The out-of-season rise in cases of RSV (respiratory syncytial virus) has caused an increase in demand for care and even the overcrowding of pediatric hospitals.
The virus is associated with up to 75% of cases of bronchiolitis, inflammation that makes it difficult for oxygen to reach the lungs, and with up to 40% of pneumonia records in children under two years old, according to the SBP (Brazilian Society of Pediatrics). The most serious cases occur mainly in babies younger than six months and some patients do not resist and die.
Traditionally, the period of greatest RSV circulation coincides with autumn and winter. It runs from February to June in the North region; March to July in the Northeast, Midwest and Southeast; and April to August in the South. But that was not what happened in 2022 and it is not what is observed in 2023.
According to Fiocruz, there was an increase in the prevalence of RSV between December 25th and 31st, with a predominance of cases in children up to four years old in São Paulo, the Federal District and in the three states of the southern region, in addition to a greater presence of virus in Espírito Santo, Minas Gerais and Roraima.
“The viruses are not respecting seasonality. After the pandemic, we are having peaks of influenza, adenovirus and RSV out of season”, says Victor Horácio, deputy technical director of Hospital Pequeno Príncipe, in Curitiba.
In the unit, ten cases were registered in September, 21 in October and 38 in November. In December, the number jumped to 53 and, in 2023, there are already 11 confirmed.
According to Horácio, the most serious cases are associated with co-infection with the Sars-CoV-2 virus, which causes Covid-19, and are observed in children under one year old who have not received a vaccine against the new coronavirus.
In São Paulo, the Darcy Vargas and Cândido Fontoura hospitals, state references for pediatric care, recorded an increase of about 20% in cases of RSV, says the State Department of Health.
At the Hospital Municipal Infantil Menino Jesus, in the central region of São Paulo, the number of cases of bronchiolitis in the last four weeks of 2022 was approximately 30% higher than the historical average. According to the Municipal Health Department, in December, 56 patients with inflammation were treated, of which 37 ended up hospitalized. In the same period of 2021, there were 102 attendances and 61 hospitalizations; in 2020, ten and four and, in 2019, 58 and 12.
At the Hospital Infantil Sabará, also in São Paulo, anyone looking for the emergency room last Thursday (5) was instructed to sign a term authorizing the transfer of the unit if there was a need for hospitalization. “We are at 100% occupancy”, says Francisco de Oliveira Júnior, the unit’s medical manager.
RSV cases started to increase in Sabará in October. Oliveira says that, at the end of December and beginning of January, with the city emptier, attendance tends to decrease. This time, however, the hospital is receiving more serious cases, which require hospitalization and increase occupancy.
The doctor explains that the viral panel (examination to identify the presence of different respiratory viruses) is not carried out in all patients, so it is not possible to establish the number of cases caused by RSV, but he gives clues: in the last week, approximately half of tests carried out indicated the presence of the virus. In this one, about a third.
In Belo Horizonte, Mater Dei Contorno Hospital decided to increase the number of beds in the pediatric ICU. It was 16 in November when cases of bronchiolitis started to rise. Now there are 22 and, as the scenario is expected to worsen, the forecast is to reach 30 by March.
“In the last week of December, we had half the ICU beds with patients with bronchiolitis, something that only happens when March, April arrives”, says the coordinator of the pediatric ICU, Luís Fernando Andrade de Carvalho.
The doctor says that it is very common for brothers who attend school to pass the disease on to the youngest at home, so the expectation was for a reduction in cases with the start of the holidays. The numbers, however, continue to increase.
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There is no vaccine for RSV. There is a form of prevention with the polyvizumab monoclonal antibody, but this option is restricted to highly vulnerable children, such as premature babies and those with heart disease. In addition, the application is carried out following the typical seasonality of the disease.
Among the preventive measures, in addition to keeping the vaccination card up to date, the SBP highlights frequent hand hygiene, wearing masks, cleaning surfaces exposed to secretions and isolating patients with a confirmed diagnosis.
With regard to signs and symptoms, experts cite cough, fever, nasal congestion, earache and sore throat.
Oliveira also mentions respiratory discomfort, which can be identified by the greater opening of the nostrils when inhaling, showing that the child is trying to take in more air; increase in breathing rate and tightening of the muscles at the side of the neck and between the ribs, indicating effort to breathe.
The Ministry of Health also lists headache, wheezing and purple lips and nails as warning signs.
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