Cases of bronchiolitis are increasing again nationally. Infectious pathology generally present from the fall and during the winter months, the bronchiolitis is very contagious. It is transmitted mainly by adults and “older” children, the latter of whom may be carriers of RSV but be asymptomatic or simply present a common cold. Transmission of the virus can occur either through respiratory secretions (coughs, sneezes, spittle) or by direct or indirect contact (kissing, objects soiled by hands or saliva).
There bronchiolitis is a very common respiratory disease in infants and children under two years of age. It is most often transmitted by the “respiratory syncytial virus” (VRS). However, other viruses capable of causing bronchiolitis are currently circulating, and in particular rhinovirus.
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Bronchiolitis: 2 new regions enter epidemic phase in mainland France
In his epidemiological bulletin of November 22, 2023Public Health France indicates that in week 46 (from November 13 to 19, 2023), “activity linked to bronchiolitis was once again clearly increasing in France for all syndromic surveillance indicators: SOS Médecins medical procedures, visits to the emergency room and hospitalizations after visits to the emergency room for bronchiolitis”.
Two new regions also entered the epidemic phase in week 46, these are Auvergne-Rhône-Alpes and Provence-Alpes-Côte d’Azur.
They join 10 metropolitan regions which were already in the epidemic phase:
- the Hauts de France
- the Great East
- Burgundy-Franche-Comté
- New Aquitaine
- Occitania
- the Ile-de-France region
- Brittany
- the Pays de la Loire
- Normandy
- the Center-Val de Loire.
In the overseas departments (DROM), Guadeloupe, Guyana and Martinique are also in the epidemic phase.
Note that the last two winter seasons (2021-2022 and 2022-2023) were marked by an earlier and longer bronchiolitis epidemic (16 weeks compared to 11 weeks usually), the 2023-2024 season seems to be heading in the same direction.
Bronchiolitis: how many cases currently in France?
The increase currently concerns all bronchiolitis monitoring indicators. In week 46 (from November 13 to 19, 2023), Santé Publique France counted:
- 772 medical procedures at SOS Médecins for bronchiolitis, or 10.1% of procedures (i.e. +2.8 points compared to week 45)
- 4,662 visits to the emergency room among children under two years old according to the Oscour network, or 18.6% of visits (i.e. +2.9 points compared to week 45)
- the number of hospitalizations after bronchiolitis was 1,423, or 34.7% of hospitalizations (i.e. +3.0 points compared to week 45).
The detection rate of RSV (respiratory syncytial virus, responsible for 80% of bronchiolitis) is increasing in cities and in hospitals. In week 45, for the first time, SPF observed “an increase in the positivity rate for RSV was observed in the city”. At the same time, other viruses likely to be responsible for bronchiolitis continue to circulate, in particular rhinoviruses.
How old are children affected by severe cases of bronchiolitis?
Among the 4,662 children under 2 years old seen in the emergency room for bronchiolitis in week 46, 4,178 (90%) were under 1 year old and 1,423 (30.5%) were hospitalized. Among the 1,423 children hospitalized, 1,331 (94%) were aged less than 1 year. “An increase in hospitalizations after going to the emergency room for bronchiolitis was observed in children under 2 years old (+3 points compared to week 44)“, noted SPF.
Among the 4,662 children under 2 years old seen in the emergency room for bronchiolitis in week 46, 23 children were hospitalized in intensive care, i.e. 0.5% of emergency room visits and 31.9% of all intensive care hospitalizations in this age group (vs 40.0% in S45). Among children under 1 year old, 22 children were hospitalized in intensive care after going to the emergency room, or 44.0% of hospitalizations in intensive care units. “A decrease in hospitalizations in intensive care for bronchiolitis is observed compared to W45“, ends SPF.
Bronchiolitis: what are the signs to identify?
Bronchiolitis most often starts with a simple cold (stuffy or runny nose), with a dry cough and sometimes a little fever. Within 2 to 3 days, the following symptoms may appear:
- There cough becomes more frequent
- Breathing difficulties appear with faster, wheezing breathing. “We may have a feeling of “shortness of breath” in children who have visible respiratory efforts and fatigue”precise ARS Rhône-Alpes.
- The child may also have difficulty eating and sleeping
In the majority of cases, the bronchiolitis heals spontaneously after 5 to 10 days. However, “increased monitoring of infants at the onset of bronchiolitis (the first 48 to 72 hours) and appropriate care are necessary. Very young children and more particularly infants under two months of age may present a more serious form requiring hospitalization”, underlines the ARS again.
Please note: an urgent consultation is essential for infants aged less than 6 weeks or born prematurely. This also concerns babies with cardiac or respiratory pathology or a disability. In addition, an infant who is not eating normally must also be the subject of a rapid consultation. We consider that a baby who drinks less than half of his bottles during at least 3 meals should be checked in the pediatric emergency room.
⋙ Bronchiolitis: when to worry? Signs of worsening to recognize
Sources:
- Bronchiolitis: situation update as of November 15, 2023, Public Health France
- ARS
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