Origin of the virus, treatments, hospitalizations... What you should know about bronchiolitis

Origin of the virus, treatments, hospitalizations… What you should know about bronchiolitis

With a sharp increase in the number of children in the emergency room in recent days, the bronchiolitis epidemic is proving early this year. Without bloodshed, pediatric services struggle to take the hit.

As an indicator… The bronchiolitis epidemic hits where it hurts the most: the lack of resources allocated to the health system. Increasing “important, fast and early” The epidemic indicators, reported by Public Health France on Wednesday, are putting pressure on pediatric services. Unlike Covid, health professionals know the disease very well but find it difficult to respond correctly. Closing of beds, shortage of caregivers and deleterious working conditions, these are all factors that push staff to leave the public hospital. Release take a look with the experts.

What is bronchiolitis?

Bronchiolitis is a respiratory disease of the small bronchi, caused by the respiratory syncytial virus (RSV), which affects children under two years of age. The most common symptoms are colds and coughs, which can become more frequent. It often heals spontaneously after ten days, although the cough may persist. Fever may also be present. Although most of the time it is benign, it represents a particular risk “for premature babies and those with heart disease or chronic illnesses,” explain to Release Professor Olivier Brissaud, head of the pediatric intensive care unit at Bordeaux University Hospital.

The disease is highly contagious and is transmitted through the respiratory tract and by contact with hands and certain objects. It is possible to prevent it and reduce the risks by “wash your hands, wear a mask when you have a cold and avoid having too many people at home”says pediatrician Rémi Salomon, director of the department of pediatric nephrology at the Necker-Enfants Malades hospital.

What treatments?

The most common treatment protocol consists of “clean the nose and give medicine for fever when there are no respiratory signs”, according to Professor Brissaud. Things get complicated when the child has trouble breathing. In this case “You have to go to the hospital and give the child oxygen”. For very sick patients, it is necessary to use “to invasive respiratory assistance, with intubations”. At the hospital, “We don’t give antibiotics unless there is a superinfection with a bacteria,” continues Professor Brissaud.

So far, there is no real vaccine against bronchiolitis. On the other hand, the European Union has just approved a preventive treatment, passive immunotherapy, developed by Sanofi and AstraZeneca. It will be available from 2023. It is the first drug capable of preventing severe forms of bronchiolitis in all babies, with a single dose. It consists of injecting monoclonal antibodies, that is, synthetic antibodies produced in the laboratory. “This new treatment is an important step forward. The advantage is that it has a longer useful life than the treatment we already knew about. It has been manufactured in such a way that it will protect the child for six months, although the effectiveness decreases after the third month.deciphers Olivier Brissaud.

Currently there is a preventive treatment but reserved for children at risk or premature: Synargis, marketed by AstraZeneca. It requires one dose per month, from October to February.

Is it an exceptional outbreak?

According to the latest data published by Public Health France, a total of 6,167 children under 2 years of age attended the emergency room for bronchiolitis in mainland France during the week of October 24-30, a jump of 47% compared to the previous week. . And nearly 1,980 of them were eventually hospitalized. “If we base ourselves on the curves of previous years, we would be at the beginning of the peak. It is conceivable that we will still have between four and five peak weeks. However, it is impossible to say on what date we will begin to take offspring, explains Professor Laurent Dupic, Head of Pediatric Smur at Necker Hospital and member of the Pediatric Interhospital Collective. It is a strong year, certainly, but it is not the delta of importance that upsets the system, it is the fact that there are not enough beds. His colleague Rémi Salomon supports these comments: “I am not saying that the winter epidemic is not strong, but it could be managed with more means. We are short of doctors in the city and we are forced to transfer patients because we are overwhelmed.

“Emergencies are the gateway and the staff is in great difficulty. At the University Hospital of Bordeaux, there are between 170 and 190 visits per day. The children are usually very young and your respiratory disease is quite serious. Hospitalizations are up a bitexplains Professor Brissaud. However, this disease has been known to health professionals for about forty years and they know how to treat it. “The problem is not bronchiolitis per se, what is happening is that the hospital is dying and we have to treat it,” he points.

Why are hospitals so stressed?

If hospitals are struggling to cope with the surge in cases, it is not because of the epidemic. For professionals it has nothing to do with Covid either, it is always a matter of means. This year “Hospitals fired white plans like the situation is almost the same year after yearemphasizes Professor Brissaud. The big difference is that in 2022 we left with fewer hospital beds.

In Paris, for example, “We are going to keep the children who need resuscitation in the classic service while we wait for a place to become available. We have a backlog in patient care, which makes the situation catastrophic and unsustainable.laments Laurent Dupic. In addition to transfers, which are not without risk for young patients in need of imminent hospitalization and specific treatments. For him, “The Presidency of the Republic and the ARS did not listen to the alarm signals sent by the people on the ground. They warned that we were heading for a looming situation that was at best tense, at worst catastrophic..

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