Written Statement: Paediatric respiratory syncytial virus

Necessary preventative measures e.g. hand-washing, masks, social distancing, taken during the COVID-19 pandemic, have resulted in an almost complete elimination of common respiratory viruses affecting children, including respiratory syncytial virus (RSV). This means that the current UK cohort of children and adults who have not been exposed to RSV is considerably higher than normal. The usual seasonal epidemic pattern of RSV was disrupted in Wales last year with only small numbers of cases seen during 2020 and early into 2021.

As social mixing restarts, we expect the RSV season to occur earlier than in previous years.  Public Health Wales surveillance data already shows RSV activity in Wales has exceeded the threshold that would indicate onset of seasonal activity of RSV. The surveillance shows positive samples for RSV infection in Wales have increased over the last four consecutive weeks from 1.9 per cent to 9.9 per cent.

It is also likely the RSV season will be of higher intensity than in previous years, potentially putting increased pressure on paediatric services. Other countries within the northern Hemisphere, including USA and France, reported unseasonal increases in RSV activity during the spring of 2021.

RSV is the most common childhood respiratory infection and most children will have had RSV by their second birthday. Very young children and vulnerable children (usually under 3 months of age) are at particular risk of paediatric critical care (PCC) admission because their airways are smaller and when inflamed (bronchiolitis) can cause breathing difficulties. The typical autumn / winter rise in RSV infections (with a peak usually occurring around December) results in significant pressures on primary care, emergency units, hospital admissions, critical care and elective surgical capacity.  

Infants identified as being at highest risk from RSV are eligible to be immunised with palivizumab, administered as an intramuscular injection, to provide protection against infection and to decrease the risk of hospitalisation. Five doses of palivizumab are usually required to cover the typical RSV season. If the RSV season was to run for longer than a typical season, up to seven doses may be given.

We have set up a group, jointly chaired by the Deputy Chief Medical Officer and Interim Chief Nursing Officer, to oversee the planning and response to a surge in the number of children contacting RSV.  Actions taken so far include:

• an all-Wales bronchiolitis pathway has been developed
• each health board has developed a plan to surge the number of paediatric beds and increase their capacity to look after children who need more acute care
• plans to double the number of level 3 invasively ventilated critical care beds at the paediatric critical care unit in the Children’s Hospital for Wales.
• additional training provided to staff who may need to be redeployed or upskilled
• ongoing work to ensure additional equipment is available if required
• commenced the roll out of palivizumab passive immunisation against RSV in at risk pre-term infants, as defined by the Joint Committee for Vaccination and Immunisation.
• The Technical Advisory Cell has undertaken modelling on the expected RSV surge and the likely impact, which will help inform decision-making and planning

We are working closely with colleagues on a UK wide basis, and with NHS England in particular to maximise the available paediatric critical care capacity, particularly in relation to North Wales who access level 3 paediatric critical care in England.

Public Health Wales undertake childhood RSV surveillance, and RSV activity is reported in the Public Health Wales weekly flu surveillance bulletin.

A press statement was issued by Public Health Wales on 23 July 2021 highlighting the rise in childhood respiratory infections in Wales. Parents are being encouraged to look out for symptoms of severe infection in at-risk children, including a high temperature of 37.8°C or above (fever), a dry and persistent cough, difficulty feeding, rapid or noisy breathing (wheezing).

Some children under two, especially those born prematurely or with a heart condition, can suffer more serious consequences from these common infections such as bronchiolitis, an inflammatory infection of the lower airways – which can make it hard to breathe.

The best way to prevent RSV is to wash hands with soap and water or hand sanitiser regularly, dispose of used tissues correctly, and to keep surfaces clean and sanitised.

We want all parents and carers of babies and young children need to be aware of the signs of RSV. In the vast majority of cases these illnesses won’t be serious and they will soon recover.  

This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Senedd returns I would be happy to do so.