A LEADING GP says parents ought to be more concerned about RSV than Strep A.
While Dr Illona Duffy says it is understandable that parents are concerned about Strep A, she added that RSV is the “big reason for admissions to hospital” at the moment.
RSV usually causes mild, cold-like symptoms but can be serious, especially for infants and older adults.
It is highly contagious and this year’s winter spike is likely the result of a reduced immune response in children after limited contact with one another last year.
“We’re definitely seeing a rise in RSV,” said Dr Duffy, “probably because in the last couple of years we haven’t seen much of anything because of Covid and the restrictions.
“That made it easier to contain the spread of infection, whereas now we’re back to mixing and mingling and also children who haven’t met these viruses because of the lockdown, many of them never met the normal virus that they would meet at this time of the year and didn’t meet them in the last two winters.”
Dr Duffy warns that this has weakened some children’s immunity and has affected their ability to combat the virus.
On Wednesday, children’s hospitals across Dublin announced they were under extreme pressure due to the high number of sick children presenting in emergency departments, and the number of very sick children already receiving care.
“RSV is the big thing and listening to the paediatricians in the hospital, they’re saying RSV is the main reason for admissions to hospital at the moment and that it’s not so much Strep A,” said Dr Duffy.
“The Chief Medical Officer has actually said that we’re not seeing a massive rise in Strep A infections, that it matches pre-Covid levels.”
Speaking to Morning Ireland yesterday, CMO Professor Breda Smyth said: “The number of cases (of Strep A) we’ve had this year is actually much lower than pre-pandemic times. But we are keeping a very close eye on it.”
Professor Smyth added: “As we know, there are a lot of bugs circulating at the moment because we had a reduced social mixing, particularly in children.”
The HSE has confirmed that a four-year-old died from a Strep A infection. There were two paediatric deaths attributed to the infection in both 2018 and 2019.
Latest figures from the HPSC reveal there have been 55 confirmed cases of Strep A so far this year.
Pre-pandemic, however, a total of 136 cases were recorded in 2018 and 108 cases were recorded in 2019.
Dr Duffy said this correlates to what she is experiencing in her own practice: “We’re not seeing a massive rise in Strep A presentations, we’re seeing what we’d normally see, but we are seeing huge rise in RSV.”
She added that “really young kids, under six months, and kids with underlying health conditions are the group that are most likely to end up being admitted with RSV”.
However, Dr Duffy said RSV levels “are probably back at pre-pandemic levels”.
“We have surges of it every winter and it’s just that this is the first winter we’ve seen it in three years. So that’s why perhaps it all seems a bit newer.
“I don’t think it’s massively higher than previous years, although the hospitals are seeing more admissions and are seeing younger kids who are sicker with it.”
Meanwhile, Met Éireann has advised that the current cold snap could extend into next week.
While there are surges in RSV cases over the winter months, this is because people spend more time indoors and in closer proximity to each other, rather than being the result of cold weather or being chilled.
Strep A concerns
While Dr Duffy said she understands the concerns of parents when it comes to Strep A because “they’re being told to worry about it, she added that “we have to use common sense”.
“At the moment, we’re seeing lots of people worried and I even had one mother this morning saying that her child has had a cough for weeks and the creche won’t let the child in because it could be Strep A. We can’t have that happening. We have to use common sense here.”
Strep A is a bacterial infection that is spread by contact with an infected person or by contact with infected skin lesions.
The HSE this week circulated advice to schools about the infection following the death of a child from Strep A.
But while Dr Éamonn O’Moore, Director of the Health Protection Surveillance Centre, said that “the news of a child death with Strep A will be worrying for parents”, he added that “most children who get ill from a Group A Strep infections will have a mild illness which can be treated with antibiotics”.
RSV also typically results in a mild illness with cold-like symptoms.
Speaking to The Journal, Dr Duffy said those who have Strep A will exhibit clear symptoms.
“Some kids end up with a generalised rash, so we talk about the scarlet fever and that gets its name from the rash that is created. So get that helps us in diagnosing and we know to get the children penicillin.”
However, she adds that a “big concern at the moment is that there is a shortage of antibiotics”.
It comes following a warning from the President of the Irish Pharmacy Union that supplies are short.
Speaking to Today with Claire Byrne yesterday, Dermot Twomey said “a number of key antibiotics that we would dispense on a daily basis are running short”.
Dr Duffy told The Journal that this underscores the need “making sure we’re getting antibiotics to the right children”.
“GPs have scoring tools that we use and we have the pain score,” she said, “and that’s really good because it helps us decide who actually is likely to need an antibiotic, as opposed to just giving it to everybody who has a sore throat or everyone who a high temperature.”
‘Have a thermometer’
“If the temperature is becoming harder to control and is not improving after a few days, and if your child is becoming more unwell and has stopped eating, and if they’re young babies and not drinking their bottles, they’re the kind of calls of concern and they’re the things where we would be saying, ‘you do need to be seen and you do need to talk to us’.”
However, Dr Duffy said if children are “mildly unwell, with snuffles and a mild cough, temperatures are controlled and they’re drinking in if they’ve reduced eating, then we’d be saying, ‘watch and wait and see’”.
Her message was to ensure there is a thermometer in the house “so that you’re able to figure if your child is unwell”.
“It’s amazing how many people still don’t have a thermometer and they’re going by touch,” said Dr Duffy.
“A child that seems really cold and sweaty may actually have a really high core temperature, so touching won’t help you to diagnosis it.”
She also advised parents and guardians to “know how manage temperature, what dose of Calpol or Nurofen or things like that to give”.
She also advised parents and guardians to “encouraging fluids, especially to younger babies, and monitor their nappies if they’re under six months”.
“I think any young child who stops eating and drinking, and there’s high temperatures, you have to be worried about that and I think that’s always a good measure; when they stop eating and drinking, you know there’s something wrong.”
She also cited undertheweather.ie as a good tool for parents and guardians.
‘Overwhelmed’
While Dr Duffy said she understands why parents are worried about Strep A, she expressed concern that the Out-of-Hours could become “overwhelmed” by worried parents.
“We need to actually tell them they need to be more worried about the RSV and preventing that and if your child is unwell, don’t send them to school or creche until their symptoms leave of their temperature settles because while you’ve got a temperature, you’re contagious.
“We’ve got to ensure that those who need to be seen, the sicker children, have access to appointments, especially in GP out of hours.
“Parents tend to know their children, and if you’re worried and you really think they’re deteriorating, absolutely see your GP.
“But in the meantime, if they’re mildly unwell, monitor them at home and seek advice from undertheweather.ie.”
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