Early surge in flu, RSV hospitalisations has doctors on edge

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Influenza is spreading rapidly among Victorian children, triggering an alarming early spike in hospital admissions that has resulted in more than double the number of children hospitalised at some health services compared with this time last year.

Doctors are also warning about a worrying rise in children arriving at hospitals with respiratory syncytial virus (RSV), a potentially serious illness that can cause pneumonia in children.

Influenza is spreading rapidly among Victorian children triggering an early and worrying spike in paediatric hospital admissions this year.Credit: Damian Shaw

Dr Sarah McNab, director of general medicine at the Royal Children’s Hospital, said she could not recall a time when there had been so many cases of RSV and influenza reported among children at the health service, so early in the year.

“We have extremely high levels of children sick with both RSV and the flu,” McNab said. “Some of these children have been extremely unwell and there have been many admitted to hospital, so it makes us worry about the winter ahead.”

Monash Children’s Hospital head of infection and immunity Dr Jeremy Carr said paediatric admissions for influenza in April were 2.5 times higher than for the same time last year.

There were 62 children admitted to the hospital who were seriously ill with the flu last month, compared with 24 influenza admissions in April last year.

Doctors are urging parents to get their children immunised against the flu as soon as possible, amid growing concerns vaccination rates have plummeted to between 30 and 35 percent following the pandemic.

“The message is clear, now is the best time to get your children vaccinated as cases will continue to climb over the winter,” Carr said.

There have been more than 7200 influenza cases reported in Victoria this year, compared with 4919 for the same period last year, according to the state’s surveillance of notifiable conditions report.

There have also been 5089 cases of RSV so far this year, compared with 152 for this time last year. However, the Victorian government did not officially begin reporting RSV cases until February last year.

Exactly why these typically winter illnesses are emerging earlier remains unclear. Some experts have speculated the reason could be “immunity debt” – a phenomenon they theorise was triggered by a reduction of seasonal bugs during coronavirus lockdowns.

Carr, however, believes the answer could be more complex, noting that outbreaks of RSV and the flu never dissipated in the warmer months as outbreaks typically did pre-pandemic.

“What is so uncharacteristic about this year is that it just never went away over summer,” he said. “But we didn’t see the hospital admissions with RSV and influenza children until recently.”

Carr said the next few weeks would determine whether it would be a severe influenza season, with some experts predicting a “significant flu season back to epidemic proportions” for 2023.

“The curve is starting perhaps a month earlier than last year and when a season starts early, there are concerns that will there will be a greater exponential rise,” Carr said. “But it also may be that cases are occurring earlier this season.”

Children aged over six months are recommended to have an influenza vaccine twice, at least a month apart, and an annual vaccine is recommended after that.

Infants under six months cannot be vaccinated against the flu, so the safest approach is for women to have the injection while they are still pregnant.

About 10 per cent of children who end up in hospital with the flu can have neurological problems, such as memory loss, seizures and learning and speech difficulties.

While RSV continued to circulate unseasonably throughout summer, it had not triggered a rise in paediatric admissions significantly until last month and Carr said there were about twice as many cases of the infection compared with the same period last year.

In 2022, Monash Health reported 36 cases of RSV in March and April, but this year there were 297 for the same two-month period.

In severe cases, RSV infection can spread to the lower respiratory tract, leading to pneumonia or bronchiolitis in young children by causing inflammation of the small airway passages entering the lungs. RSV is the most common cause of respiratory and breathing infections in children.

There has also been marked increase in children with ​Invasive group A streptococcus, a dangerous bacterial infection that caused the deaths of two Victorian children, presenting in hospital in the last year.

Eight people died from Invasive group A streptococcus across Australia last year, according to figures from the Australian Bureau of Statistics, which have prompted doctors to raise awareness of the potentially deadly illness.

The infectious disease is caused by the group A streptococcus bacteria, found in the throat and on the skin. It mostly triggers mild symptoms including a sore throat, but in rarer cases can lead to life-threatening invasive group A streptococcal infections. There have been 320 cases reported between October and April this year.

Case numbers appear to have risen in December 2022, decreased in January 2023 and stabilised in March this year.

Carr said Monash Children’s Hospital had reported 13 cases between September and December last year, and another dozen between January and May.

“I think we’re past the rapid peak,” Carr said. “But we’re still seeing high numbers of presentations with really significant illnesses with group A strep, which remains a concern.”

Carr said his advice to parents was to trust their instinct when it came to their children’s health and seek medical help if they were concerned about symptoms such as lethargy, high fevers, laboured or fast breathing, a child being unable to maintain feeds or fluids. This was particularly important for children under the age of 1 year.

Parents can seek care from a medical professional including a nurse on-call service, GP or visit their nearest emergency department.

Meanwhile, the first approval for a vaccine offering protection against RSV for adults aged over 60 has been given by the US Food and Drug Administration this week.

An application to approve the same protein-based vaccine in Australia is also currently under consideration by the Therapeutic Goods Administration.

Professor Rhonda Stuart, the head of infection control and prevention at Monash Health, said the RSV vaccine announcement was significant, and she was hopeful it would soon be available for pregnant women, who could pass the antibodies onto their babies, at most at risk of severe disease.

“There are a lot exciting things happening in the future around this disease,” she said.

Nurse on call be reached on Call 1300 60 60 24

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