Children’s hospital ‘swamped’ by record surge in respiratory cases

Record levels of a common respiratory illness that particularly affects babies is putting children’s hospitals under unprecedented pressure. Almost 1,000 cases of respiratory syncytial virus (RSV) were notified to authorities last week, and almost 370 patients, most of them children, were hospitalised.

Case numbers and hospitalisations are already almost twice as high as last winter, which was regarded as very severe for RSV. Meanwhile, cases of flu, while relatively low, near doubled last week.

The surge in cases has led to extreme overcrowding at Children’s Health Ireland (CHI) at Crumlin and forced the cancellation of other work. “We’re absolutely swamped,” said Prof Suzanne Crowe, consultant in paediatric intensive care at the hospital. “It’s been a really terrible season so far.”

Since the start of last month up to 40 children a week have been admitted to intensive care (ICU) at Crumlin due to RSV-related breathing issues. On one day last week, Prof Crowe said, 39 children required ICU care. The hospital only has 32 ICU beds, but accommodated the overflow by opening surge capacity on a day ward.

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Crumlin has had to cancel virtually all complex surgery involving an ICU stay for the past four or five weeks due to the pressures caused by RSV cases, she said.

While other European countries are also experiencing a spike in cases, Prof Crowe said “the game has totally changed” since the development of RSV vaccines earlier this year.

Minister for Health Stephen Donnelly has commissioned an assessment of the cost-effectiveness of the vaccines – one providing protection for babies through administration to the mother during pregnancy and the other for older people – and of which would provide more benefit to the health service. The health technology assessment by the Health Information and Quality Authority (Hiqa) will take months to complete, so an RSV vaccine will not be available until next winter at the earliest.

Prof Crowe said it was vital a decision was made as quickly as possible on adding the RSV vaccine to the existing schedule of vaccinations. While the virus was very rarely fatal it exerted a significant burden on the health service in terms of illness, cost and impact on other services.

Affected children with severe RSV typically spend three to seven days in ICU and a further two weeks in hospital before being fit for discharge.

Last week 985 cases of RSV were notified, up from 730 the previous week. This compares to less than 600 cases recorded in the equivalent week last year. Almost 80 per cent of cases are in children aged under 15, but the cases among over-65s are also growing.

Parents of babies who have breathing difficulties and are not feeding are advised to seek medical attention. Prof Crowe also advised families with newborns to be cautious about visiting relatives over Christmas so as to minimise the risk of infection over the holiday period.

Dublin, as the most populated county, recorded the largest number of RSV cases, followed by Donegal, Westmeath and Cork. Longford and Louth had the lowest numbers.

Some 368 patients were hospitalised with RSV, up from 342 the previous week. Three RSV outbreaks were recorded last week.

Although the number of flu cases increased to 172 last week from 90, levels are still along way off last winter’s peak, which saw more than 3,000 cases notified in the first week of this year. The largest number of flu cases last week was in children aged 0-14 (52), followed by over-65s (48). The number of flu patients in hospital jumped to 56, from 23 a week earlier, and there were three outbreaks. There were no deaths or intensive care admissions.

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