A similar picture is emerging everywhere in Germany, says pediatrician Robin Kobbe. He researches infections in children at the Eppendorf University Hospital (UKE) and the Bernhard Nocht Institute in Hamburg. In the emergency rooms of some hospitals, infections are increasing again after a slight drop during the autumn holidays, he says: “Even here in Hamburg, in the emergency room and also in private surgeries, respiratory diseases are quite common and the rescue center is full.”
Founded by the University of Dresden and the German Society for Pediatric Infectious Diseases The nationwide system for registering respiratory infections in children is striking: Most of the children who come to the hospital for this reason are infected with the so-called human respiratory syncytial virus (RSV). This is also reported by Reinhard Berner, director of the Children’s Hospital in Dresden. RSV is a common virus that also infects adults. For them, the infection usually takes the form of a mild cold. However, younger children in particular have narrower airways, which means that bronchitis can develop more quickly and the infection can be particularly severe.
Training effect for the immune system
The fact that so many children are affected is also due to the preventive measures taken during the corona pandemic, says Hamburg pediatrician Kobbe. He talks about an “immunological gap”: Because many people’s immune systems have seen fewer pathogens in the past two or three years when they wore masks and kept their distance, they weren’t trained. It was not “immunologically held in check” by mild or asymptomatic infections.
An explanation that is hotly debated among parents on social media – and often with an ideologically motivated flavor. According to some, measures to protect against the coronavirus would leave young people with an “immune debt”, i.e. they would permanently damage the immune system. Now other viruses could attack more violently. However: Infection “may not have our immune system,” virologist Isabella Eckerle wryly tweeted. “There is no ‘infection bill’ you have to work your way through to break even at the end of the year.”
Friedrich Reichert, chief physician of the pediatric interdisciplinary emergency department at the Stuttgart clinic, says: “The immune system works great even when precautions have been taken. There is no evidence that the absence of infections weakens the immune system in any way.” .” So the “training effect” isn’t really necessary—but it’s there nonetheless.
Because what Kobbe is talking about is certainly a consequence of the measure, but only in the form of a shift in seasonality. Last year, the seasonal wave of RSV infections started earlier and had a particularly high R value, Reichert points out. This means that there were more people who were susceptible to the virus. On the one hand, because even in known respiratory diseases, immunity decreases after a while after an infection has been overcome. This means that if the last, possibly undetected, infection was too long ago, it is easier to get infected again.
The time of initial infection is irrelevant
In addition: Due to pandemic measures, several infectious years have failed in children. 90 percent of children usually get an RSV infection in the first two years of life, 50 percent even twice. But now many of them have their first encounter with the virus only in kindergarten. These first infections are often particularly severe, with later infections easing. And some of today’s five-year-olds have yet to experience a second or third respiratory pathogen infection as a result of the pandemic. “Only this booster, if you want to call it that, has not materialized for this age group,” explains Dresden pediatrician Berner.
Doctors cannot say whether there might be an advantage or disadvantage if the initial infections occurred later, purely from an age point of view. The risk of a severe course is greatest within six months – on the other hand, infection can occur already in infancy later asthma can be the result. “Weighing the whole thing against each other wouldn’t really be scientifically based,” says Stuttgart doctor Reichert. The shift therefore takes place at the population level and, in principle, has no medical significance for the individual child.
The role of the coronavirus is unclear
The debate about the consequences of the corona pandemic for children also has an “opposite point of view”: According to the theory, the virus itself could have left traces on the immune system. Also for those who – like most children – had a very mild course of Covid-19 and did not develop any post-Covid symptoms. Some pediatricians express this assumption because it is well-known and well-documented from other viruses: for example, measles has longer-term effects on T and B cells, immune defenses against other pathogens are weakened: those who have experienced measles infection often have to stay with it for a long time fight complications.
After the flu, bacterial pathogens often have it easier, explains pediatric infectologist Reichert – for example, staphylococci. It is related to the poor function of granulocytes, which make up the majority of white blood cells. However, after Covid-19, Reichert was not able to make this observation in daily clinical practice: “The primary change in the blood picture in the first weeks looks like other viruses”. There are laboratory studies that show effects even weeks after infection. However, it has not yet been proven whether this actually leads to further infections in real life. Even pediatricians Kobbe and Berner consider such an effect unlikely. However, it is likely to be difficult to seriously investigate this, as it is almost impossible to create a control group that has not yet had a coronavirus infection.
A “normal” wave of RSV?
In fact, the perceived reality could also be deceptive, and the wave of RSV is not particularly high this year: Stuttgart doctor Reichert sees a kind of normal situation again for this time of year, last year was different. The wave looks “business as usual”, as data from Great Britain also showed. But the director of the Berner clinic in Dresden believes that cases will increase sharply in the coming weeks. Noisy The Robert Koch Institute keeps the RSV wave going, especially among young children.
Fear of overloading children’s hospitals
Pediatricians are currently particularly concerned about another virus: the flu. Normally, the “true flu” does not play a role until later in the season, often after the turn of the year. But cases are already on the rise, Reichert points out: “This year RSV and flu started at the same time.” If the flu wave is high, there will be acute supply problems. The flu pathogen also brings many children to the hospital in heavy waves—and even in normal times, children’s hospitals are structurally understaffed compared to adult medicine. In the US, there are already warnings of a “triple epidemic” of RSV, influenza and Covid-19 in children.
Also vaccinate children against the flu
Reinhard Berner from Dresden and Robin Kobbe from Hamburg therefore recommend caring for sick children at home and following hygiene measures such as hand washing, sneezing into the crook of your arm and wearing a mask if you have cold symptoms to protect vulnerable people. Otherwise, it could be like in Switzerland in the past weeks: “There, children were flown from Zurich to Lausanne because there were simply no ventilation places,” says Berner.
A number of pediatricians therefore recommend that children be vaccinated against the flu in schools and kindergartens. Several EU countries such as Finland, Slovakia and Great Britain now also vaccinate children of different age groups.
A corresponding Stiko recommendation was also expected in Germany for a long time – but apparently the coronavirus pandemic got in the way. After all, the vaccine has been around for a long time and is also approved for children. However, it is not yet possible to actively vaccinate against RSV. But the pharmaceutical company Pfizer recently published a press release that gives hope: According to it, an RSV vaccine for pregnant women has been successfully tested that also protects newborn babies. It’s too late for this wave – but maybe leverage for next fall.