Male: Coughs and wheezes under here, is that an asthmatic?
Dr. Marcus: Sometimes it is. Many times it is not. There are many children who will cough or wheeze from viral infections in that first year of life. And these first episodes may happen once and never repeat. What we have learned is that about 25% to 30% of these children who cough and wheeze very early will go on to develop more frequent episodes of wheezing and thereby will be diagnosed as having asthma. But many children will have only one or two episodes in that first one or two year of life and never have another episode.
Male: Little babies who wheeze very young get a disease called RSV and they wheeze heavily. Does that mean they are being asthmatic or the infection, RSV is making him wheeze? What is that story about?
Dr. Marcus: RSV is one of the most common viruses that children are infected with. In fact, within the first two years of life, virtually every child has been infected by this virus at least once. Most children who get RSV infection get nothing more than a runny nose, mild cough, which goes away in five to seven days. But 25% to 30% of these children will go on to develop wheezing and difficulty breathing and some of these children actually end up in the hospital to care for these episodes. What we have learned is that the children who wheeze from their RSV infection do have a higher risk of developing asthma as they get older. But it is not 100% risk. And so, what we tell parents is that if children are wheezing from their RSD then we need to monitor them closely over the next several years. So that if asthma develops we can treat it properly, minimizing future problems.
Male: If a certain group you have heard about go on it, what group would be the most risky group? Is that big babies, little babies, what group is that?
Dr. Marcus: Well certainly there are children who have greater risks of having serious problems when they develop RSV infection. And we have characterized those children into certain groups. The groups that are at the greatest risk are babies who had been born prematurely. Babies born prematurely have lungs which are either not fully developed at birth or have lung development after birth which is slightly different than a full-term baby. This difference in lung development makes these children at significantly greater risk for having wheezing and more serious problems when they get their RSV infection.
Male: These tiny prematures, like maybe 30 to 32 weeks really at high risk, is there anything we can do so they don’t get so sick?
Dr. Marcus: Certainly. There are a number of different strategies that we use. The first of course is to try to minimize the risk of getting that infection at the earliest age. So we want minimal exposure to other children who maybe carriers of the virus. We want to make sure that anybody who touches or handles these children wash their hands properly and are otherwise not sick. Once we take these usual proportions to minimize exposure, the next thing we do is to immunize these patients with a new vaccine which prevents the serious form of the RSV infection. This vaccine is called Synergist and it is required to be given once a month throughout the high risk time of the year. That is from October through March and then in the East Coast. In other areas of the country, the risky time of year maybe slightly different. But generally we give this vaccination once a month for a five to six month period during this high risk period to minimize the seriousness of RSV infection if the premature infants can tract it.
Male: When you say premature, how premature does a child have to be to be considered to get this vaccine?
Dr. Marcus: Any premature child can be considered for this vaccine and then there are various risk factors which we factor in to decide which child actually gets it or not. But the starting point is always prematurity all by itself. The more premature the child is, the greater their risk and so the greater likelihood is that they were qualified. Children that are near term, 34 to 36 weeks would need several other risk factors before they would be required to get the RSV Synergist vaccination.
Male: If a child wheezes…
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