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 How does Respiratory Syncytial Virus Infection cause?

Caused by respiratory syncytial virus or fusion virus (RSV). It belongs to paramyxovirus RNA type, with a diameter of 100-140nm. The nucleocapsid is composed of 32 symmetrical icosahedral capsids and has a capsule. Not destroyed by ether and chloroform. Human cells, diploid cells, and primary monkey kidney cells can be used to culture viruses and produce special fusion cells. With fluorescent antibody technology, the virus can be detected in the cytoplasm of infected cells. The disease is transmitted through the droplet respiratory tract and has the characteristics of wide spread, high infection rate, and long duration. It is spread and spread in various countries around the world, and a major epidemic occurs almost every year or every other year.

 Pathogenesis of Respiratory syncytial virus infection

Respiratory syncytial virus infection passes through air droplets or directly into the respiratory tract of susceptible persons. After RSV invades the body, it first multiplies in the nasopharyngeal mucosa and causes upper respiratory tract infection.

Infants with low immune function, the elderly, RSV can extend from the nasopharynx to bronchial and alveolar levels at all levels, and then develop severe bronchitis, bronchiolitis and pneumonia.

Respiratory virus invades human ciliary epithelial cells on the surface of the respiratory tract, replicates and spreads within it and directly causes damage to infected cells, causing local lesions or producing symptoms of systemic toxins.

Some virus-infected tissue damage may be mediated by the body's immune response. For example, respiratory syncytial virus has the least direct damage to respiratory cilium epithelial cells, but can cause serious respiratory diseases in infants and young children; the most vulnerable age is mother-to-child transmission. 

The stage of the highest antibody level

Aafter the vaccination, the condition of the naturally infected person is worsened, all suggesting that the onset may be related to the immune response. The pathological changes of respiratory virus infection include nasal, pharyngeal, and laryngeal mucosal congestion, edema, exudation, and monocyte infiltration. Some cells can degenerate, necrotize, and fall off. Inclusion bodies can be seen in the cytoplasm or nucleus of epithelial cells. 

The extent of the disease is related to the type, type and site of infection. After a few days, the epithelial cells can regenerate and return to normal. If the lesion involves the bronchioles, epithelial cell necrosis and exfoliation can occur. The bronchiolar wall has extensive mononuclear cell infiltration. Fibrin, cell debris and thick mucus can block the lumen and cause atelectasis and emphysema. 

Viral Pneumonia Manifestation

Viral pneumonia initially manifests as a progressive reduction of cilia, formation of vacuoles in epithelial cells, followed by degeneration of epithelial cells, substantial necrosis and collapse of alveoli, necrosis and thickening of alveolar walls, interstitial edema and monocytes, lymphocytes infiltration.

When bacterial infection is complicated, mucosal hyperemia, neutrophil infiltration, and mucopurulent secretion can be seen. In severe cases, pulmonary abscess, sepsis and purulent changes in multiple organs can occur.

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According to the 1st Joint United Nations Estimates, a Stillbirth occurs every 16 Seconds

Disruption of health services related to COVID-19 may worsen the situation, and the number of stillbirths may increase by nearly 200,000 within 12 months. According to estimates of the first joint stillbirth issued by the United Nations Children’s Fund, the World Health Organization (WHO), the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs, nearly 2 million infants are stillborn every year, that is, every 16 seconds, there is a stillbirth.

According to the new report "Neglected Tragedy: Global Stillbirth Burden"

 the vast majority of stillbirths (84%) occur in low- and middle-income countries. In 2019, three-quarters of stillbirths occurred in sub-Saharan Africa or South Asia. 

The report defines stillbirth as the birth of a fetus with no signs of life at 28 weeks of gestation and above.

Henrietta Fore, Executive Director of UNICEF on Still Childbirth, said: 

"The death of a child at birth or during pregnancy is a devastating tragedy for a family, which can often only be endured silently, and such tragedies are everywhere in the world. It happens too frequently. 

Every 16 seconds, a certain mother in a certain place will suffer an unspeakable stillbirth tragedy. 

In addition to the loss of life, this will also cause serious and lasting psychological and economic consequences for women, families and society costs.

For many of these mothers, this is not the case. With high-quality monitoring, proper prenatal care and skilled midwives, most stillbirths can be avoided."

The report warned that the COVID-19 pandemic may increase the number of stillbirths worldwide

 In 117 low- and middle-income countries, health services have been reduced by 50% due to the pandemic, which may increase nearly 200,000 stillbirths within 12 months. 

This is equivalent to an 11.1% increase in the number of stillbirths. According to the modeling of the report by researchers at the Bloomberg School of Public Health at Johns Hopkins University, the number of stillbirths in 13 countries may increase by 20% or more in 12 months.

Most stillbirths are due to poor quality of care during pregnancy and childbirth. The report pointed out that the key challenge is the lack of investment in antenatal and delivery services and in strengthening the nursing and midwifery team.

More than 40% of stillbirths occur during childbirth. This loss can be avoided if well-trained health workers are present at the time of delivery and timely emergency obstetric care is provided.

 About half of stillbirths in sub-Saharan Africa and Central and South Asia occur during childbirth, compared to 6% in Europe, North America, Australia and New Zealand.

Timely and high-quality care to prevent stillbirths

Even before the pandemic severely disrupted health services, few women in low- and middle-income countries had access to timely and high-quality care to prevent stillbirths. 

In terms of eight important maternal health interventions, including caesarean section, prevention of malaria, management of hypertension during pregnancy.

The detection and treatment of syphilis, among the 117 countries analyzed in the report, half of the countries have coverage rates of less than 2% to the highest is only between 50%. 

Vaginal delivery is an important intervention to prevent stillbirth during childbirth, but it is estimated that its coverage is less than half of pregnant women in need.

Slow Progress in Still Child Birth Reduction

Therefore, despite advances in health services aimed at preventing or treating the causes of child deaths, progress has been slow in reducing the stillbirth rate. 

From 2000 to 2019, the annual rate of decline in the stillbirth rate was only 2.3%. In contrast, the neonatal mortality rate fell by 2.9%, and the infant mortality rate for infants aged 1-59 months fell by 4.3%. 

However, as long as there are reasonable policies, plans and investments, progress can be made.

WHO Director-General Dr. Tedros on Still Childbirth said: 

“It should be a very happy moment to welcome the birth of a baby, but every day thousands of parents are griefed by the stillbirth of the baby. 

The tragedy of the stillbirth shows that strengthening and How important it is to maintain basic health services and how important it is to increase investment in nurses and midwives."

The report also pointed out that stillbirth is not just a challenge facing poor countries 

In 2019, 39 high-income countries had more stillbirths than newborn deaths, and 15 countries had more stillbirths than infant deaths. The education level of mothers is one of the most important factors that contribute to inequality in high-income countries.

Whether in a low-income environment or a high-income environment, the stillbirth rate in rural areas is higher than in urban areas. Socioeconomic status is also associated with a higher incidence of stillbirths. 

For example, in Nepal, the stillbirth rate of a few caste women is 40% to 60% higher than that of upper caste women.

Minorities in high-income countries, in particular, may not have access to adequate health care services. 

For example, the report points out that, according to observations, the stillbirth rate among Inuit in Canada is nearly three times that of other parts of Canada, while the risk of stillbirth among African American women in the United States is nearly twice that of white women.

Muhammad Ali Pate, Global Director of Health, Nutrition and Population Affairs of the World Bank and head of the Global Financing Facility for Women, Children and Adolescents, said: 

“Due to the disruption of life-saving health services, COVID-19 has triggered a battle for women, children and adolescents. A devastating secondary health crisis. 

Pregnant women need continuous access to quality care during pregnancy and childbirth. We are supporting countries to strengthen their health systems to prevent stillbirths and ensure that every pregnant woman has access to high-quality health care services. "

About the United Nations Inter-Agency Group on Child Mortality Estimation

The United Nations Inter-Agency Group on Child Mortality Estimation was established in 2004 to share child mortality data, improve child mortality estimation methods, report progress towards child survival goals, and improve the country’s ability to estimate child mortality in a timely and appropriate manner.

 The United Nations Inter-Agency Group on Child Mortality Estimation is led by UNICEF and its members include the World Health Organization, the World Bank Group and the Population Division of the United Nations Department of Economic and Social Affairs. 

For more information, may visit: http://www.childmortality.org/.

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