Origin virus, treatments, hospitalizations… What you need to know about bronchiolitis – Liberation

With a sharp increase in the number of children in the emergency room in recent days, the bronchiolitis epidemic is proving to be early this year. Bloodless, the pediatric services are struggling to take the hit.

As an indicator… The bronchiolitis epidemic hits where it hurts: the lack of resources allocated to the healthcare system. The increase “important, fast and early” epidemic indicators, reported by Public Health France on Wednesday, is putting a strain on pediatric services. Unlike Covid, health professionals know the disease very well but find it difficult to respond to it correctly. Closure 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 around with the experts.

What is bronchiolitis?

Bronchiolitis is a respiratory disease of the small bronchi, caused by 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. Often, it heals spontaneously after ten days, although the cough may persist. Fever may also be present. Even if most of the time it is benign, it represents a particular risk “for premature infants and those with heart disease or chronic disease,” explain to Release Professor Olivier Brissaud, head of the pediatric intensive care unit at Bordeaux University Hospital.

The disease is very contagious and is transmitted by the respiratory route and by contact with the hands – and certain objects. It is possible to prevent it and reduce the risks by “washing your hands, putting on a mask when you have a cold and avoiding having too many people at home”says pediatrician Rémi Salomon, director of the pediatric nephrology department 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”. To the hospital, “we do not give antibiotics unless there is a superinfection with a bacterium”, continues Professor Brissaud.

So far, there is no actual 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 medicine to be able to prevent severe forms of bronchiolitis in all babies, with a single dose. It consists of injecting monoclonal antibodies, that is to say synthetic antibodies produced in the laboratory. “This new treatment is a significant step forward. The advantage is that it has a longer lifespan than the treatment we already knew. It has been manufactured in such a way that it will protect the child for six months, although the effectiveness decreases from the third month.decrypts Olivier Brissaud.

Currently, a preventive treatment is available but it is 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 the age of 2 went to the emergency room for bronchiolitis in mainland France during the week of October 24 to 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 very beginning of the peak. It is possible to think that we will still have between four and five weeks of peak. However, it is impossible to say on what date we will begin to take the descendant, explains Professor Laurent Dupic, head of pediatric Smur at Necker Hospital and member of the Inter-hospital Pediatrics Collective. It’s a strong year, certainly, but it’s not the delta of importance that alters the system, it’s the fact that there are not enough beds. His colleague Rémi Salomon supports these remarks: “I’m not saying that the winter epidemic is not strong, but it could be managed with more means. We are short of doctors in town and we are forced to transfer patients because we are overwhelmed.

“Emergencies are the front door and the staff are in very great difficulty. At the Bordeaux University Hospital, there are between 170 and 190 visits per day. Children are often very small and their respiratory disease is quite severe. Hospitalizations have increased a little, explains Professor Brissaud. However, this disease has been known to health professionals for about forty years and they know how to deal with it. “The problem isn’t bronchiolitis per se, what’s wrong is that the hospital is dying and needs to be dealt with,” 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 the Covid either, it’s always a question of means. This year “hospitals triggered white plans as the situation is almost the same from year to 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 children who need resuscitation in classic service while waiting for a place to become available. We have a delay in the care of patients, which makes the situation catastrophic and untenable., 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 hear the alarm signals carried by the people on the ground. They warned that we were heading towards a situation that was looming at best tense, at worst catastrophic..

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