Thomas Christie Williams Profile picture
Apr 22, 2021 14 tweets 7 min read Read on X
as lockdown is lifted across the UK and Ireland, what could happen in paediatric emergency departments and hospitals this summer? a 🧵1/n
firstly, some context

in the first year of the pandemic, there were 5,336 hospital admissions associated with a positive SARS-CoV-2 test in children in England 2/n
but ...

in a typical year in England, there are ~36,000 admissions for bronchiolitis (mainly caused by Respiratory Syncytial Virus, RSV) in infants under the age of 1 thorax.bmj.com/content/75/3/2… 3/n
the pandemic saw an almost total disappearance of RSV across the UK gov.uk/government/sta… @PHE_uk 4/n
this was reflected in emergency department attendances for bronchiolitis across Scotland

in contrast to a usual winter peak, there were very few attendances, most likely representing ongoing rhinovirus circulation (@P_H_S_Official data) 5/n
much of the Southern Hemisphere saw a similar pattern

but what happened when lockdown was released?

in Western Australia the peak was larger than the normal winter peak academic.oup.com/cid/advance-ar… 6/n
in France, where schools have remained open throughout the winter and into spring, there is an unusual pattern to this year's epidemic, with a delayed start, and it isn't clear yet whether the peak has been reached santepubliquefrance.fr/maladies-et-tr… @SantePubliqueFr 7/n
what will happen in the UK?

very hard to predict & only a prospective study, collecting and releasing data in real time will allow us to see what is happening and act on this information

which is exactly what BronchStart @PERUKItweep sets out to do medrxiv.org/content/10.110… 8/n
some scenarios:

1. A larger unexposed cohort than usual with less maternal protection through recent RSV exposure, leads to larger peak than usual

2. Ongoing restrictions mean that we see a smaller peak, with rebound peak this autumn/winter when restrictions fully released 9/n
will RSV spread in its usual pattern (seeding through the metropolitan centres of London and Manchester thorax.bmj.com/content/75/3/2… @ThoraxBMJ ) or in a slower wave from France/Belgium northwards? 10/n
will we see an initial peak of rhinovirus bronchiolitis as restrictions are eased, followed by a delayed RSV peak? 11/n
all open questions, and in my opinion much more of a reason to worry about our summer holidays than vaccine passports

we need this information to understand how infants and children will present to EDs, guide decisions on palivizumab, and inform PICU service planning 12/n
we welcome comments on the study pre-protocol medrxiv.org/content/10.110… & participation of your emergency department through the PERUKI network

we thank all the people who have contributed towards the design of this study so far 13/n
and hope that this study, and others like it, will contribute towards the introduction of an effective RSV vaccine path.org/resources/rsv-… END

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Thomas Christie Williams

Thomas Christie Williams Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @Williams_T_C

Dec 1, 2023
While the rest of the world deliberates about the logistics of introducing maternal immunisation against RSV, or nirsevimab (a long lasting anti-RSV monoclonal antibody)
Galicia in NW Spain has cracked on with giving nirsevimab to all newborns
What is really impressive ... 1/n Map of Galicia in Spain
is their commitment to releasing their data in near real-time. You can read their latest report from two days ago here:
Report_RSV_week47.pdf () 2/n sergas.es
Image
My two take home messages from the report:
1. Uptake for nirsevimab was very high- we should make sure we learn from the Galicians how they encouraged parents/carers to decide to protect their newborn infants against RSV 3/n Image
Read 7 tweets
Jan 19, 2023
our paper from the @WHO RSV Surveillance Laboratory Group is now out in the @IsirvEpi journal onlinelibrary.wiley.com/doi/full/10.11…
impressive results for the detection and typing of RSV using RT-PCR from 26 National @WHO collaborating centres globally 1/4
whole genome sequences for the strains used in this External Quality Assessment conducted by @UKNEQAS available @GISAID 2/4
with RSV immunisations edging close and closer, more and more important to accurately detect and quantify the burden of disease as a baseline prior to introduction 3/4
Read 4 tweets
Jan 10, 2023
huge amount of recent interest in invasive group A streptococcus (iGAS) infection in children
but up until now little patient-level clinical data on this spike in cases
we hope our case series @TheLancetInfDis will help address this knowledge gap thelancet.com/journals/lanin… 1/n Group A streptococcus paediatric empyema cases in Scotland 2
back in the autumn a group of us at the Royal Hospital for Children in Glasgow noticed a spike in empyema cases in children

in Nov 23 alone we looked after 9 children with empyema requiring a chest drain, almost as many as we'd expect to see in an entire year at our centre 2/n
Scotland is a small country so we reached out to our colleagues in other centres that manage paediatric empyema (pus in the chest cavity) in Edinburgh and Aberdeen to see if they were experiencing a similar phenomenon 3/n
Read 27 tweets
Oct 6, 2022
Dr. Ravi Balakrishnan @UKHSA @NPEG12 presents data for TB in England

in 2011 England had high TB notification rates (amongst highest in western Europe) but have been falling since

comprehensive report available (much to learn here for other diseases): assets.publishing.service.gov.uk/government/upl…
fortunately very few paediatric TB cases in England in 2020: 146 2/n
more than half of TB cases (99/146) were in children born within the UK 3/n
Read 5 tweets
Oct 2, 2022
but price is going to be key: how much these interventions costs will determine how widely they are used 6/n costs savings at different ...
another important question is whether it is going to be possible to interrupt community transmission for RSV with a vaccine for infants
the PHIRST study was designed to look at this pubmed.ncbi.nlm.nih.gov/34019838/ for influenza, RSV and later on adapted for SARS-CoV-2 7/n infections for influenza by...
unpublished results for RSV presented today show similarly high burden of disease 8/n
Read 5 tweets
Oct 2, 2022
now @rsv2022 Prof. Cheryl Cohen @WitsUniversity talks about key considerations in implementing an RSV vaccine 1/n
these are:
-burden of disease
--in relation to other vaccine preventable disease
--age specific burden
--different severity endpoints
--seasonality
-cost of disease
-cost-effectiveness
-risk groups for severe illness
-pathogen factors
-transmission dynamics- indirect effects 2/n
key to implementation will be age distribution of disease: both monoclonals and maternal immunisation will only prevent disease for a time-limited period 3/n
Read 5 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(