SOUTH AFRICA – National Institute of Communicable Diseases (NICD), the national public health institute of South Africa, has announced an unusual rise in respiratory syncytial virus (RSV) cases in infants that may be associated with higher than usual RSV circulation.

Respiratory Syncytial Virus is a leading cause of bronchiolitis and lower respiratory infections (LRTI) in infants, vulnerable young children and immunocompromised individuals with no existing efficient therapeutic that is estimated to affect 64 million people around the world every year.

According to Head of the National Institute of Communicable Diseases Professor Cheryl Cohen, LRTI is among the most common causes of death in young children in South Africa, it is estimated that between 178 000 and 443 000 children under the age of five will be infected with RSV annually.

Infants under six months of age, children with underlying chronic illness such as chronic lung conditions, heart disease or immunodeficiency along with infants born prematurely are at greatest risk of developing severe disease.

RSV is the most common cause of bronchiolitis and lower respiratory tract illness among young children. It is highly contagious and infection with RSV does not result in
permanent or long-term immunity and re-infections can occur.

RSV is a highly contagious virus spread by infected droplets produced when coughing, sneezing or kissing, by touching surfaces contaminated with the virus and then touching your eyes, nose or mouth. Moreover, children are often exposed to the virus at school.

The National Institute of Communicable Diseases highlighted preventive measures to curb the spread of the respiratory syncytial virus transmission including isolation of children with influenza-like symptoms and teaching children as well as adults looking after infants to practice sneeze and cough hygiene

In addition, NICD urged healthcare providers, clinicians and pediatric hospitals including intensive care units in South Africa to prepare and allocate adequate resources to respond to the anticipated surge in RSV cases as well as an increase in pediatric admissions during the 2022 RSV season.

A mathematical modelling study conducted by NICD in 2021 suggests that South Africa will see a third percent increase in RSV cases in children compared to the pre-pandemic period and that the age group will shift to a slightly older age group with more children aged six months to two years affected.

The modelling studies state that infants last year didn’t really experience RSV season so they didn’t develop immunity to the respiratory virus, highlighting that the immunity gap created over the last two years would lead to an unusually severe RSV season.

Although there is no vaccine to prevent RSV infection, several promising vaccine candidates are under development that would likely be cost-effective for South Africa as RSV-targeted interventions are likely to be an important component of infant mortality rate reduction strategies globally.

Meanwhile, the monoclonal antibody palivizumab administered monthly throughout the RSV season to children at high risk of severe RSV disease has been shown to be effective for prevention but high costs coupled with the need for monthly intramuscular injections throughout the RSV season limit its use.

Professor Cohen advised pregnant women to receive the available vaccine that protects their infants and ensure their babies get the long-acting monoclonal antibody administered monthly throughout the RSV season, noting that the strategies reduced RSV illness and hospitalization by 70 to 80% in trials.

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