Pediatric Infectious Diseases - Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

Caused by viral lower respiratory tract infection in infants and young children
Acute inflammation, edema, increased mucus

Question 2

What is the clinical presentation of bronchiolitis?

Answer 2

Cold-like symptoms
◦ Fever
◦ Rhinorrhea
◦ Cough
◦ Sneezing
Increased work of breathing
◦ Nasal flaring
◦ Accessory muscle breathing
◦ Can progress to respiratory failure in some cases
May take up to 2 weeks to resolve; symptoms often peak around day 5

Question 3

What causes bronchiolitis?

Answer 3

Many different viruses cause similar symptoms Most common is respiratory syncytial virus (RSV)!!
Others include rhinovirus (2nd most common), metapneumovirus, influenza, adeovirus, parainfluenza, coronavirus

Question 4

What is RSV?

Answer 4

One of most common diseases of childhood
Re-infection throughout life is common (no long-term immunity)
Incubation period 2-8 days
◦ Symptoms may persist for up to one month
Season generally November to April in IN (varies with location, high mask use)

Question 5

What are risk factors for bronchiolitis?

Answer 5

Age < 6 months
Pre-term birth
Cyanotic or complicated CHD
Chronic lung disease
Weakened immune system

Question 6

What is the mainstay of treatment in bronchiolitis?

Answer 6

supportive therapy!!
◦ Oxygen
◦ Hydration
◦ Mechanical ventilation
◦ ECMO

Question 7

How can you prevent bronchiolitis?

Answer 7

Non-pharmacologic: Hand washing, Isolation, “Sick pods”
Pharmacologic: Influenza vaccine, Everyone 6 months and older, Children 6 months to 8 years who have NOT gotten 2 doses – > 2 doses separated by at least 4 weeks
RSV specific: Nirsevimab (Beyfortus®) - new, Maternal RSV vaccination while pregnant, Palivizumab (Synagis®) – old/going away?

Question 8

What are 2 ways to protect babies from severe RSV disease?

Answer 8

1. Vaccination of pregnant people - when 32-36 weeks gestation
2. Monoclonal antibody for infants
   ◦ Palivizumab (Synagis)
   ◦ Nirsevimab (Beyfortus) (what we use!)

Question 9

Vaccination of pregnant people

Answer 9

• Bivalent RSVpreF vaccine (Abrysvo - Pfizer)
• Reduces baby’s risk of being hospitalized from RSV by 57% in the first 6 mo after birth
• Who qualifies: Administered before and during start of RSV season (Sept through Jan); People who are 32 through 36 weeks pregnant; Some increased risk of preterm birth in trials
  HAVE to give 2 WEEKS before delivery
• Provides protection if given at least 14 days before delivery
• In most* cases, this replaces infant RSV immunization

Question 10

What are the monoclonal antibodies for infants

Answer 10

• Nirsevimab (Beyfortus)
  Birth parent did not get RSV vaccination at least 14 days before delivery; Typically for infants < 8 months of age
  HAVE to GIVE during RSV SEASON
  High risk patients may receive dose in 2nd RSV season (rare)
• Only indicated for prevention of RSV (not active infection); has not been studied as
  treatment of RSV disease
• Can be given with other routine vaccinations

Question 11

When to get a 2nd nirsevimab dose?

Answer 11

• Infants and children aged 8-19 months entering 2nd season with increased risk for severe disease may get 2nd dose
  Chronic lung disease of prematurity
  Chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen within 6- month period before the start of the second RSV season
  Severely immunocompromised children
  Hemodynamically significant congenital heart disease
  Cardiopulmonary bypass = extra dose
  American Indian or Alaska Native children