ICUs are no longer filled with babies with bronchiolitis: why?

BarcelonaVaccines and immunization strategies are the most effective public health measure to prevent serious diseases and complications. The most recent example is bronchiolitis, which until now was the leading cause of hospitalization in children under 1 year of age in Catalonia. Two years ago, the Department of Health launched a vaccine against bronchiolitis. a campaign against respiratory syncytial virus (RSV), the pathogen that causes this pathology, to protect babies under six months old. Thanks to the good coverage this year, admissions to intensive care units (ICU) fell by 90%, infections were reduced by almost 70% and visits to emergency rooms fell by half (55.5%).

"It is a before and after in the approach to this disease," said the Secretary of Public Health, Esteve Fernández, in a press conference this Tuesday during the IV Symposium on Respiratory Syncytial Virus, organized at the Hospital Sant Joan de Déu. Before, this disease collapsed emergency rooms and health services, since many of the children required hospital admission due to the complications derived from it, but that is now "in the past," said Fernández. This year, a provisional global coverage of 90.73% has been achieved, while last year it was 87.8%.

Bronchiolitis is a "very worrying" disease that can cause very long hospital stays for children, as explained by the pediatrician at the San Juan de Dios ICU and deputy medical director of the center, Iolanda Jordan. Two years ago, this hospital had an average of 120 admissions due to complications arising from bronchiolitis per year, but since the immunization campaign was launched, the number has fallen to 47, that is, almost a third of the total number of hospitalizations previously existing. According to Jordan, this data had never been recorded.

Bronchiolitis is a "very worrying" disease that can cause very long hospital stays for children, as explained by the pediatrician at the San Juan de Dios ICU and deputy medical director of the center, Iolanda Jordan.a common respiratory infection in children under two years of age, especially during the cold months of the year. The disease causes inflammation of the bronchioles, which are the smallest tubes that are responsible for transporting oxygen through the lungs from the bronchi to the alveoli. This inflammation causes mucus to form, making it difficult for air to enter and leave the lungs. Babies who contract the disease are not only at risk of developing a serious respiratory condition that requires hospitalization, but it can also lead to the development of wheezing or recurrent bronchitis in the first years of life.

Risk of pneumonia

The protection of these children against severe pneumonia, which is the great nightmare of parents of infants, comes from nirsevimab, a monoclonal antibody that prevents complications associated with the virus that causes bronchiolitis. It is not exactly a vaccine, because there is no inoculation of any virus, but antibodies are administered that make it difficult for RSV to enter the cells. A single dose has an almost immediate impact: the baby generates defenses at the time of receiving the injection and they last for five months. Immunization has been carried out in primary care centers (CAP) for those born between April and September and in hospitals for those born from October onwards.

Patients with severe bronchiolitis admitted to ICUs requiring mechanical ventilation may suffer, as a complication, pneumonia. According to a study by the Hospital Sant Joan de Déu, these children have altered microbiota. Carmen Muñoz-Almagro, one of the authors of the study and a microbiology specialist at the hospital, explains that they analyzed the microbes in the mouth and nose of children to identify patterns that could be related to the disease and the risk of needing mechanical ventilation. "These singularities can serve as initial markers of the risk of ventilator-associated pneumonia and guide prevention strategies in pediatric ICUs," says the expert.