measures, they advocate the creation of a national working group dedicated to RSV or the restructuring of the group that developed the standard for Palivizumab, the monoclonal antibody used to prevent serious illness and which is administered only to a few priority cases.

They also intend that there should be a “universal preventive method” that is available “in an equitable way” to all children.

Manuel Magalhães recalls that in addition to the monoclonal antibody used in some cases in Portugal (Palivizumab), another one is available (nirsevimab), approved in Spain.

France and Italy “are also advancing in this direction”: “The strategy would be to administer this monoclonal antibody to prevent serious infection in children in the first year of life, protecting them all”.

“Palivizumab was not approved to be given to everyone, only premature babies and babies at high risk. This new molecule [nirsevimab] is tested and approved to give to everyone, safely. Universal administration before the seasonal season of RSV can truly change acute respiratory illness in childhood,” he adds.