Roshni Mistry is a Paediatric ST5 at Whittington Health NHS trust.

James Hibberd is a Salaried GP in Islington.

In a previous article in Autumn 2020 the authors wrote of the potential dangers of managing the usual seasonal winter peak of paediatric viral infections during the COVID-19 pandemic.

In reality, there have been negligible winter rates of Respiratory Syncytial Virus (RSV) and influenza due to dramatically reduced social mixing. This is a pattern that has been repeated around the world with low rates of respiratory viral infections reported in America, Australia and Finland.

RSV levels could rise rapidly following relaxation of behavioural … interventions.

As restrictions relax however, not only has the usual summer lull in paediatric infections not occurred, but some paediatric A&Es have even reported becoming overwhelmed. This pattern has also been recognised elsewhere in the world with inter-seasonal peaks in RSV infections in Australia and the Southern United States.

Growing concern of a increasing wave of childhood infections has led the Academy of Medical Sciences (AMS) to release a report suggesting that, ‘RSV levels could rise rapidly following relaxation of behavioural … interventions, with a peak outbreak in early autumn of between 1.5 and 2 times the magnitude of a ‘normal’ year’.

It isn’t clear why these increases are happening but data from an American study  suggests that the interventions put in place to control the pandemic may have reduced the childhood population’s resistance to normal endemic diseases leading to a ‘build-up of susceptibility’.

This matters because, as the AMS report points out, ‘A peak in RSV would put pressure on primary care, which sees the majority of RSV patients’. If we have learnt anything from the COVID-19 pandemic it is the importance of being as prepared as possible. As we come out of the worst of the restrictions put in place it is important that GPs consider how best to manage the paediatric infection surge that is likely just around the corner.

 

Featured photo by Nathan Dumlao on Unsplash