Health experts had predicted an early start to a severe flu season and a rise in COVID-19 cases as new variants emerge. But a recent surge of respiratory syncytial virus — or RSV — now swamping pediatric units and children’s hospitals across the country caught many people by surprise.
Children's Health of Orange County (CHOC) reported a dramatic increase in patient volume in the inpatient wards and emergency room, primarily in children with RSV, which spreads through droplets and respiratory secretions. By Oct. 31, CHOC’s two pediatric hospitals were so overwhelmed that the Orange County Health Care Agency declared a health emergency.
RSV, which usually results in mild, cold-like symptoms and lasts for a week or two, can be serious in children under age 2, even deadly for infants whose small airways can be easily overwhelmed by the infection.
“RSV can require hospitalization in children especially those under 12 months of age, pre-term babies and those whose immune systems are compromised,” says UCI Health pediatrician Dr. Coleen K. Cunningham, chair of the UCI School of Medicine’s Department of Pediatrics and pediatrician-in-chief and senior vice president for CHOC.
“It also can be serious in older adults, especially those with chronic heart or lung disease or weakened immune systems,” added Cunningham.
What is RSV and how does it spread?
RSV is a highly transmissible respiratory virus that spreads via droplets and respiratory secretions. This can happen if we touch a contaminated surface then touch our eyes, mouth or nose. It also can spread by inhaling droplets from an infected person’s sneeze or cough.
Most children have had an RSV infection by their second birthday and most children recover on their own within a week or two. But in babies under 12 months of age, it is the leading cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (lung infection).
Over the last two years, however, COVID-19 masking, social distancing and other precautions reduced RSV infections dramatically. In a normal year, only the youngest children would be experiencing their first infection with RSV.
"This year we have a pool of infants through 3 years of age who are all experiencing RSV for the fist time," says Cunningham. "Children who acquire RSV aren’t sicker than they would be in a regular year, there are just so many more who are experiencing the virus for the first time."
The RSV surge is superimposed on a late summer surge of other respiratory viruses and potentially will overlap with an early start to what is expected to be a severe flu season and a resurgence of COVID-19 as we approach the winter months.
What are RSV symptoms?
Children and adults usually begin to show symptoms of RSV infection within 4 to 6 days after exposure. Symptoms include:
- Runny nose
- Decrease in appetite
In very young infants, the only symptoms may be irritability, decreased activity and breathing difficulties.
How do I protect my child from RSV?
As we did with COVID-19, be sure that everyone in the household washes their hands or uses an alcohol-based hand sanitizer before and after touching your baby. Avoid contact between your infant and anyone who is ill, even if that person just has a “cold”.
To reduce the risk of exposure to RSV, the American Academy of Pediatrics (AAP) recommends all babies, especially preterm infants:
- Be breastfed
- Be protected from contact with smoke
- Avoid childcare situations with large numbers of other kids during their first winter season
- Avoid contact with sick people
If your baby is at high risk for RSV complications, the AAP recommends monthly injections of a drug called palivizumab, a monoclonal antibody that can prevent severe infection. Ask your healthcare provider if your child is at high risk for RSV.
COVID-19 precautions apply for RSV, too:
- Don’t go to school or work when you are symptomatic.
- Wash your hands frequently, especially before and after eating and using the bathroom.
- Avoid kissing, hugging, sharing cups or utensils when you or others are sick.
- Cover coughs and sneezes with a tissue, the inside of your elbow or your upper shirt sleeve, not your hands.
- Wear a mask around others when you feel sick.
When should I seek medical care?
For most children, an RSV infection will be like a cold, and they will recover on their own. Try the following at home to help your child feel better:
- Provide plenty of fluids. Babies may not feel like drinking, so offer fluids in small amounts often.
- Clearing a baby’s nose before offering fluids can make it easier for them to drink. If your child is too young to blow their own nose, use saline (saltwater) nose spray or drops and a nasal aspirator (or bulb syringe) to remove sticky nasal fluids.
- Treat fever using a non-aspirin fever medicine like acetaminophen or, if your child is older than 6 months, ibuprofen. Do not use over-the-counter cold medicines, which can be dangerous for young children.
- Avoid hot-water and steam humidifiers, which can be hazardous and can scald skin. If you use a cool-mist humidifier, clean it frequently to prevent mold and bacteria growth.
- Allow time for recovery and keep them home from school or childcare to prevent spread.
Call your pediatrician if your child:
- Has a fever of 100.4°F or higher and is 1 to 3 months of age
- Has a fever that rises above 104°F repeatedly
- Is coughing, wheezing, breathing rapidly or has other symptoms that worsen over time
- Shows signs of dehydration, such as fewer wet diapers than usual
- Has lips, skin or fingernails that look gray or blue
Visit your nearest emergency department if your child:
- Is under 28 days old and has a fever of 100.4°F or more
- Is having severe trouble breathing
- Is showing significant behavioral changes like decreased activity or alertness
RSV vaccines on the horizon
More than 30 preventive RSV treatments, including vaccines, are currently in development for adults and children. Nine are in advanced trials.
Several U.S. research teams also are working on vaccines for young children. One group led by Cunningham, a nationally regarded expert in pediatric infectious diseases, is testing a nasal-drop vaccine containing a weakened version of the RSV virus developed at the National Institutes of Health (NIH) for children between the ages of 6 and 24 months.
Cunningham said the advantage of a nasal drop is two-fold: “It’s not a shot, so you don’t have to worry about needles. A nasal vaccine would produce antibodies in the nasal passage, where the virus enters the body, in addition to those in the blood to prevent infection more effectively.”
This week, Pfizer announced that its RSV vaccine proved effective at preventing hospitalization among 82% of infants under 90 days old and 69% in infants age six months or younger. The manufacturer said the vaccine being tested has not yet met the U.S. Food and Drug Administration’s threshold for preventing doctor visits, but said the vaccine will be submitted for agency approval by the end of this year.
A Pfizer RSV vaccine for pregnant women, given in the late second to third trimester, has also proved effective. That clinical trial revealed that the mother’s antibodies can cross the placenta to the fetus, protecting the baby for the first few months after birth.
“Hopefully, we’ll have a vaccine for this serious childhood illness very soon,” says Cunningham. “In the meantime, we do have effective and safe vaccines for the COVID-19 and influenza viruses which still remain a serious health risk for kids. Parents should make sure to vaccinate their children for both the flu and COVID.”