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Why are caregivers already alerting to a future epidemic?

Wheezing, an endless fit of coughing, 39 ° fever … In general, parents dread this kind of combo that ticks the boxes for bronchiolitis. A common pathology, but nevertheless worrying for children under 2 years old. However, after a historic winter with very few cases and hospitalizations, as of this month of October, the figures are on the rise. A trend that worries caregivers.

Indicators that invite vigilance

Bronchiolitis is a viral respiratory disease, mainly caused by the respiratory syncytial virus (RSV), which is very common and highly contagious. It affects 30% of children under 2 years of age in France each year and is the leading cause of hospitalization in pediatrics during the winter.

But in general, the curves panic around November. However, this pathology has already clearly taken hold in the landscape. From September 21, the weekly update from Public Health France (SPF) showed an increase of + 88% in emergency room visits for bronchiolitis in children under 2 years old! In its bulletin of October 5, SPF warns: “We retain a level of passages higher than the three previous years for bronchiolitis”. With between September 27 and October 3, a 24% increase in emergency room visits, 28% in hospitalizations and 14% in SOS Médecins interventions for this pathology. However, SPF only places two regions in the pre-epidemic phase: Grand-Est and Hauts-de-France. “Our departments are not full, but are experiencing unusual activity,” warns Robert Cohen, president of the National Professional Pediatric Council.

“Pediatric emergencies are already saturated!” Warns Christèle Gras Le Guen, president of the French Pediatric Society. It is difficult to know if we are already in the epidemic phase or if the epidemic wave promises to be more intense. Usually, we have time to anticipate to open additional beds. There, we are not ready. We are trying to mobilize the ARS, the hospital management, the cabinet of Olivier Véran. “

In the winter of 2019-2020, some newborns had to be hospitalized miles from their parents for lack of pediatric intensive care places … And the situation is different today. “Last winter, patients suffering from bronchiolitis were replaced by an influx of young patients affected by psychiatric disorders,” continues Christèle Gras Le Guen. The cohabitation between the latter and patients suffering from winter epidemics promises to be complicated… ”

A rebound effect?

One of the explanations for this early influx is that the 2020-2021 bronchiolitis epidemic was much lower than in past winters: 33,971 emergency room visits for children under 2 years old last winter concerned this pathology, against 56,427 the previous winter. And hospitalizations have remained low, even in December 2020, the usual peak. This has not escaped the notice of the Scientific Council, which warns in its opinion of October 5 that “this observed minimal circulation entails a risk of circulation of the virus for children not immunized during the 2020-2021 epidemic, as well as for children. children who will be born between now and the second month of circulation of the virus. It should therefore be anticipated that the size of the RSV epidemic will be larger this winter compared to previous winters, in particular if it is postponed to January or February 2022. “

Diagram showing cases and hospitalizations due to bronchiolitis over the past three years. – Surveillance of bronchiolitis / Public Health France

This fear is based on a signal from the other side of the world. Direction Australia, where the Zero Covid policy had an unexpected effect: during their southern summer, namely our winter, cases of bronchiolitis exploded. In the Brisbane region, between January and March 2021, a total of 2,251 people contracted bronchiolitis compared to 591 cases the previous year.

“There is a whole generation, born between spring 2020 and spring 2021, who has not encountered bronchiolitis,” continues Christèle Gras Le Guen, pediatrician at Nantes University Hospital. “All of this was predictable because of the immune debt linked to the measures taken against the Covid, which were nevertheless necessary”, assures Robert Cohen. Even if it is only children under the age of two who are severely affected? “While RSV affects children and adults, it is only serious in those under six months of age and the very old. It is one of the “obligatory viruses, which we catch several times [au cours de sa vie], sometimes the same year. However, the entire population has lost its antibodies, and this is what creates situations conducive to epidemics. As it is the children who express the “best” this immune debt, it is the pediatric services which are affected. “But this” immune debt “applies to all winter epidemics …

How to avoid traffic jams?

The bronchiolitis virus is spread by sneezing, coughing, hands and soiled objects by an infected person. Unsurprisingly, therefore, the barrier gestures are the same for Covid-19, gastro, influenza and bronchiolitis. In the event of a strong epidemic, pediatricians urge the reinforcement of barrier gestures, the only protection in the absence of a vaccine against this pathology. Not for the whole population, tired of the constraints, but for parents, grandparents and childminders in contact with infants. “Last year, during this period, the children were in the community and they did not have a mask,” recalls Christèle Gras Le Guen. What was decisive in this poor circulation of bronchiolitis is the attitude of adults. This is why wearing a mask when you have a cold, washing your hands very regularly, avoiding crowded places with a newborn baby is always recommended. “Given the saturation of emergencies, families must come only on medical indication or for babies under 3 months,” adds the pediatrician.

“It is also necessary to verify that the children have received the obligatory vaccines, adds Robert Cohen. No question of having meningococci, pertussis … “Especially with the Covid, some vaccines have been able to go to the ace.

“This is the time to ask the question of getting the vaccine against gastro,” adds his pediatrician colleague. A vaccine recommended, but not mandatory. The rotavirus, responsible for gastroenteritis, causes 30,000 emergency room consultations and 14,000 hospitalizations of children under 3 per year. “We became aware of the degree of fatigue of hospital workers,” concludes Robert Cohen. Can we afford an increase in overload in pediatric wards this winter? “

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