RSV: Why many children have to go to the clinic right now

»In winter 2020/2021 we saw almost no RSV infections in the German children’s clinics. The cold season is virtually canceled “(Burkhard Rodeck, Secretary General of the German Society for Child and Adolescent Medicine)

For small risk patients there is a possibility to prevent or at least reduce an infection with RSV. Children at particular risk are given antibodythat bind to the virus and prevent it from affecting cells. This procedure, known as passive vaccination, also works well, but only if prophylaxis can be started early enough. The antibodies have to be administered in single doses over a period of weeks, which requires a corresponding lead time. But there wasn’t that year.

The fact that the RS virus hits younger children so hard and hard this time is due to the corona pandemic. In autumn and winter 2020 it was necessary to reduce contacts and wear a mask throughout. Day-care centers and schools closed again and again, and public life was cut back. The measures have not only slowed down the Sars-CoV-2 coronavirus. »In winter 2020/2021 we saw almost no RSV infections in the German children’s clinics. The cold season is virtually canceled, ”says pediatrician Rodeck. The RS virus simply had no way of spreading.

Since that late summer of 2021, RSV seems to be catching up on the season. This is hardly surprising for Rodeck: “In September the virus hit not just one, but two cohorts of immunnaive children.” Because not only children born in 2021, but also those who were born the year before are, face the current wave of infections with RSV – based on their specific immune status – defenseless.

The children’s clinics are full

It’s a dilemma. Because the medical staff is already working at the limit due to the corona pandemic, including in the children’s clinics. And the bed capacity could soon reach its limits nationwide. Of the approximately 2700 beds available in the children’s intensive care units are up-to-date more than 2000 occupied. However, children with a severe course of RSV infection cannot wait until a place in an intensive care unit becomes available.

“In the event of acute breathing difficulties, the children must be immediately taken to a clinic and given oxygen,” says Rodeck. This is often the only therapy that can help in the situation. As with many viral diseases, there are no effective drugs against the RS virus. It remains to treat the symptoms, for example by lowering the fever and keeping the airways free with decongestant agents. Small children in particular need such oxygen administration over a period of one to two weeks, depending on the severity of the disease.

To make matters worse, children who are hospitalized for RSV infection have to be isolated so that they do not infect other children. To do this, the clinics need space and staff. Both are missing. “The children’s clinics are currently in the situation that they either cannot comply with the lower nursing staff limit regulation or they have to send children to other clinics or even have to turn them away,” says Rodeck. The Nursing Staff Lower Limits Ordinance (PpUGV) regulates how many caregivers must be available around the clock for a certain number of sick children. If a clinic does not adhere to this requirement, there is a risk of fines. Rejecting sick children due to a lack of staff could, however, be seen as failure to provide assistance, says Rodeck. He therefore calls on the legislature to at least temporarily suspend the sanctions for falling below the lower limit for nursing staff.

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