Monika Raman, PSG College of Technology, Coimbatore
Children with severe respiratory infections are on the rise in hospitals in the UK. In toddlers as young as two months – there is an unseasonal rise in an infection called the respiratory syncytial virus (RSV). It has led to increased hospital admissions to bronchiolitis, a bronchitis-like lung inflammation.
In general, RSV is the most frequent cause of childhood lower respiratory tract infection. A variety of clinical symptoms, including upper respiratory tract infections, bronchiolitis, pneumonia, asthma aggravation, and viral-induced wheezing, may appear as RSV infection.
Bronchiolitis usually occurs in children under the age of 1 but may also be detected in children under the age of 2. RSV generally manifests as URTI, pneumonia, viral-induced wheezing, or aggravation of asthma in older children.
What is RSV?
RSV is a common human-restricted pathogen and usually spreads through hands, fomites, and aerosols. It is so common that, by the age of 2, almost all of us may have got infected with it. This virus causes a moderate illness resembling heavy cold, runny nose, and cough in a majority of patients. Such symptoms usually resolve after a week or two without treatment too.
Why some infants with RSV have minimal symptoms while others have severe symptoms is yet unknown. Age (one-month-olds are at the highest risk), gender (males are statistically at more risk than females), environmental factors like smoke exposure, underlying lung disorders, and genetic factors have all been linked to severe RSV sickness.
So why is RSV a winter disease that peaks in the summer of 2021?
In brief, restrictions introduced to prevent the spread of COVID-19 also retained other breathing viruses. Since many nations relax these restrictions, numerous respiratory illnesses are re-emerging now.
RSV can cause bronchiolitis, bronchial inflammation, the smallest airways in the lungs, however, for roughly one in three kids. It is characterized by low-grade fever, cough, coryza, respiratory difficulties, and reduced feeding. The higher risk of wheeze and asthma in later life is linked to severe RSV bronchiolitis in the first year of life.
Although bronchiolitis – managed with paracetamol and fluids, it can sometimes become a severe condition. When the breathing of a young child becomes seriously limited, symptoms may develop and cause temperatures more than 38°C, blue lips, and increasing respiratory difficulties.
Very young children – those who live in their first months – are more likely to get hospitalized because the airways are narrower. Bronchiolitis is potentially deadly, although most of the instances – may be managed. Each year approximately 3.5 million children are hospitalized worldwide, with around 5% of them die tragically.
Delayed surge:
The improved handwashing, mask usage, and reduced close contacts between individuals of COVID responses seemed to have led to a considerable decrease in the influenza season in winter 2020-21.
The same was true for RSV, with research indicating that bronchiolitis-related hospitalizations in northern hemisphere countries were 84% lower than in previous years. In Australia, there were also significant declines. Now the contrary is happening, affecting a whole year of newborns not exposed to numerous respiratory diseases due to the restrictions.
Despite this information, it is still impossible to predict which children may have bronchiolitis in the future. Individuals are designated as high-risk in some countries based on these known risk factors and given prophylactic treatments.
Palivizumab – For treatment:
Like all infectious agents, an immune response is essential to the removal of this infection. We know that high amounts of neutralizing antibodies (including maternal antibodies and antibody therapy such as palivizumab) protect against deadly illness. Yet RSV immunity is not entire or particularly persistent because most of them get reinfected all our lives. In addition, RSV shows that few immune responses increase the severity of the condition and are associated with asthma development.
They are part of why no vaccination is currently available, despite efforts by various research groups. Due to the enormous burden of the illness and the related costs of RSV, research into the creation of a well-tolerated and efficient vaccination is necessary.
Infants, school children, pregnant women, and older adults are targeted primarily in vaccination populations. Multiple vaccine techniques, including live attenuated/chimeric, whole-inactivated, particle-base, subunit, nucleic acid, and gene-based vectors, are under study. Efforts to develop long-acting (to cover an entire RSV season) monoclonal antibodies (mAbs) for babies are also ongoing.
The discovery of a well-tolerated RSV vaccine and treatment agent with clinical efficiency and cost-effectiveness remains a global health objective.
Also read: Glioma Progression influenced by Long Non-Coding RNAs
References:
- Barr, R., Green, C. A., Sande, C. J., & Drysdale, S. B. (2019). Respiratory syncytial virus: Diagnosis, prevention and management. Therapeutic Advances in Infectious Disease, 6, 2049936119865798. https://doi.org/10.1177/2049936119865798
- Respiratory Syncytial Virus: What is it? Why are child cases surging in the wake of COVID-19? (n.d.). The Economic Times.
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About the author:
Monika Raman is an undergraduate student pursuing her final year B. Tech in Biotechnology. She is an enthusiastic Biotech student aspiring for an opportunity to develop skills and grow professionally in the research field. Extremely motivated and possess strong interpersonal skills.
Read some of her published articles at BioXone:
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