Tired of being sick! This winter 2022-2023 was marked by an increase in infections. To explain it, some people talk about an “immune debt”. If specialists reject the idea that our system has weakened individually, there is indeed a lack of collective immunity.
Like many countries, France experienced a triple epidemic of bronchiolitis, flu and Covid this winter. For some, viruses would have a field day due to an “immune debt”. This term is used for the first time by French pediatricians in 2021 in an opinion article where they explain that due to barrier measures and the low circulation of viruses responsible for respiratory infections, gastroenteritis or chickenpox, the children’s immune system has not been trained enough. An under-stimulation suggesting a resurgence of these pathologies once the barrier measures are lifted. This hypothesis was taken up at the top of the State, but also by many French people who have had a series of infections this winter. A flagada system?
This concept of immune debt is far from unanimous in the scientific community. Main downside: it suggests that our immunity has weakened. “This term suggests, wrongly, that our immune system needs to be strengthened like a muscle, which is false,” explains Professor Olivier Schwartz, director of the virus and immunity unit at the Pasteur Institute. In fact, there is not an optimal number of annual infections to contract for our defenses to build up or to prevent them from fading. Moreover, immune memory is not always effective: you can be contaminated several times by the same virus and be sick each time. Confinement and masks don’t change anything.
Viruses are catching up with us
“Regarding this exceptional season, I would rather speak of virological debt,” adds Professor Schwartz. Other experts speak of an exposure debt. Two expressions which designate the same concept: barrier measures have limited the number of infections, in particular those caused by airborne viruses such as SARS-CoV-2. However, they never disappeared and waited patiently for us to take off our masks and return to our previous lives. It’s a bit like we’ve pressed the pause button on the machine and it’s catching up. In this sense, there is a form of collective debt.
This explains in particular the strong epidemic of bronchiolitis which led to nearly 9,000 visits to the emergency room at the height of the epidemic compared to 5,000 to 6,000 between 2018 and 2021. Usually, all 2-year-old children are infected at least once. times by respiratory syncytial virus (RSV). However, over the last two years, it has circulated very little. As a result, more children are experiencing it for the first time. “We also assume that children born since the start of the pandemic received fewer anti-RSV antibodies during pregnancy or during breastfeeding since their mothers were less exposed to it,” says Professor Guy Gorochov, head from the AP-HP Department of Immunology.
Seasonal flu
However, this exposure debt is only one of the possible explanations for this triple epidemic. “There are other hypotheses, one of which, and not the least, is that SARS-CoV-2 infection could increase the susceptibility, even the virulence, of other infections in the event of co-infections,” notes Samuel Alizon, research director at CNRS. Scientists are also studying the possibility that SARS-CoV-2 “erases” the immune memory built against other viruses, which would then make these people more vulnerable. And Samuel Alizon adds: “for the flu, the seasonal rhythms vary greatly. It comes back a little different every year but, some years, every four or five years, it comes back very different. We can therefore have years with many cases of flu. Also, we cannot exclude that the variant currently circulating is more contagious. »
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