While many eyes are on current levels of influenza and COVID-19 activity across the U.S., another virus is on the rise, impacting both
adults and children. Pediatric cases of respiratory syncytial virus, or RSV, are causing an influx of hospitalizations. RSV is a virus that causes the common cold and while illness is typically mild, it can lead to bronchiolitis and pneumonia and even be life-threatening for infants and children.
Quarantine over the past three years helped protect children from COVID-19, but it also limited exposure to other viruses. In general, children have their first exposure to RSV by the time they are two years old (CDC, 2022). However, many children are having their first exposure to RSV now and their immune systems are not prepared. Pediatric hospitals are feeling the impact, and many are at or over capacity. Some pediatric hospitals are even experiencing a shortage of ICU beds (Advisory Board, 2022).
As clinicians, we need to be aware of this surge in cases and hospitalizations, brush up our knowledge, and contribute to efforts to curb transmission.
Distinguishing RSV from other Respiratory Illnesses
How important is it to recognize RSV and distinguish it from other viral infections, such as COVID-19 and influenza? Symptoms among these three viruses are often quite similar, but it’s important to recognize those children at high risk of complications as well as the subtle differences in the presentation of RSV.
The pediatric groups at high risk include premature infants, infants 6 months and younger, children younger than 2 years old with chronic lung disease or congenital heart disease, children with suppressed immune systems, and children who have neuromuscular disorders, including those with difficulty swallowing or clearing mucus secretions (CDC, 2022).
Infants and young children with RSV may have rhinorrhea and decreased appetite as their initial symptoms. Cough usually develops one to three days later, sometimes followed by sneezing, fever, and wheezing. In very young infants, irritability, decreased activity, and/or apnea may be the only symptoms (CDC, 2022).
Laboratory testing is key to diagnosis. Both real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) and antigen testing can confirm RSV infection.
Preventing Severe Illness and Hospitalization due to RSV
As adults, we can help prevent the spread of RSV ourselves and educate others, including parents and caregivers of children at high risk for severe RSV infection, on infection control practices, such as hand hygiene, covering coughs and sneezes, cleaning frequently touched surfaces, and avoiding close contact with anyone who is sick.
For those with RSV, treatment is supportive and includes fever reducers and pain relievers, such as acetaminophen or ibuprofen, and fluids to prevent dehydration. Palivizumab is a monoclonal antibody available to help prevent serious lower respiratory tract disease caused by RSV in certain infants and children at high risk for severe disease (Lexicomp, 2022).
As we get deeper into the fall and winter, it’s important that we stay informed on the status of seasonal viral illnesses. Though they are being referred to as the ‘triple threat’ or ‘triple-demic’ in many headlines, RSV, influenza, and COVID-19 are only three of the many viruses that spread during the colder months. Together we can take steps to minimize the spread of all infectious diseases, keep patients safe, and support our healthcare workers.
References:
Advisory Board. (November 8, 2022). 'Crisis mode': RSV surge overwhelming pediatric hospitals. https://www.advisory.com/daily-briefing/2022/11/08/rsv-surge
Centers for Disease Control and Prevention (CDC). (October 28, 2022). Respiratory Syncytial Virus (RSV). https://www.cdc.gov/rsv/clinical/index.html
Tags :