"Sick all winter"

Severe RSV season is on the wane

(Bild: stock.adobe.com - t.tomsickova)

The RSV season is only just subsiding, but it is already clear that this year's wave of illness was at least as severe as in 2022/23 and in the years before the coronavirus pandemic.

This is also confirmed by Bernhard Resch from the Department of Neonatology at MedUni Graz: "In principle, we had the same timeline as before Covid-19, but a very, very high number of admissions and admissions to the pediatric intensive care unit." The Austrian Association of Vaccine Manufacturers (ÖVIH) also reported on Tuesday that there were many hospital admissions and severe cases among senior citizens.

Season a little earlier and with influenza
Compared to immediately after the pandemic, the season had shifted slightly more to the beginning of the year and ran concurrently with the influenza epidemic. Most hospital admissions were recorded at the beginning of February, when the positive rate of samples sent in was 20 percent - an epidemic situation is assumed from ten percent: After a few RSV-related hospitalizations in October, admissions increased to more than 450 in just one week in February, including 13 in intensive care.

Often serious consequences for babies and the elderly
Resch described the case of a premature baby who had become infected in hospital: "The infant's condition deteriorated massively after just a few hours, although he was actually about to be discharged. The boy was admitted to the children's intensive care unit and had to be intubated and ventilated for two weeks. After that, he had to stay in the intensive care unit for weeks, while the unaffected twin sister had already been at home for five weeks." A seven-month-old baby even died in Vienna.

A cold or an insidious RSV infection? What parents need to look out for

• What actually is the RS virus?
  The respiratory syncytial virus (RSV) is one of the most common seasonal pathogens for respiratory diseases. Most children contract RSV within the first two years of life, but all age groups can be affected. There is no long-term immunity; you can fall ill again and again.
• What are the symptoms and how does the disease progress?
  An infection usually progresses like a flu-like infection. In younger children, however, the lungs can be more severely affected, which often requires oxygen administration and even artificial respiration. The illness usually lasts around a week, but can also last much longer.
• When should you definitely take your child to the doctor?
  If children, especially infants, have persistent breathing difficulties (especially if they stop breathing) and have difficulty drinking, alarm bells should ring and a doctor should be consulted. Decongestant nasal drops can provide initial relief.

In working-age adults, RSV usually presents as a "cold" with a cough and runny nose. Older people can develop bronchitis, pneumonia and worsening of existing heart and lung diseases. According to the ÖVIH, there are around 145,000 hospitalizations due to RSV in over-65s in the EU every year, 2300 of them in Austria.

Many are now ill all winter. First they have coronavirus, which weakens their immune system. Then they fall ill with influenza - because many are unvaccinated - and then with RSV.

Stefan Winkler, stv. Leiter der Klinischen Abteilung für Infektionen und Tropenmedizin an der MedUni Wien

According to Stefan Winkler, Deputy Head of the Division of Infectious Diseases and Tropical Medicine at MedUni Vienna, RSV and influenza are now equally problematic for older people. "Many are now ill all winter. First they have corona, which weakens their immune system. Then they fall ill with influenza - because many are unvaccinated - and then with RSV." An RSV infection can be life-threatening, especially for people with a pre-existing lung condition.

Vaccines available, but expensive
Vaccines for senior citizens and pregnant women have been available since fall 2023. According to the ÖVIH, the two vaccines for people over 60 have shown high efficacy against severe courses of RSV in the approval studies; one is also approved for pregnant women. The mother's antibodies are transferred to the unborn child via the placenta. In Austria, there is a passive immunization for "at-risk infants", which must be administered once a month. A long-acting monoclonal RSV antibody has already been approved at EU level, which is only administered once per season. Discussions are underway in Austria. Another long-acting monoclonal RSV antibody is still in development.

There are therefore possibilities "to reduce the disease burden caused by RSV in Austria. They just need to be used accordingly," says the ÖVIH. However, the RSV vaccines, which have been available for the first time since last year, have to be paid for by the patients themselves and cost far more than 200 euros.