Recently, whooping cough has been on the hot search again, plus last winter's flu, new crown, mycoplasma, adenovirus, syncytial virus...... Every once in a while, there seems to be a concentrated outbreak of one or even several respiratory infections, and for children, respiratory diseases are more serious. Recently, Professor Shen Kunling, Honorary Chairman of the Pediatric Branch of the Chinese Medical Association, was interviewed by Xinhuanet to explain in detail the epidemic situation of respiratory infectious diseases in children, especially emphasizing the prevention and control strategy to deal with the "must come every year" influenza.
In winter and spring, a variety of pathogens are prevalent, and respiratory diseases are highly prevalent
In the natural environment, there are many pathogenic microorganisms, including influenza virus, new coronavirus, respiratory syncytial virus, adenovirus, rhinovirus, parainfluenza virus, Mycoplasma pneumoniae, etc., which can cause respiratory diseases. Given the long-standing presence of these pathogens, why are there concentrated outbreaks of respiratory diseases in the spring of 2023 and the winter and spring of 2023-2024, especially in children?
Shen Kunling explained that in general, children will be infected more frequently in the first two years of life. Taking influenza as an example, after the influenza virus invades the respiratory tract, it will destroy the epithelial cells of the respiratory mucosa, multiply in the cells, stimulate the body to produce an immune response, and cause symptoms such as fever, cough, and muscle aches. With each infection, the body's specific immunity to one virus increases, and it also strengthens non-specific immunity to other viruses.
Professor Shen Kunling, Honorary Chairman of the Pediatric Branch of the Chinese Medical Association
Every autumn and winter is a period of high incidence of multiple pathogens and respiratory infections, and there are also sporadic infections in other seasons. However, in the past few years, people have been insisting on strict non-drug prevention and control measures such as wearing masks, washing hands frequently, and maintaining social distancing.
"Not just on the mainland, almost every country has gone through this process. Shen Kunling said that over time, the peak of infections will gradually subside, and the number of infections with respiratory diseases has decreased in the same period this year compared to the same period last year.
Influenza comes every year, and high-risk groups are at high risk of severe disease
Influenza virus is the most "powerful" virus among respiratory tract infections, with high incidence, rapid infection and great harm. Globally, influenza infects about 5%-10% of adults and 20%-30% of children each year, causing up to 5 million severe cases and 650,000 deaths. Studies show that China has an average of 88,000 excess deaths from influenza-related respiratory diseases every year, accounting for 8.2% of the deaths from respiratory diseases, bringing a huge social burden.
According to the World Health Organization, the global influenza epidemic has seen a significant epidemic peak between October 2022 and February 2023, and is significantly higher than the activity level of the past 10 years. At the same time, data from the Chinese Center for Disease Control and Prevention also showed that the level of influenza activity in the mainland has continued to increase since the beginning of February this year. As of early April, influenza activity remained at a high level.
Shen Kunling stressed that the understanding of influenza cannot be overemphasized. Influenza has a definite seasonality, with epidemics in the north in autumn and winter, and two peaks in autumn, winter and summer in the south. "One of the biggest characteristics of the flu is that it must come every year!" said Shen Kunling, adding that for people with high-risk factors, once infected with the flu, the risk of severe disease is higher, including people younger than 5 years old, more than 60 years old, and people with chronic underlying diseases. "Every family will have elderly people and children, which means that there are high-risk groups in every family. Fortunately, there is relatively good research on influenza, which is a virus that has both a vaccine and a therapeutic drug, and if it can be prevented by timely vaccination, or through drug treatment and post-exposure prophylaxis, the harm of influenza can be greatly reduced. She said.
Identify the "traffic lights" of children and scientifically prevent and control influenza
With the continuous in-depth research on influenza viruses, the means to combat influenza are also constantly improving. In terms of testing, in addition to going to the hospital for diagnosis, you can also buy antigen kits for home testing to reduce the risk of cross-infection in the hospital, and take drugs in time if you find a positive one. Mabaloxavir is an RNA polymerase inhibitor, which acts on the viral RNA replication stage, so that the virus loses its ability to replicate itself, and the time to control the virus is shorter, and it is only taken once in the whole course of the disease, and can be used by adults and children over 5 years old with influenza A and B.
On January 5, 2024, mabaloxavir dry suspension was approved for the treatment of children aged 5 to 12 years old, which will further meet the clinical drug needs of children with influenza who need to be accurately administered according to body weight, and bring more influenza treatment options to children with difficulty swallowing tablets.
Anti-influenza virus drugs can also be used for post-exposure prophylaxis against influenza. Shen Kunling suggested that post-exposure drug prophylaxis can be carried out as soon as possible for close contacts with high-risk factors for severe influenza disease, such as children, the elderly, and patients with underlying diseases, and it is recommended that medication should be taken no later than 48 hours after exposure, which can more effectively avoid the possibility of subsequent severe disease.
Fever is the most common and predominant symptom of respiratory illnesses, including influenza. Shen Kunling said that fever is the body's response to external infections, and many parents are very anxious about fever and have a "fever phobia" mentality. Shen Kunling told reporters that on the basis of understanding that fever is a normal immune response of the human body, it is necessary to evaluate the fever, if the body temperature is above 38.5 °C and the fever continues to be high, it indicates that the body has produced an excessive inflammatory response, which will cause damage to the body, and antipyretic analgesics should be used to reduce the body temperature to a suitable range to relieve the symptoms of hyperthermia, but antipyretic analgesics cannot actually change the inflammatory state, and other corresponding therapeutic drugs are also needed.
In the process of contracting the flu, the most dangerous thing is to develop severe disease. Shen Kunling suggested that the "traffic light" method can be used: If the child is in a good mental state and can eat and play during the course of illness, home care can be adopted; if there are symptoms such as difficulty breathing, listlessness, difficulty in feeding, and decreased urine output, it is recommended to seek medical attention as soon as possible or immediately.
Fever in children is not simply judged by the severity of the temperature and the duration of the fever, and the traffic light system can be used. (Source: "30 Questions on Children's Fever Health Education") (Source: Xinhuanet)