“Children are important vectors for influenza transmission”

“This time of year, the pediatric population is affected by respiratory illnesses, particularly bronchiolitis and influenza.”

“Nirsevimab is a monoclonal antibody, it is not a vaccine, which is why we talk about immunity and not vaccination”

Pediatrics It is an indispensable medicine from conception to puberty. This specialty involves everything related to the care of healthy newborns, children and adolescents, as well as the approach to comprehensive and ongoing integrated medical care of sick children and adolescents.

Gregorio Marañón, Director of the Department of Pediatrics at the Infant Hospital, Doctor of Medicine at the Autonomous University of Madrid, and Associate Professor of Pediatrics at UCM since 2017. Rosa Mª Rodriguez Fernandez, will speak O’Connell Changes in Spanish paediatrics in recent years, the main diseases that children suffer from, as well as seasonal illnesses such as bronchiolitis or influenza, which are particularly prevalent throughout the country this winter.

Question: Will this winter be particularly difficult for little ones because of seasonal illnesses like bronchiolitis and the flu?

Answer: This is an epidemic seasonal disease that occurs every year from October to March. Most cases of bronchiolitis during epidemics are caused by respiratory syncytial virus (RSV). It primarily affects pediatric one-year-old infants and produces respiratory symptoms that sometimes require admission to hospital for oxygen and respiratory support.

Every season, during the cold months, we see a significant increase in care activities related to this epidemic of bronchiolitis, caused by respiratory syncytial virus, in health centres, emergency services and hospitals. In 2020, coinciding with the covid-19 pandemic, something unexpected happened, namely that the virus almost disappeared during the winter and reappeared outside of the colder months of summer 2021. This may be due to the use of masks and social distancing during the epidemic. Subsequently, respiratory syncytial virus gradually returned to seasonality, and a significant bronchiolitis epidemic occurred in the winter of 2022-2023.

In the 2023-2024 season, the fact is that the epidemic is much milder and there are significantly fewer cases admitted to hospitals.

Q: – With the new RSV vaccine being given to newborns, how are immunizations changing for young children?

A: Nirsevimab is a monoclonal antibody, it is not a vaccine, which is why we talk about immunity and not vaccination. It is a monoclonal antibody directed against RSV surface fusion protein F. Clinical trials have shown that it is effective and safe for infants. The advantage is that it has a long half-life, which means that one dose at the beginning of the outbreak in October can prevent infection in October. Lasts 5 months. station.

This year, for the first time, the monoclonal antibody is being administered to infants younger than 6 months old and, of course, to all newborns between October and March at the start of the season in October. Susceptible groups: people with heart disease, premature infants, bronchopulmonary dysplasia, etc. In fact, the situation in health centers this winter is very different from previous years. The number of infants admitted to hospital with RSV bronchiolitis has significantly decreased, and it can be said that the epidemic is much milder than in previous years. Most children admitted to hospital with RSV infection are unimmunized children or children older than 6 months of age.

Q: What general steps can be taken to prevent bronchiolitis?

A.- Among the general measures to prevent RSV bronchiolitis, we can focus on promoting breastfeeding, avoiding passive smoking in children, avoiding crowds and mass gatherings when there are babies at home, and practicing good hand hygiene.

Q: If children are the primary spreaders of influenza among susceptible populations, how should we treat them?

A: It is well known that children are important vectors for the spread of influenza, but they also get the flu and sometimes develop significant symptoms. This season, the Vaccine Advisory Committee of the Spanish Pediatric Association recommends that all children aged 6 to 59 months, as well as those in high-risk groups, receive the influenza vaccine. Influenza vaccination is also recommended for children who live with high-risk adult patients. Therefore, the best course of action is to get a flu shot.

Q:- What diseases can lead to admission of children to hospital?

A: This time of year is dominated by respiratory illnesses, especially bronchiolitis and influenza.

Q: Are new treatments, artificial intelligence… innovations and advances in pharmacology reaching this population?

A.- Regarding respiratory syncytial virus and bronchiolitis, progress is mainly in the area of ​​prevention, of which there are two types: long half-life monoclonal antibodies (nirsevimab) and maternal RSV vaccination to prevent neonatal infection with RSV, the virus, at the beginning of life A few months of virus.

Overall, outside of the field of respiratory viral infections, in the next few years we will see advanced cell and gene therapies in different areas in pediatrics: pediatric oncology-hematology, neuropediatrics, etc. On the other hand, some advanced therapies in the pediatric field have become a reality, such as CAR-T therapy in the field of oncology and hematology, or therapies based on CRISPR technology or gene therapy in the field of neuropathology. Certainly, advanced therapies will represent important changes in our profession.