Exclusive: Government alert over surge in respiratory virus affecting babies and toddlers

Public Health England modelling shows a possible sharp rise in cases of respiratory syncytial virus (RSV), which can cause bronchiolitis, this autumn and winter, several senior sources said. The modelling shows between 20 and 50 per cent more cases needing hospitalisation than normal, HSJ understands.

Official projections conclude that such a surge would require, at least, a doubling of paediatric intenstive care beds and a significant increase in other critlcal care resources for sick children. 

According to the Oxford Vaccine Group and Oxford University around 30,000 children under the age of five are estimated to be be hospitalised every year in the UK because of RSV. However, most of those expected to be affected by the rise in RSV this year are forecast to be three years old or younger.

The UK’s four chief medical officers are considering the issue and planning to write to ministers to highlight it, the sources said, while NHS England is working on a response plan, and is expected to alert local NHS leaders. 

The modelling suggests the spike could begin as soon as September. 

Public health officials believe that, because many children have missed out on normal exposure to RSV due to lockdown measures including school closures, the virus may have much more spread and impact in the coming autumn/winter season. 

One senior source close to the national discussions told HSJ: “There is a concern that children this year have missed out on normal RSV viral exposure… They would normally be exposed to this but won’t have because of lockdown.”

HSJ understands that children’s critical care is a particular concern because there is limited capacity, especially outside larger acute and specialist trusts. It would, therefore, be harder to quickly increase the number of bed as was done for adults during the covid pandemic. As a result, NHS officials are working on plans to expand acute capacity, and maximising the contribution of primary/community services to manage the increased demand.

The RSV season in the UK typically begins in the autumn, earlier than the adult flu season, and runs through winter. A September spike could also coincide with a new covid wave created by the lifting of restrictions.  

Experts are reviewing the current RSV season in the southern hemisphere to see if it is more severe.

Senior critical care doctors and paediatricians have told HSJ they are concerned about a potential rise in RSV, and said viral infections in children in general were already increasing. And a public health director said: “We may get a big surge of routine respiratory conditions this autumn/winter as most people avoided contact last winter - ie not just kids.”

NHSE said it had recently received the modelling and added: “The NHS plans for a wide-range of scenarios ahead of winter and will continue to adapt plans in line with any further advice from Public Health England.”

The Department for Health and Social Care and Public Health England have been approached for comment.