BRONCHIOLITIS. The bronchiolitis epidemic is still raging everywhere in France and leads to a considerable number of hospitalizations of children under 2 years old. The figures exceed the records recorded in the last ten years while the strongest of the wave is yet to come.
[Mis à jour le 15 novembre 2022 à 11h57] The bronchiolitis epidemic has spread throughout France and continues to rage. While all regions have been in the red since the beginning of November in the face of the circulation of the virus, no improvement is in sight. If contagion is problematic to contain the epidemic, the real difficulty of this wave and the number of hospitalizations it causes. Nearly 6,900 children under the age of 2 were admitted to the emergency room because of the contraction of the virus in one week according to the latest report from Public health France, dated November 9. Statistics that testify to the magnitude of the epidemic wave which is reaching record peaks as the winter season is just beginning. The epidemic peak of bronchiolitis is usually expected during the first half of December. SPF notes that “50% of hospitalizations following a visit to the emergency room in children under two years old” are due to bronchiolitis when “this percentage was around 40% during the peaks of previous seasons”. The health authority is already registering record figures compared to the previous ten years.
The bronchiolitis epidemic is all the more subject to concern as it strikes at a time when pediatric services are overwhelmed and put in difficulty by a lack of means. On November 9, faced with the saturation of pediatric services, the Minister of Health, François Braun, launched the white plans. In addition to the emergency plans which make it possible to organize the massive reception of patients by giving less time to one-off treatments, the hospitals organize transfers of patients, in particular children, to ensure the care of the greatest number. At the beginning of November, more than thirty pediatric intensive care transfers had already been carried out from Ile-de-France to other regions in order to avoid the saturation of pediatric emergencies, according to the Ile-de-France ARS.
Bronchiolitis is a highly contagious respiratory disease that mainly affects babies and the elderly is most often transmitted by adults and older children who are carriers of the virus without any symptoms or a simple cold. The epidemic spreads quickly because many people carry the virus and are contagious without knowing it. This seasonal disease usually begins in mid-October, peaks in December, and ends in late winter.
The infection initially resembles a cold or nasopharyngitis, accompanied by a slight fever. Quickly, a dry cough is added to these symptoms and the baby’s breathing is rapid and wheezing. If he is less than 6 months old, if he drinks only half of his bottles three times in a row, if he is a former premature baby aged less than three months, if he already has a respiratory disease or cardiac identified, if he vomits systematically, if he sleeps constantly or if he cries in an unusual way and cannot fall asleep, the child must be taken to the emergency room quickly. Generally, the symptoms subside in a few days and, in eight to ten days, the infant is cured – a residual cough can however persist for a fortnight, before disappearing.
In order to support healing, parents are advised to clean their child’s nose at least six times a day with physiological serum, in particular before giving him food or drink. It is also recommended to give him water regularly, in order to avoid any dehydration. Finally, splitting meals into smaller but more regular amounts aids healing. Physiotherapy sessions are sometimes also recommended to help patients breathe.
Bronchiolitis is a respiratory infection of the bronchioles (small bronchi located at the end of the bronchi), of viral origin, which affects babies. Common and highly contagious, it usually affects around 30% of babies under two years of age each year. It is the leading cause of pediatric hospitalization in children under two years of age. Causing a cough is labored, rapid, wheezing breathing, it is – most of the time – benign, although distressing for new parents. In some cases, it requires a visit to the emergency room, or even hospitalization. As a reminder, there is currently no vaccine against bronchiolitis: only its symptoms can be treated. Usually, it puts pressure on pediatric emergency services in mid-November, reaching its peak in December and ending at the end of winter.
It is recommended to limit visits to the circle of very close, non-sick adults. As far as possible, it is best not to take public transport, not to go to the supermarket or restaurant with babies under two months old, and to avoid large parties and family meals. We just have to keep these children safe from viruses, until they are strong enough to be able to resist them. It is really the first two months of life that lead children to serious forms of the disease.
If the child is infected, it is recommended, as far as possible, to find an alternative to the emergency room, not to go there directly, except for toddlers, those under two months old. The emergencies being overloaded, the other children, in particular when the symptoms are of low severity, must be taken care of by their general practitioner or their pediatrician. In the event of the appearance of the first symptoms of bronchiolitis, only children under two months old must absolutely consult the emergency room, where they will be hospitalized “a few hours or a few days for monitoring and treatment of symptoms”, specifies the French Society of Pediatrics on his website. The National Public Health Agency has given several recommendations to avoid contamination:
- By washing hands for 30 seconds with soap and water before or after contact with the infant.
- Avoid confined public places.
- Wash children’s toys.
- Ventilate the room where the baby sleeps at least 10 minutes a day.
- If an adult is sick around the child, do not kiss the baby and wear a mask.
In a press release dated November 1, 2022, the American laboratory Pfizer has announced that it is well advanced in the race for the vaccine. The health giant has unveiled the results of trials of its bivalent vaccine on pregnant women to protect the infant after birth. During phase 3 of the test, it was observed by the group that in the first three months of life, the vaccine would be 81.8% effective against severe forms of bronchiolitis, and a substantial effectiveness of 69.4% in the first six months. These percentages, which have not been corroborated by independent scientists, are nevertheless encouraging. These tests were carried out from June 2020 in 18 countries on 7,400 pregnant women.
For its part, the Sanofi laboratory had also announced on September 16, 2022 in a communicated that a first vaccine against bronchiolitis, named Beyfortus, has been recommended by the European Medicines Agency, for all babies under one year of age. This vaccine developed jointly by Sanofi and AstraZeneca would be administered in a single dose. “If approved, Beyfortus will become the first and only single-dose passive immunizing agent indicated for all infants, including those who are healthy, born at term or prematurely, or those with certain medical conditions.” added the French company. However, there is already a vaccine (Synagis) against bronchiolitis marketed by AstraZeneca. However, it is only administered in specific cases (only in at-risk or premature children).
France info specifies the operation of this future protection: “rather than a vaccine, the Sanofi-AstraZeneca injectable solution is a preventive treatment, a monoclonal antibody which will protect babies under one year of age throughout the epidemic period, it is i.e. fall and winter.” Asked by BFM TVFlorence Flamein, pediatrician and national coordinator of the Harmonie study, which is testing the effectiveness of this vaccine in real life, said that this vaccine was “a treatment that is really promising for young infants, which will probably allow protect them effectively every winter and limit over-hospitalizations.”
This preventive vaccine has yet to be approved by the European Commission. If the results are conclusive, the product could arrive on the market by 2024. For its part, the Moderna laboratory has also indicated that it is working on a vaccine intended for the elderly who are also particularly vulnerable to this virus.