Health experts are warning Kiwis to be vigilant this
winter with new data showing hospital admissions in Auckland
for acute respiratory diseases are up 13% on the same time
last year.[1]
Data from government health research
agency Institute of Environmental Science and Research (ESR)
shows the number of hospitalisations from severe respiratory
illness, including acute conditions such as COVID-19,
influenza, and RSV last year, peaked at levels higher than
at any time in almost a decade.[1]
The figures also
show the number of acute respiratory admissions since the
start of this year exceeds the previous
year.[1]
Respiratory diseases such as influenza,
COVID-19 and respiratory syncytial virus (RSV) are seasonal
with case numbers expected to spike during the winter
months.[2][3][4][5]
Respiratory syncytial virus (RSV)
is a highly contagious respiratory virus that can affect
people of any age, but older adults are at greater
risk.[6][7][8][9][10][11]
Maori, Pacific peoples and
those living in lower socioeconomic areas also have a
greater risk of hospitalisation from the
disease.[12]
RSV is associated with severe respiratory
disease in people aged over 60 years, and so far this year,
along with Rhinovirus it is the most common respiratory
virus among those tested in hospital. COVID-19 and influenza
are now the third and fourth most common respiratory viruses
detected, respectively.[13][14][15][16][17][18]
Dr
Lutz Beckert, Professor of Medicine at the University of
Otago and a respiratory specialist with Te Whatu Ora
Canterbury, says RSV is under-recognised and can be a
serious illness in adults, particularly those with existing
respiratory disease.[19][20]
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“RSV is an airborne
virus and spreads much the same way as influenza and
COVID-19, through respiratory droplets via direct contact
with an infected individual or, with contaminated surfaces –
where it can live for up to six hours.[21][22][23]
We
must not forget our COVID-19 lessons. During the pandemic we
were able to maintain hygiene standards, wore masks and
practised social distancing when we were sick,” he
says.
Professor Beckert says experts are concerned
that a combination of respiratory diseases particularly
influenza combined with RSV could see an influx of hospital
admissions over the coming winter months.
“Maori and
Pacific peoples are more likely to be exposed to risk
factors that increase the likelihood of harm from RSV. These
risk factors include overcrowding and housing instability,
lower paid employment opportunities and less access to
timely medical treatment,” he says.
“Although
healthy adults with RSV may have symptoms similar to the
common cold and mostly be able to recover at home, older
adults, especially those with compromised immune systems or
heart or lung conditions, can be at higher risk from RSV.
They may be more likely to suffer from severe consequences,
such as pneumonia or even hospitalisation. Babies and very
young children are also at higher risk and can become very
unwell quickly.[24][25][26][27]
“The initial
symptoms are not dissimilar to a common cold so it is
important that patients monitor their symptoms and seek
immediate medical assistance if they find themselves short
of breath, wheezing, feverish or their cough
worsens.[28][29][30]
“RSV is a notifiable disease in
Australia and Beckert says it would be of benefit to have it
added to New Zealand public health data to improve national
surveillance,” he says.[31]
Professor Beckert says
RSV infections typically follow a seasonal pattern,
generally peaking during winter.[32]
“We need to
treat RSV as seriously as we treat COVID or influenza,” he
says.
Professor Graham Le Gros, immunologist and
director of the Malaghan Institute of Medical Research says
older adults and those with existing medical conditions need
to be vigilant in protecting themselves against RSV as the
weather cools.[33]
“We know that those in this
cohort who have chronic medical conditions such diabetes,
asthma, chronic obstructive pulmonary disease (COPD) and
heart failure do have an elevated risk of hospitalisation
from RSV,” he says.[34][35][36][37]
Le Gros says
while the disease is often associated with young children,
older adults are also particularly
vulnerable.[38][39][40]
“Scientists have been
working for decades on ways to prevent RSV infection through
immunisation. We know that without vaccination our
population is vulnerable to infectious diseases like RSV as
was seen in the 2021 outbreak with multiple elderly patients
and children hospitalised.[41][42][43]
“RSV reduces
your ability to breathe and affects the chest and lungs with
symptoms which are very similar to pneumonia in children and
the elderly,” he says.[44][45]
Le Gros says any
natural immunity built up from a prior infection is minimal
so older patients do need protection against the
disease.[46][47]
“RSV is an extremely contagious
disease and in environments like aged care facilities, there
is a risk of the virus infecting multiple residents at any
one time which can put enormous pressure on the health care
system,” he says.[48][49][50][51]
Arexvy is the
world’s first respiratory syncytial virus (RSV) vaccine
for older adults and has been registered for use in Canada,
Australia, the US, the UK, the European Union, Japan and New
Zealand. Research shows almost a quarter of US adults aged
60+ have reported receiving a RSV
vaccine.[52][53][54][55]
Trial data shows Arexvy has
an overall efficacy of 82.6% against RSV-Lower Respiratory
Tract Disease (LRTD) however as with other vaccines, the
vaccine may not protect all recipients. The vaccine is now
available from New Zealand GP clinics for private
purchase.[56][57][58]
[1] ESR Respiratory Illness
Dashboard. Data time frame = Jan 2024 to 12 May 2024.
Accessed 16 May 2024. (Calculation = see
here). https://www.esr.cri.nz/digital-library/respiratory-illness-dashboard/
[2]
Hatter L, Eathorne A, Hills T, Bruce P, Beasley R.
Respiratory syncytial virus: paying the immunity debt with
interest. Lancet Child Adolesc Health. 2021
Dec;5(12):e44-e45. doi: 10.1016/S2352-4642(21)00333-3. Epub
2021 Oct 23. PMID: 34695374; PMCID: PMC8598182.
[3]
Chadha, M. S., Hirve, S., Bancej, C., Barr, I. G.,
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Barakat, A., . . . Zambon, M. (2020). Human respiratory
syncytial virus and influenza seasonality patterns—Early
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[4]
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[5] Bloom-Feshbach K;PloS
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[8] Learn about
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[22] Green book;Chapter
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[27] Respiratory syncytial virus
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[31] Australian
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[37] GSK;Press
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| RPH. (n.d.). Retrieved May 13, 2024, from https://www.rph.org.nz/public-health-topics/illness-and-disease/influenza/influenza-information-for-aged-residential-care/2dhb-influenza-like-illness-arcs.pdf
[52]
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[53] GSK;Press release;2024;1-6
Australia’s first RSV vaccine (v1.0)
[54] Venkatesan
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[55] Vaccination
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https://www.cdc.gov/respiratory-viruses/data-research/dashboard/vaccination-trends-adults.html#:~:text=The%20percent%20of%20the%20population%20reporting%20receipt%20of%20a%20flu,%25%20(22.8%2D25.1).
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[58] For adults aged 60 and older
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