Ein Arzt untersucht ein krankes Kleinkind, das auf dem Schoß von seiner Mutter sitzt Ein Arzt untersucht ein krankes Kleinkind, das auf dem Schoß von seiner Mutter sitzt

RSV – omnipresent and yet forgotten?

Human respiratory syncytial virus - at least some of you have heard of this tongue twister - until winter 2022: Pediatricians in Germany report extremely high numbers of cases of RSV in infants and small children. Practices and clinics are reaching their limits. The RS viruses attack the lungs and airways and can cause severe symptoms. Vaccines against RS viruses are not yet available in this country - but there is news.

What are RS viruses and what are the symptoms?

Acute shortness of breath, severe coughing and rapid breathing: This is an indication of an RSV infection, especially in small children. RSV stands for "Respiratory Syncytial Virus". It is a very common virus that can cause mild to severe respiratory diseases, particularly in infants, young children and older adults.

While the world was already struggling with Corona as a serious lung disease, the RSV wave came in Germany in winter 2022. Paediatricians were stretched to the limit of their capacities: compared to previous years, 5x more babies and toddlers with the virus had to be treated in a clinic.

Coughing, runny nose or sore throat occur at the beginning of an RSV infection. After one to three days, the lungs and bronchi can also be affected, resulting in a stronger cough. The condition of the infected children can quickly deteriorate significantly. In addition to loss of appetite and nausea, acute shortness of breath is a common symptom in severe cases. The congestion in the bronchi makes it difficult for the sick children to breathe out, resulting in poor oxygen saturation and a blue discoloration of the skin.

What is insidious about RSV infection are the partly unspecific symptoms, which rapidly worsen and can result in numerous visits to the doctor in a short time. Sick children are therefore often hospitalized for observation.

Where did the 2022 RSV infection wave come from?

Why was the RSV wave so violent in winter 2022? The health insurance company DAK-Gesundheit commissioned a study on this question, and the results support the assumptions of many doctors: The large wave of RSV infections in infants and small children is a so-called catch-up effect of the corona measures. Due to the ban on contact and the closure of day care centers and schools in winter 20/21, children were isolated from infections - and were therefore unable to form any antibodies. After the protective measures were then relaxed, the RS infections rose very sharply.

According to the Robert Koch Institute (RKI), up to 70% of children have an RSV infection in their first year of life, and almost all of them by the age of two. However, due to the corona protection measures, these infections were almost non-existent.

According to the DAK analysis, extrapolated to all children living in Germany, around 17.000 children under the age of 12 months are hospitalized. That is five times more than in the same period of 2018. At the same time, the proportion in intensive care units has increased by 350 percent.

How can I get infected with RSV?

The RS virus is transmitted from person to person by droplet infection, e.g.B through coughing, sneezing, or through infected objects. The virus can survive on hands for up to 20 minutes and - according to scientists - for up to several hours on contaminated surfaces and thus remain contagious for this period of time.

In principle, you can become infected at any age, even if you have already had a "passive vaccination". There is no long-term immunity to RSV. People with previous lung diseases, certain heart defects or a weakened immune system are particularly at risk.

Vaccine approved in the EU

The development of a vaccine against the RS virus has been researched for decades. The vaccine from the British pharmaceutical company GlaxoSmithKline (GSK) has now been approved in the USA and the EU - initially only for people over 60 years of age. The market launch of the vaccine is then scheduled for autumn 2023, before the next RSV season begins.

In the summer of 2021, 25 people worldwide were already involved in a study on the effectiveness of the GSK vaccine.000 people participated. The focus here was on seniors. From Germany, 200 people over the age of 60 took part in this study; The place of study was the Klinikum Würzburg Mitte. The effect in the following RSV season in winter 2021/22 was significant, reported chief physician Prof. Tino Schwarz told the Augsburger Allgemeine Zeitung after the study: "In 94 percent, the vaccination protected against a severe course, in 83 percent against milder RSV diseases.Schwarz continues: "The effect on seniors is impressive."

The RSV vaccine race is on; many other pharmaceutical companies want to enter a quite large market with RSV vaccines. As with Corona, the companies are relying on mRNA vaccines. In addition to older people, Pfizer and Co have a second target group in mind: pregnant women. Because with a vaccination towards the end of the pregnancy, the mother should be able to transfer the antibodies to the unborn child and thus ensure protection in the first months of life. This principle of antibody transfer is already used in other vaccinations, such as whooping cough or influenza.

Arm von Frau, die gerade geimpft wurde und noch einen Wattetupfer auf ihre Wunde gedrückt bekommt

In addition, research is already being done on active and passive vaccines; In addition to vaccination shortly after birth, administration of antibodies (passive immunization) can also be possible.

How is RSV tested?

The most reliable method of detecting RS viruses in the human body is a PCR test. This can be done by means of nasal or Throat swab or a gargle test and then analyzed in the laboratory. Although rapid antigen tests provide a faster result, they are less specific and valid. Blood tests look for RSV antibodies; these tests provide well-founded information on past RSV infections, but they are less helpful for the acute diagnosis.

Sources:

RKI - RKI guide - Respiratory syncytial virus infections (RSV) How safe are the new RSV vaccines from the USA? (faz.net) Würzburg: Fight against RS virus with help from Würzburg: The vaccine for seniors and pregnant women is coming so quickly (augsburger-allgemeine.en)