INTERVIEW The virus with the highest rate of hospitalization in children can also cause serious complications in adults: “It has taken the place of the flu”

Respiratory syncytial virus (RSV) infection is the most common of the serious colds in young children and can progress to bronchiolitis or pneumonia. More contagious than COVID-19, the virus is currently responsible for more illnesses in adults than the flu. HotNews spoke with two well-known doctors from Bucharest about the danger posed by RSV.

• The respiratory syncytial virus “took the place of the flu during this period”, says Dr. Adrian Marinescu, infectious disease doctor and manager of the “Matei Balș” Institute of Infectious Diseases. While the flu season is coming to an end, the number of respiratory syncytial virus illnesses remains high, both in children and in adults: “It does not have such a strictly seasonal component as the flu.”
• Among the viral infections of small children, the respiratory syncytial virus has “the highest rate of hospitalization, the highest rate of complications and, unfortunately, can even lead to death”, explains Dr. Mihai Craiu, pediatrician at the National Institute for Mother and Child Health. But not only children are affected.

We are talking about a virus that “affects extreme ages”, according to infectious disease doctor Adrian Marinescu: elderly people or adults with chronic conditions and low immunity can be just as affected as children, and in some cases serious complications or even death can result.

“In terms of severity, it has the same potential as the flu, in the case of adult patients”, adds Dr. Mihai Craiu.

There is no specific treatment for this infection, according to the manager of the “Matei Balș” Institute: doctors treat the symptoms and possible complications, but there is no targeted treatment for the virus.

Regarding prevention, there is a vaccine, but it is not compensated in Romania, unlike other countries.

A virus that “did not enter the public eye”

In Romania, no institution centralizes the number of respiratory syncytial virus infection cases, as happens with flu illnesses.

“Until now, this virus has not come to the attention of the public and the media in Romania, because for a long time we did not look for it, we did not test for it. The patients were labeled with bronchopneumonia, intubated and ventilated. Some were doing better, others did not lose the fight. But without knowing who is the “unwanted guest” who attacked the lower airways”, explains Dr. Mihai Craiu.

He adds that testing for RSV, a rarity before the pandemic, is now much more accessible.

It affects extreme ages

In the case of children under one year old, respiratory syncytial virus infection is the main cause of hospitalization both in Romania and in the world, says pediatrician Mihai Craiu, in the dialogue with HotNews.

But also in the case of adults, during this period, in terms of the number of illnesses, “influenza viruses are replaced, to a large extent, by the respiratory syncytial virus. There are more cases than the flu. It is an upward trend”, explains Dr. Adrian Marinescu, manager of the “Matei Balș” Institute, for the HotNews audience.

This is due to the fact that this virus “does not have such a strictly seasonal component as the flu. It also depends on the season, but to a lesser extent than the flu,” adds the infectious disease doctor.

In April, for example, flu cases are exceptional, but not respiratory syncytial virus cases, says Adrian Marinescu.

And right now “we have illnesses. I wouldn't say it's an explosion, but there are cases that we have every day: grandparents or adults with chronic conditions.”

Most of the patients have mild forms of the disease, but there were also people who suffered complications and needed hospitalization in Intensive Care, even if these cases are rare, says the doctor.

There is no specific treatment for infection with this virus: “The intervention must be done in relation to the symptoms, on the one hand, but also to the subsequent complications. If we have a patient with major complications, we intervene at the level of those complications: for example, it can lead to kidney failure, organ changes.”

Testing for VSR, from “luxury” to fast results

Only a few years ago, the diagnosis of respiratory syncytial virus (RSV) infection was a “luxury” reserved only for large hospitals, generally university hospitals.

The Institute for Mother and Child Health, where Dr. Mihai Craiu works, was the first hospital in Romania to test for RSV, as early as 2009, he says: “It was my prize at a world congress of pediatric infectious diseases that took place in Warsaw. I received a whole set of test kits, which I used for about half a year.”

Currently, however, thanks to an “unexpected legacy” left by the pandemic, diagnosis with this virus is possible in no more than 10 minutes.

“Initially, respiratory syncytial virus infection was diagnosed almost exclusively by elaborate virological tests, the famous PCR tests. There were some detection cassettes for several viruses, called multiplex cassettes. It cost between 100 and 200 euros for a single test, not to mention the fact that they were only available in university hospitals or in areas where scientific research was carried out. For example, family doctors did not have access to these tests”. explains Dr. Mihai Craiu.

During the pandemic years, rapid antigen tests have developed a lot, and more and more hospitals and doctors' offices have access to them. “Now, in less than 10 minutes, we have the diagnosis. It's just like the rapid flu test you buy at the pharmacy.”

Due to the expansion of testing, Dr. Mihai Craiu says that “at this moment, we know that the respiratory syncytial virus not only affects small children, that it affects all ages. But it affects as severely as the little ones, up to 2 years old, and their grandparents, that is, the seniors.”

The symptoms. “It's not a simple cold”

Respiratory syncytial virus infection is the most common of the serious colds in young children and can progress to bronchiolitis or pneumonia.

“It's not a simple cold, just a runny nose. The videos with children with functional respiratory syndrome are very impactful,” says Dr. Mihai Craiu.

Doctors at the Institute for Maternal and Child Health test for RSV all the little ones who arrive here with symptoms of bronchiolitis – an infection of the lower airways.

But what are the signs that should attract the attention of parents that it is time to go with the little one to the hospital?

“The answer is very simple: it's called respiratory distress or functional respiratory syndrome. The child's difficult, labored breathing,” explains Dr. Mihai Craiu.

“The parent should not be afraid of a little temperature and cough. In the case of fever, we try to hydrate him better, lower the fever, give antithermics.”

“But if we notice wheezing, difficult breathing, with movements of the head back like a piston and beating of nasal fins – the child seems to smell something, a flower or a perfume, and opens the nasal fins – and the belly also seems to work like a piston – the chest is raised, and the child breathes almost exclusively with the belly – then we need to go to the hospital”, is the pediatrician's advice.

At that point, “the little one can't be treated at home, neither with plantain syrup, nor with honey, nor with antibiotics. The child needs monitoring, oxygen and possibly non-invasive ventilation, if not more.”

More contagious than COVID-19

During the pandemic, recalls Mihai Craiu, there was often talk about the number of people to whom a person infected with the SARS-CoV-2 virus could transmit the disease.

A patient with COVID-19 could infect 2-3 other people.

With measles, for example, the contagiousness is much higher: the virus is transmitted to approximately 16-20 other people, explains Dr. Craiu.

Respiratory syncytial virus is more contagious than SARS-CoV-2, but less than measles: depending on the season, an infected person can transmit it to 4-5 other people.

“If we take a child with a runny nose, who coughs a little, to the nursery, if he has an RSV infection, he will transmit it to 4-5 other children. Sometimes, it also leads to respiratory failure,” says Mihai Craiu.

For this reason, young children in the initial phase of the disease, which is the most contagious, should not be taken into the community: “Even before the onset of wheezing and functional respiratory syndrome, the child is very contagious.”

Respiratory syncytial virus is not only more contagious than COVID-19, but also more dangerous for children, says the pediatrician: “In general, cases of RSV in young children are more serious than the disease of COVID. There are many more children who need oxygen, who need a ventilator and who have developed life-threatening complications than in the case of COVID-19.”

“And yes, one can also die. I don't like to say this,” adds Dr. Mihai Craiu.

The number of illnesses is not known

In Romania, the number of respiratory syncytial virus illnesses is not distinctly centralized, like the number of flu cases. The National Institute of Public Health only publishes weekly data on the total number of acute respiratory infections and influenza illnesses.

At the Institute for Mother and Child Health, “we have a really efficient emergency department for a small hospital”, says doctor Mihai Craiu. Here, “we run 45,000 to 55,000 urgent presentations a year.”

Of these, the doctor says, 4-5 thousand are bronchiolitis. “Typically, one-tenth of presentations are associated with respiratory viruses. And if we look at who produces them, one of the most common post-pandemic causes is respiratory syncytial virus.”

“Fortunately, this year we didn't have any deaths from respiratory diseases. But there were children who needed ventilation,” he adds.

There is a vaccine, but in Romania it is not compensated

There is a vaccine that prevents infection with respiratory syncytial virus, but it is not compensated in Romania. The price of the vaccine in pharmacies is almost 2,000 lei.

The respiratory syncytial virus vaccine can be given to pregnant women, to protect newborns, and adults over 60 years of age.

Like the vaccines against SARS-CoV-2, the vaccine is available both in “conventional” form and based on messenger RNA, explains Dr. Mihai Craiu.

In countries where the vaccine is compensated – Spain, Italy, Great Britain – the number of cases is lower. In Romania and other countries, where the vaccine is only available for a fee, the number of cases decreased during the pandemic, following isolation measures. But it continued to grow in the years after, the pediatrician says.

Mihai Craiu believes that, in terms of respiratory syncytial virus prevention, “we should focus on the two arms of U – very young children and the third age”.

If in the case of children, mothers should be vaccinated during pregnancy to give them immunity, the grandparents of these children, who “take a lot of care of the little ones and thus end up coming into contact with the virus”, sometimes suffer “some complications that come on fragile ground, either from age or from associated diseases”.

For this reason, Mihai Craiu would like that, in Romania, the vaccine be compensated for the most exposed categories.

“Some regulations should be made. Because RSV infection, really, is one of the diseases that costs a lot of money to care for and produces complications as severe as the flu. Not as common as the flu – unlike children, RSV infection is less common in adults. But in terms of severity, it has the same potential as the flu.”