Risk of hospitalization for RSV is 16 times higher in premature infants – 04/11/2023 – Health

The risk of hospitalization for respiratory syncytial virus (RSV) in premature babies, born up to 32 weeks, is 16 times greater than in babies born at term.

In babies born at 37 weeks of gestation or more, the incidence of hospitalization is 1% to 2%; in cases of premature babies, this rate is between 8% and 25%.

The mortality risk is also high for premature babies: from 1% to 4%. For babies born in the normal gestation period, the mortality is 0.1%.

The main causative agent of bronchiolitis in babies up to one year old, the respiratory syncytial virus is highly contagious and can cause seasonal epidemics of respiratory diseases in children.

The data are from the SBP (Brazilian Society of Pediatrics) and were presented this Tuesday (11) at the event “Prevention of RSV: far beyond a detail”, organized by the pharmaceutical company AstraZeneca for journalists. Present at the event were infectologist and president of SBP, Renato Kfouri, Denise Leão Suguitani, executive director of the NGO Prematuridade, and Rafaela Brites, presenter and mother of a baby who was hospitalized for RSV in the first three months of life.

RSV has transmission similar to other respiratory viruses, such as influenza, through the air, coughing or surfaces. RSV infection occurs in more than half of cases of bronchiolitis (70%) in the first six months of life, with 5 out of 10 in the first three months.

In premature babies, the risk of having bronchiolitis as a result of the infection is 60%, while other babies have a 30% chance of developing the condition within one year.

This is due to the so-called moment of prima infection, or the first time the child has contact with the virus. In babies up to 11 months old, the risk of serious illness is higher, and it increases in premature babies. Age is a protective factor, since reinfections that occur throughout life are usually milder – in adults, an RSV infection is practically asymptomatic.

With the pandemic, there has been a change in the circulation season of other viruses, and many children can become infected at a later age. In addition, hospitalization due to complications of infection in premature infants up to one year old is three times higher: 63.86 hospitalizations per thousand babies (against 20.01 hospitalizations per thousand).

For Renato Kfouri, one way to prevent serious infections and hospitalizations is through the use of the monoclonal antibody palivizumab, available on the SUS for babies considered at higher risk.

“Palivizumab was the first monoclonal antibody available for the prevention of an infectious viral disease, 20 years ago, but today we still have barriers to wide access”, says the infectologist.

Currently, the offer of palivizumab in the public network is restricted to babies up to one year old who were born at 28 weeks or less or who have serious heart or lung diseases. In the supplementary health system, the medicine is also offered for children aged 29 to 32 weeks.

“The SBP makes an attempt at dialogue based on scientific studies that show the benefits of using the antibody in babies up to six months who were born at 29 to 32 weeks to try to expand access also in the public network”, says Kfouri.

Prematurity today affects about 12% of all live births in the country, according to data from the Ministry of Health. Premature babies are at increased risk of mortality by age five from a variety of illnesses, not just RSV.

It is for this reason that the NGO Prematuridade seeks to disseminate information and expand knowledge about the virus and the possible complications of its infection. “It is essential to carry out several campaigns aimed at specific groups, such as parents, doctors, teachers and guardians, so that each one is touched with the information”, says Suguitani.

In addition to the monoclonal antibody, RSV prevention consists of non-pharmacological measures, such as maintaining good hand hygiene, avoiding contact with people who have flu symptoms, and using masks in the presence of babies up to one year of age if they have symptoms.

Studies are currently seeking the development of a vaccine that is capable of preventing RSV infection in babies up to one year old by vaccinating pregnant women, through the transfer of antibodies in breast milk, and an attenuated vaccine for application in children of 2 to 5 years, also considering the virus load in RSV hospitalizations.

According to the InfoGripe bulletin released on March 4, with data up to March 25, there was an increase in hospitalizations for SARS (severe acute respiratory syndrome) in children under four years of age in 15 states in the country in the last epidemiological week.

“We are already seeing a clear rise of VSR in the first quarter of 2023 compared to the same period of 2022, and it will be possibly the worst VSR season since 2019”, adds Kfouri.