Increase in bronchiolitis in infants caused by RSV

NOVEMBER 28, 2022: The Department of Public Health Mid-West and UL Hospitals Group are urging parents to be vigilant of their children’s symptoms, as we are seeing an increased incidence of bronchiolitis caused by RSV, and young children hospitalised.

RSV (respiratory syncytial virus) is a highly contagious respiratory disease, which generally occurs between October and April, with cases peaking in December.

RSV is mostly mild in adults and older children but can cause bronchiolitis (croup) in very young babies. This may lead to breathing and feeding difficulties and can result in hospitalisation. It can also be serious and life-threatening for older adults, individuals with weak immune systems, and children who are premature or have chronic heart and lung disease.

RSV is one of the leading causes of bronchiolitis, which is a common chest infection in babies (under six months) and young children (under two years).

According to provisional Computerised Infectious Diseases Reporting (CIDR) data, there have been 206 confirmed cases of RSV in the Mid-West region since the start of October.

Nationally, we are seeing twice as many cases of RSV as we would normally see at this time of year, which is placing increased pressure on health services. More than 50% of laboratory notified cases have been hospitalised.

Most cases of bronchiolitis/RSV can be cared for at home, and can clear between two to three weeks without treatment. However, symptoms can worsen quickly, so it is important to watch symptoms.

Advice regarding creches and childcare services

At this time of year, children may have a runny nose or slight cough, and they should not be prevented from attending if they are feeling well with one mild symptom. However, if a child is feeling unwell with more significant symptoms, or combination of symptoms (cough, runny nose and mild fever) then they should be at home until the fever and their symptoms have gone. Children may have a persistent cough for after infection for a few weeks so once the fever and other symptoms have gone, they should not be excluded for the cough alone.

Good ventilation of shared spaces, good hand hygiene and cleaning of surfaces, and good cough etiquette (coughing into tissue or elbow rather than on hands) also help in preventing spread.

Initial symptoms can include

• runny nose
• blocked nose
• mild fever (temperature of 38 degrees Celsius)
• slight cough

Further symptoms usually develop over the next few days, including:

mild fever (temperature of 38 degrees Celsius)

• a dry and persistent cough
• rapid or noisy breathing (wheezing)
• feeding less
• fewer wet nappies
• vomiting after feeding
• being irritable

Dr Marie Casey, Consultant in Public Health Medicine at Public Health Mid-West, said: “We are seeing higher rates of RSV than what we would normally record at this time of year. While most cases will be mild, this can have a disruptive impact on life at home, parents who are working, and a domino effect of potential outbreaks in childcare services and crèches. If you suspect your child has symptoms of a cold or flu, please keep them at home until they are feeling better. We want to minimise the impact this might have on our busy daily lives, and hospital services, should a child require care.”

The Paediatric Emergency Department at University Hospital Limerick (UHL) is currently managing much higher attendances of infants with respiratory illnesses than ever before.

Dr Barry Linnane, Paediatric Respiratory Consultant at UHL, said numbers of infants being assessed or treated in UHL for RSV reflected the national trend, which is rising earlier in the year towards a higher peak than previously.

“Over the past five years, incidences of RSV have reached a peak just before Christmas, and in 2021, that peak was approximately 520 cases. This year, the Health Protection Surveillance Centre reported 650 cases in mid-November. So RSV is coming earlier, and the data suggests a major peak this year,” Dr Linnane said.

He added: “RSV is very contagious and most infants will have an infection of the upper respiratory tract, with symptoms such as mild cough, cold or runny nose. But for 25% of infants, the virus goes down into the lungs and cause bronchiolitis, which can put the lungs under severe pressure, leading to hospitalisation in some cases. There are no vaccines so we have to follow advice we’ve become familiar with from COVID-19, such as hand-washing, and coughing and sneezing etiquette. However, those who are most susceptible, the under-2s and under-1s, need a lot of help with that. So we urge parents of children with symptoms not to let them mix with other people, or to allow infants to mix with anyone who has those symptoms. It’s very difficult to manage in this particular age group, but it’s imperative that we do what we can to limit the spread of RSV to protect our children and minimise pressure on the hospital system”