Understanding and Preventing Respiratory Infections in Children

Gavin Nimon: As we enter the winter months and with the COVID restrictions now reduced, the incidence of influenza, rsv and the common cold is rising. Many of us will not give this a second thought and will tolerate these conditions quite well. However, even in their healthy and particularly for those who are immunocompromised, infection with these viruses can be life-threatening. One particular group is a newborn or young child, for whom an infection can lead to long-term morbidity, hospitalisation, admission to intensive care and even death. Today we are going to learn about the viruses that lead to respiratory compromise in the young child, the treatment of, prevention for these conditions, and hear the story from someone who has had the heartbreak of losing the young child to such a condition. Good day and welcome to Aussie Med Ed, the Australian Medical Education podcast Programmed, born during COVID times, to emulate that general chit chat and banter around the hospital, the idea of educating you, the medical student and GP alike. 
 
 Gavin Nimon: I'm Gavin Nimon, an orthopedic surgeon based in Adelaide, and it's my pleasure to bring Aussie Med Ed to you. 
 
 Gavin Nimon: And in this episode of Aussie Med Ed, we're joined by Professor Christopher Blyth, professor in Infectious Diseases from the University of Western Australia and also Pediatrician from the Perth Children's Hospital, and he's joined by Catherine Hughes, a lady fuelled by the loss of her young son to Hooping Cough at one month of age, who has worked tirelessly to raise awareness, to promote vaccination and ensure that families have access to vital information to prevent such conditions affecting their families. 
 
 Gavin Nimon: Her work has been recognised by being appointed as a member of the Order of Australia and I'm looking forward to hearing her inspiring story about how she coped with the grief of her loss of her son and has put a reference into trying to prevent this happening to anyone else. I'd like to start by acknowledging the traditional owners of the land on which this podcast has been produced, the Kaurna people and, by my respect, the elders, both past, present and emerging Now. It's my pleasure now to introduce Professor Christopher Blyth. He's a professor in Infectious Diseases at the University of Western Australia and also a pediatrician at the Perth Children's Hospital. He's going to talk to us about infectious diseases in young children, so a warm welcome to Professor Chris Blyth. 
 
 Professor Chris Blyth: Thanks very much and thank you for the invitation to talk. 
 
 Gavin Nimon: Yeah, thanks very much for giving up your precious time to talk about such an important issue. The guy was aware of it being an issue around the world, but I didn't realise I was going to hit Australia quite as much as it does. and when I heard Catherine Hughes' story about how she lost her young child at a young age and the efforts that she's made to try and prevent this happening to other people, what do you hear more about it So that she can tell me a little bit about why it's important to know about respiratory infections and what type of infections occur in affecting young children in Australia? 
 
 Professor Chris Blyth: Yeah, thanks very much for the question and I think it's probably important to reflect that. You know every parent appreciates that young children get lots of infections. That's part of growing up, being exposed to common infections, particularly respiratory viral infections, and so you know it has big impacts on families. But, importantly, in healthcare it has significant impacts as well. Most frequent cause for general practice presentation and I work in a children's hospital The most common cause for hospitalisation or ED presentation are respiratory infections and they are predominantly respiratory viral infections caused by some of the pathogens, such as RSV, but also many of the other common pathogens that we see. 
 
 Gavin Nimon: I thought that came to mind was obviously we're aware of a motor vehicle accident where a young child loses their life, but is the actual extent of respiratory infections across the board, if you consider the total number, cause more of a problem overall? 
 
 Professor Chris Blyth: Yeah, as far as frequency and impact on families in the community, an enormous impact. And, importantly, every year in Australia we have a number of children who die from respiratory infections, and sometimes they are previously well children. So the frequency of morbidity and mortality from respiratory infections is far greater than some of those uncommon events and actually more common than other infections that we see in the media as well, like meningococcal disease. And that's not to importantly reduce the significance of meningococcal disease, but just give some idea about how frequently this occurs. If you look in a busy emergency department in the middle of winter, more than half the children are there within a respiratory infection. 
 
 Gavin Nimon: And do you think these things are trivialised by calling it a cold and not thinking it's something more serious? Obviously, being a healthy person, we recover it from fairly quickly, but in a young child or someone who's immunotably compromised, it can lead to long-term morbidity as well. 
 
 Professor Chris Blyth: You're right. So certain groups of children are at more risk of severe respiratory infection. So those with underlying lung disease, particularly those born pre-term, who have ongoing scarring as a result of that, those whose immune systems don't work as well, and also those with other comorbidities, such as children with underlying neurological conditions, heart and lung conditions, kidney disease they are all at risk of more severe respiratory infection. But importantly, it's not to forget that actually most children who get hospitalised with a respiratory infection, including some who have very severe outcomes, are normal children from the community. So, although certain groups are at greater risk, actually the bulk of disease is actually healthy kids who, thankfully, most have a short illness, but for some it can be significant and severe. 
 
 Gavin Nimon: What sort of infections are we talking about? Obviously in the media, the last few years has been COVID and what are the main ones that actually affect you and you actually see that you're concerned about in the community? 
 
 Professor Chris Blyth: Most of these are both viral and bacterial infections. Of the viruses that we most frequently see, rsv tops the list as far as the most common cause of lower respiratory tract infection in hospitalised children. Other important viruses include influenza, and certainly every year we see severe influenza in hospital, other infections such as para influenza and human metamemovirus. All of those actually cause hospitalisation and GP presentation and sometimes severe disease in children. We do see severe COVID in children and although children are less likely to get severe COVID than adults, we have seen a number of children over the last couple of years with severe COVID and some of the other seasonal coronaviruses. 
 
 Professor Chris Blyth: Of the bacterial infections, there's a couple of important ones that cause respiratory infection. By far the most common is pneumococcal disease, so Streptococcus pneumoniae, common bacteria and globally still causes huge numbers of lower respiratory tract infection. Other pathogens, such as haemophilus influenzae , group A strep, cause lower respiratory tract infection and we can't forget pertussis hooping cough. So although hooping cough is uncommon in Australia, we still see severe hooping cough and unfortunately we still see children who die from hooping cough as well, which is a bacterial infection which particularly affects children too young to be vaccinated. 
 
 Gavin Nimon: And certainly we're going to hear from Catherine Hughes about her experience and that later on in the interview. 
 
 Professor Chris Blyth: Absolutely, and her advocacy in this space has been really important. 
 
 Gavin Nimon: Which of these cause symptoms of the common cold? Is it any of them, or is it just one particular virus itself likes RSV. 
 
 Professor Chris Blyth: Yeah, good question. Now most people who have the common cold don't know which virus they've got. Now most of those are going to be rhinovirus and I didn't mention, though, that before because that is a less common cause of lower respiratory tract infection in hospitalised, but actually a common cause of wheeze in older children and in you and I. You know that basically sore throat and runny nose often that's rhinovirus. So again, that is an important and common pathogen. But all respiratory viruses can present in similar ways with upper respiratory tract symptoms such as runny nose, sore throat, and also lower respiratory tract symptoms such as cough and breathlessness. 
 
 Gavin Nimon: So you're dividing the cold into the upper and lower respiratory tract infections. When it comes to infancy, i understand you can also divide the lower respiratory tract infections into things like croup, laryngotrachyrobronchitis or bronchitis or bronchiolitis. And there's a medical student and even now I still struggle to get my head around the difference in the symptoms and what the conditions occur. 
 
 Professor Chris Blyth: Yeah, sometimes it's actually really hard and often the division is based on anatomy which part of the airway is most frequently infected. 
 
 Professor Chris Blyth: So sort of going from the top end pharyngitis, infection at the back of the throat, presenting with sore throat, tracheitis or laryngotrachyitis, you know, infection of the windpipe, the wide windpipe and the larynx, causing, you know, husky voice and things like that. Then you can get some bronchitis or inflammation of the bronchi, and then, particularly of importance in young children, bronchiolitis, which is really the terminal airways, the most narrow airways and the most susceptible to the edema or inflammation that occurs with these respiratory viral infections. And that's why we see bronchiolitis as a particular issue in young infants. Clearly young infants have the smallest and most narrow airways and any edema, any inflammation, any excess mucus that build up or spasm of that airway has a significant impact on their ability to breathe. And then you know, lastly, along that respiratory tree and I've gone from top to bottom is the alveoli. You know the breathing space and you know typically pneumonia is where you get inflammation of those alveoli and filling with fluid and infection. 
 
 Gavin Nimon: And can infection in any of these areas lead to long-term scarring and predisposed bronchectasis or other asthma-type conditions as well? It? 
 
 Professor Chris Blyth: can. So we know that recurrent infection, particularly the lower airways, can cause significant damage. That may be ongoing inflammation after the acute infection, but actually if that's recurrent it can cause damage to the airway and result in bronchiectasis. We do know also that those who have respiratory viral infections are more likely to have ongoing symptoms, so early life RSV infection are more likely to have recurrent wheeze. Now the tricky thing about that is that cause effect. Is it actually the more infections you are, the more likely your airways are to be problematic? or is it the person who's got problematic airways who's more likely to present with RSV? And I think the jury's out on that? but we do know The child who presents with recurrent lower respiratory infection, including viral lower respiratory infection, are at risk of ongoing lung disease and we've got to keep an eye out. So importantly, the child who has persistent ongoing cough and we normally say that's more than four weeks after respiratory infection we usually want to have a look at again to make sure they're on the improved. 
 
 Gavin Nimon: And what about the pathology that occurs in these conditions? Does it just lead to edema around the airways and fluid in the lungs, or is there actually such a toxin that occurs that actually damages the vessels and the tissue itself and actually makes it a worse disease, rather than just pure bit of inflammation? 
 
 Professor Chris Blyth: Yeah, it's more than inflammation at this stage. So, for example, bronchiolitis, a complex combination of airway edema, airway spasm and mucus production And, importantly, that normal airway is a complex basis trying to move both air as well as particles in the air forward. You know it's got. you've got cilia that are moving all the time with a layer of mucus and damaging of that can certainly lead to ongoing challenges. 
 
 Gavin Nimon: Is there a risk of fibrosis as well that can lead to long-term fibrotic condition later in life? 
 
 Professor Chris Blyth: We see early life damage resulting more in bronchiectasis, where you get dilation of the airways and pooling of secretions, rather than fibrosis per se, and so fibrosis is thankfully an uncommon problem in children compared to the other conditions. 
 
 Gavin Nimon: And, in your opinion, what are the best ways of trying to prevent these diseases? Obviously, we know about the use of masks, and we also know about washing hands and, as well as the vaccinations, but some of these diseases don't have vaccinations. So what other preventive measures are there And what is the order of priority for these measures? 
 
 Professor Chris Blyth: Well, i think you've described a number of different strategies to prevent them. I think they're all relevant. Covid has clearly demonstrated that actually many of those primary prevention strategies are actually really quite effective. So one you know, making sure that you don't come to work with your crook, making sure you know as much as possible. We have respiratory etiquette, you know, particularly if you're unwell and you're in a public space. You know using masks. Now I know that's easy for me to say as an adult and it's much more challenging for younger children. 
 
 Professor Chris Blyth: Some of those pathogens we have vaccines for. So in the virus space, flu vaccines we have, and we also have COVID vaccines. And in the bacterial space we have vaccines for pneumococcus. So of the 13 most common cause of pneumococci, we have a vaccine against those, and also there are vaccines that are trying to extend that to the 15 and 20 most common pneumococci. We have vaccines against pertussis. 
 
 Professor Chris Blyth: But, as that really highlights, there are gaps. We don't have vaccines for everything in the respiratory infection space And so children will continue to get respiratory infection. So the best we can do to try and prevent it by some of those primary processes and, importantly then, managing children who do have respiratory infection. I know you'll be talking to Catherine about RSV, but we've actually got some really exciting developments in the RSV space. We've now got phase three clinical trial data demonstrating the effectiveness of a vaccine given to mums to prevent disease in the first six months of life. We've also got data about a long-acting monoclonal called the 7MAB, which is also looking at preventing RSV in the first six months of life, and also data about the use of these vaccines in the elderly. So there's going to be a lot of change in the RSV prevention space over the next couple of years, and so I do actually think what we see now will be very different in a couple of years time, once programs using the prevention strategies come on board. 
 
 Gavin Nimon: And is it because of the COVID years and the research that's occurred during it and the money that's been put into the research that's made these new vaccinations available? Or is it purely just by chance that these other vaccinations are coming at the same time? 
 
 Professor Chris Blyth: We've been looking for an RSV vaccine for more than 60 years, so research into an RSV vaccine started in the 1960s and there's been a number of attempts to do that. But certainly the technology involved in vaccine researchers has accelerated and that both led to the early discovery of COVID vaccines and some of the vaccines we're talking about. So there is healthy investment in vaccine discovery at the moment and that is a good thing. To try and target some of the pathogens that remain a challenge for us. 
 
 Gavin Nimon: Well, for those young children that do become unwell, what are the signs we need to watch out for And how do we actually treat it once we see a child come down with one of these pathogens that could actually affect their airways in the young child? 
 
 Professor Chris Blyth: So most of the children presenting with an acute respiratory viral infection will develop theta, thank you. May have runny nose, may have cough, may be off their food because they've got a sore throat or not feeling well, may vomit as well, and then they just be sleepy or not as active. And you know, every parent who has a young children will recall an episode such as that, when infection gets into the lower airways. And that's where things are more challenging is breathlessness is most important and cough is most important, and sometimes, when that progresses, difficulty breathing. So for young children, that's one. their respiratory rate increases so they're breathing heavy. They may also be using their tummy muscles to breathe, they may be clearing their nostrils a little more than they normally do, all to try and generate the energy to try and breathe. 
 
 Professor Chris Blyth: And so they are the signs that we particularly look out for in children with respiratory infections, to work out those who may need that extra degree of support. And the reason that's important is because most children with these infections recover by themselves. So most of the time with the very mild respiratory infections we don't need to do anything. We can watch, we can use some extra fluids and some extra medications that may relieve discomfort, like paracetamol or norefine, but most of the time they get better by themselves. But as those are on the more severe end, those who have difficulty with breathing and, if it progresses, difficulty with oxygenation and difficulty with tolerating fluids and diet that we bring into hospital to support. 
 
 Gavin Nimon: And I always remember being taught that the children can sort of compensate quite well for a period of time and then suddenly they crash and go down suddenly, as opposed to a slow deterioration. Is that the case? 
 
 Professor Chris Blyth: Absolutely the case. You know, children have remarkable physiologies as far as being able to maintain their core function, so their heart rate, their blood pressure, their oxygenation but things can change quickly in children, and so parents as well as doctors need to be aware of that. So you know, when you're seeing someone with mild infection is talking to the parents about these are things to look out for. So particularly breathlessness, particularly drowsiness, particularly not tolerating fluids, would be some of those red flags that I've talked to families about if I'm seeing them with a mild illness, because children can deteriorate quickly. I think it's also important to note that, although we talk about respiratory infections, some of them are bacterial infections, and so some of these children will need antibiotic treatment as well, and we don't have great ability to distinguish bacterial and viral infection, and so the more severe children usually get treated for both. 
 
 Gavin Nimon: And what would be the broad spectrum antibiotic you might use in that scenario to treat the symptoms for the medical student to be aware of? 
 
 Professor Chris Blyth: Most of the time we don't use broad spectrum antibiotics because we know that the common pathogens and pneumococcus is the pathogen that's most important there. So if a child we think is having bacterial pneumonia, so particularly for the medical student the child has cough, may have breathlessness and may have focal signs on auscultation of the chest, we'll reach to a moxicillin or the main olimoxicillin, because most of those cases will be pneumococci, which is susceptible to penicillin and amoxicillin. But the more severe the child, we usually cover broader pathogens, including some of the unusual pathogens, if there's fear enough to come into our intensive care unit. But actually most children who come to our emergency department and the ones who get admitted to hospital we treat with amoxicillin and sometimes preventive penicillin. 
 
 Gavin Nimon: When you haven't mentioned I presume is because of the cause of the older child is Epstein-Barr virus. Does that cause much respiratory issues? Is it more purely upper respiratory and in an older child scenario? 
 
 Professor Chris Blyth: Most EBV infections are asymptomatic in childhood, but usually the older the child, the more likely they are to be symptomatic. Pharyngitis is the most common presentation, So the classic presentation is the adolescent who presents with a sore throat, maybe fever, maybe lymph adenopathy. Ebv rarely causes lower airways disease. It's more a disease of the throat and the lymph nodes and you sometimes get livers and spleens as well. 
 
 Gavin Nimon: Excellent. Now, while we're talking about the younger child being at higher risk of lower respiratory tract infections, what subgroup of the younger child do we have to watch out for that are higher at risk? even again, i expect this child with cystic fibrosis is at a higher risk. We'll report it at the indigenous populations and other subgroups that we need to be extra careful for. 
 
 Professor Chris Blyth: So any child with a history of airways disease and clearly there's lots of different types of airways disease the group that probably is largest is those who have been born pre-term. So those who have been born before 37 weeks, but particularly those who have been born before 32 weeks, are at increased risk of many of these respiratory viral infections. They get it more severe, they're more likely to be hospitalized And with structural lung disease and CF is one of the types of bronchiectasis are at increased risk of disease as well. So anyone with underlying lung disease we would warn parents that they may get more unwell. 
 
 Professor Chris Blyth: You talked about Aboriginal children. Certainly Aboriginal children have a higher rate of admission with respiratory infections and also actually a higher rate of progression to diseases such as bronchiectasis, and that's likely to be multifactorial. But it does mean that you know that is a group that is at increased risk and we need to certainly be cautious in that population. And then other things, such as those who've got abnormal immune systems, whether that be one primary problem or as a result of chemotherapy and those sort of things, and also those with particularly heart disease. Some of the children with congenital heart disease are at a particular risk of any of these respiratory viral infections. 
 
 Gavin Nimon: Brilliant Well, once the child is admitted to hospital. when they are deteriorating, what are the main treatment options you would perform? Obviously, oxygen is the first line of call, but what other methods would you use? Would you use humidification still, or is that something you do at home before they go? 
 
 Professor Chris Blyth: We do. Certainly, supportive care is the most important thing. So one making sure they're adequately hydrated and adequately oxygenated are the two most important things. So oxygen, you know, whether that be one, some nasal prong oxygens, or then increasing respiratory support like high flow, or even CPAP or ventilation for someone with severe disease. We use all of those modalities in children with respiratory infections. Most don't need it, but certainly a proportion do. 
 
 Professor Chris Blyth: Those children who are breathless or feel unwell don't drink. We need other ways to maintain their hydration. So often for particularly the smaller child, even a nasogastric tube with some enteral fluids is a way to try and maintain their adequate hydration. But then if that's not working, intravenous fluids or other forms of hydration is important. And then really the third thing is in the proportion that we think have bacterial infection, antibiotics are used as well. We don't use a lot of things like bronchodilators, salbutamol and the like, unless it's clear they have wheeze or an older child. And we don't use a lot of steroids unless it's in a similar population, Those who are likely to have asthma rather than just an acute respiratory infection. We do use. So certainly the airway. if we're pumping unhumidified oxygen into the airway it certainly dries out secretions and makes it more difficult. So we, particularly those who are having respiratory support, we try to keep the air and oxygen as humidified as possible. 
 
 Gavin Nimon: Is there a role for antivirals in this population with the deteriorating, or is that more for the older person with COVID? 
 
 Professor Chris Blyth: There is. So up until recently we haven't had a lot of antivirals. We've had flu antivirals such as Osseltamivir, and so Osseltamivir has reasonable data about its effectiveness in flu. So certainly for those who have a mild flu illness Osseltamivir shortens the duration of the illness And those who are severe enough to be hospitalized it reduces complications. So we do use Osseltamivir and other flu antivirals in the child with flu in hospital. We haven't had to use a lot of antivirals for COVID antivirals in this population But those with severe COVID we have used flu antivirals. Unfortunately we don't have great antivirals for the other respiratory infections at this stage And you know that would make a significant difference for those who are unlucky enough to have severe RSV and para-influenza and human metonymavirus infection. At the moment we don't have those antivirals readily available. 
 
 Gavin Nimon: Now if we're going to give a take home message to the listener. I understand that obviously the respiratory infections in the young children's and the infants is quite a large number, but the actual mortality rate is quite low. But has that kept under control because of the hand hygiene, the social distancing or other aspects, including vaccinations? I mean, how important are these measures to be kept going? If we stop them, would it be more of an issue? 
 
 Professor Chris Blyth: I think we need to put it in perspective. If you look at global under five mortality, respiratory infections cause about a fifth of that, so actually it's the most common cause of childhood death globally at this stage. Now we are incredibly lucky in Australia. We have a great healthcare. We have access to supportive care that could support young children through these illnesses. We live in an environment that we don't have as much exposure to environmental challenges such as cooking smoke and those sort of things. So in Australia we're incredibly lucky. 
 
 Professor Chris Blyth: But that means that for most children, a respiratory infection is usually mild and usually self-limiting. So it would be silly for us to ignore all the things that we have done to get to this position, and clearly vaccination is a critical component of that. We're in the middle of flu season at the moment. Our flu vaccine uptake in young children, even though it's on the national immunization program, is not as good as it could be. So it means there's large numbers of young children that increase risk for flu out there who remain unvaccinated, and we know vaccination keeps them out of hospital. 
 
 Gavin Nimon: Yes, certainly. I know people who have had the flu recently and have been really knocked out by it. So certainly in a young child or an immunocompromised young infant, this could be really quite serious. So I think it's really important to really hammer this home to the listener to make sure they're actually aware of how serious these infections can be. 
 
 Professor Chris Blyth: Yeah, absolutely So, thank you. I totally agree with that message and certainly as much advocacy I can do to highlight the benefit of this to all children is important. We have the tools. They're not perfect tools, but they have proven to be effective at reducing hospitalization and severe disease. We should use them. 
 
 Gavin Nimon: Excellent. Thank you very much, Professor Chris Bly. thank you very much for your time. 
 
 Professor Chris Blyth: My pleasure. Thank you for the chat. 
 
 Gavin Nimon: Now to really emphasise how important these respiratory infections are in the young child and infant. Our next guest is Catherine Hughes. Catherine has an amazing story having lost a child at one month to Hooping Cough, She's established the Immunisation Foundation of Australia to try and actually reduce the chance of anyone else having to go through the same heartache. For efforts she's received an order of Australian medal and she's going to talk to us about her experience and what she's trying to do to make sure and highlight the issue of RSV in the community. Catherine, can you introduce yourself and tell us how you got involved in this whole process? 
 
 Catherine Hughes: Thank you for having me. So I'm Catherine and I got involved in the immunisation process, i suppose, after I lost my newborn son, riley, to Hooping Cough back in 2015. So when he was about three weeks old, he began displaying what we thought were cold symptoms. So he just had a bit of a runny nose, a bit of congestion, and he was occasionally coughing, but then one evening he just did not wake, so overnight feeds. So we got a bit concerned and we took him down to our local children's hospital here in Perth. But yeah, unfortunately, during his stay in hospital, he sort of grew worse every day. On day three we found out that he'd contracted Hooping Cough, which we now know is a highly contagious respiratory bacterial infection. But to make matters worse, it progressed into pneumonia, which happened in about a quarter of babies who got Hooping Cough. And so, despite the doctor's incredible efforts, really, his heart and lungs began to fail on any possible way. 
 
 Catherine Hughes: On his fifth day in hospital, he was just two weeks shy of being eligible for his own Hooping Cough vaccinations, and it was during this heartbreaking time in hospital with Riley that my husband and I learned about preventative measures that were being taken in other countries to protect newborns from Hooping Cough. They were offering vaccines during pregnancy to pregnant women, providing really crucial, important immunity to infants during those very vulnerable period of their child's life, and so we were really fueled by grief and by desire that this did not happen again to other babies. So my husband and I, we embarked on a big campaign to raise awareness and advocate for free Hooping Cough vaccine programs for pregnant mums across Australia, which all pregnant women now in Australia are eligible for these pregnancy vaccines, which is amazing. Through our advocacy work, we've also had the privilege of connecting with a number of families around the country who've also been affected by vaccine preventable diseases and really nasty respiratory infections, and it's really these connections that prompted us to establish the Immunisation Foundation of Australia in 2016. 
 
 Gavin Nimon: It's truly an amazing story and it's fantastic you've found the strength to move on and be able to put your efforts towards helping other people in this area. Obviously, having heard from Chris earlier, the extent of respiratory infections in Australia is quite extensive and whilst it's not always causes mortality, it also does occasionally have such high risk of morbidity and long-term issues. it's really important, so you've really got to be applauded for taking on such an important role and advocating for such an important issue. 
 
 Catherine Hughes: Thank you. I just think you know it's something that no baby should have to endure. You know no family should have to witness and you know no doctor should have to care for a child with a disease that can be prevented. So you know, if it can be prevented, we've got to. We've got to prevent it. 
 
 Gavin Nimon: That's truly amazing. As part of your advocacy work, you've also taken on the issue of other respiratory issues as well, not just whooping cough, and one of these that's caught your attention is RSV. What's the issue with RSV and why is this so important? 
 
 Catherine Hughes: Well, you know, since we've been involved in the immunisation space and, i suppose, the respiratory disease space, i've met with so many families who have been traumatised by having their children, their little babies, hospitalised with RSV, and so many of them were like you know we've never heard of RSV until our child was definitely sick with it. So you know, i've come to learn that RSV is really the leading cause of hospitalisation for Australian babies and kids under five, but it's just not as well known as you know other common respiratory infections like flu and and whooping coughs and, of course, covid as well. So you know, we came to realise that it's pretty urgent that we did some work in this area so that parents knew about RSV. they knew what it looks like and what its symptoms are, and also what severe RSV disease looks like Such an unpredictable disease and parents need to know, you know, when is the right time for them to seek medical attention. 
 
 Gavin Nimon: Now I believe that you may also have had experience with RSV infection in a child and also speaking to other parents, what thoughts go through the parents' mind when their child gets RSV and they end up in hospital, and how long does a child end up in hospital once they get infected with RSV4? 
 
 Catherine Hughes: Well, it's quite unpredictable, so it could be really minor in some kids, you know, just a little sniffle, but then in others. You know I've talked to families who've had their kids in ICU for a couple of weeks in an induced coma. So it can be really severe and certainly, you know, it's something that my family experienced as well. So 18 months after Riley passed away we had another child, lucy, who was about three weeks old, and she started getting cold symptoms and we just thought, oh my God, you know this can't be happening again. And you know we breastfed her, we kept her home, we've done everything we could think of to protect her. 
 
 Catherine Hughes: But unfortunately her older sister came home with a little bit of a minor sniffle. You know it was nothing, you know, in a four-year-old, but in a baby it was quite severe. So she did need to be hospitalized for two nights. But I've come to realise that I think she was actually one of the lucky ones. She only needed a bit of oxygen support and she was out of hospital in two days, whereas in other babies, unfortunately, it can be a much worse experience. 
 
 Gavin Nimon: What would be your advice to watch out for? What are the things apart from just a little sniffle and what looks like a cold? what would you make your concern to take the child to hospital? What did you think was important for you and the people you've spoken to? 
 
 Catherine Hughes: Well, i think it's quite clear that babies and young children can deteriorate quite quickly and suddenly. So I think as parents, we need to be able to be empowered to watch out for things like wheezing. If the child is wheezing, if their head is bobbing, if they have really short, shallow, rapid breathing or making like little grunting sounds as they're breathing. Also, you can watch under their ribs and see if their chest is kind of caving in between and underneath their ribs, and then, of course, watching out for things like a blue tint around the lips, on the fingernails, even underneath the eyes. But I think most importantly of all this is what I've said to parents is they need to you know, you need to trust your gut and you know when your child's not well. You know, you often know, you know when it's time to be concerned and seek medical attention. So definitely, you know, listen to your instinct as well. 
 
 Gavin Nimon: Excellent. Now I believe, as part of this, you've also made an animation to make it easier for parents to understand what the signs of respiratory distress are and to watch out for them when children should get sick. I believe this is available on the Foundation website. Is that correct? 
 
 Catherine Hughes: Yes, that's right. So in June so June 4th to 10th our Foundation is launching the RSV Awareness Week, which is the first really RSV event of its kind in Australia. And as part of our Awareness Week, we've got our website set up with lots of campaign resources and materials, and one of those is a little video which shows quite clearly those signs that we just talked about to watch out for if your baby, you know, does have RSV or a respiratory infection of any kind. These are the things that you need to look out for. So yeah, it's all available on our website during our RSV Awareness Week. 
 
 Gavin Nimon: And what's that website address? again, thanks, catherine. 
 
 Catherine Hughes: Yes. So if you head to ISA, so Immunisation Foundation Australia, isaorgau forward, slash RSV and me. So the campaign is called RSV and me because we're encouraging parents and anyone really to share their stories about RSV and themselves. 
 
 Gavin Nimon: Yeah, I think one of the most important things that's come out of the COVID era is that your awareness of the importance of social distancing and being taking precautions when you are on. well, And these measures and being aware of the signs of respiratory distress can be life-saving for young children. So thank you very much. 
 
 Catherine Hughes: Yeah, look, we definitely saw a decrease in RSV cases during the height of the pandemic, when we were all socially distant and washing hands and doing all those things. And as these things have slipped, RSV is making a big comeback. So you know, personally, especially with a little baby or a young child in the house, it's extra important that we do those hand washing things and, you know, stay away from crowded places with sick people as much as we practically can. 
 
 Gavin Nimon: Absolutely right, and what I'll also be placing on our website is a link to the video that you and your husband, greg, made regarding Raleigh's events. That's really quite heartbreaking and also explains why this is such an important issue. 
 
 Catherine Hughes: I think one thing our foundation really tries to do is to. you know, we are a patient advocacy organisation, so we really try to use human stories from the community to share, you know, the important messages about vaccination, because we know that some figures are great, they're useful, but they're often not enough to change people's mind or to influence them to take action. So we use human stories Raleigh's story, there's, you know, a bunch of other stories from parents who've kindly, you know, shared their pain with us. And, yeah, that's how we feel is the best way to advocate immunisation, to tell stories and hopefully protect lives. 
 
 Gavin Nimon: Brilliant. Now, in finishing up, what would you say the most important message you could pass on to the listener when listening to this podcast regarding respiratory infections in the young? 
 
 Catherine Hughes: I think the most important thing to say about RSV is that it is super common. It's so unpredictable, so you just don't know what's going to happen if your child contracts RSV, and just you know. encourage everyone to be empowered with the knowledge of what severe respiratory illness looks like and really go with a gut instinct if they're worried about their child. 
 
 Gavin Nimon: Well, thank you very much for your time, catherine. It's been fantastic having you on Aussie Med Ed. It's brilliant, and we'll look forward to your campaign going out on the 4th or the 10th of June and all the best with it. Thank you so much. Thanks for having me. No worries. I'd like to thank you very much for listening to our podcast. I'd like to remind you that the information provided today is just for general medical advice and does not pertain to one particular medical condition or one way of treating a particular condition. If you have any concerns about information raised today, please do not hesitate to contact your general practitioner for further information. We hope you've enjoyed the podcast and please don't hesitate to give us a like or tell your friends about it or give us a positive review. We look forward to presenting another podcast to you in the near future on a different topic. Until then, stay safe. Thank you very much.