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RSV surge puts youngest children at risk

Lack of immunity results in more severe illness

CHICAGO --- RSV or respiratory syncytial virus in Chicago and around the country is surging much earlier than would be normally expected and overwhelming pediatric hospitals, report Northwestern University pediatric experts. And children are experiencing more severe illness than in the past, they say.

Here the experts explain why the respiratory illness is surging, who is at highest risk and when to seek medical care for a sick infant who is struggling to breathe or has a high fever.

The experts:

Dr. Bria Coates is an assistant professor of pediatrics at Northwestern University Feinberg School of Medicine and an attending physician in critical care at Ann & Robert H. Lurie Children’s Hospital of Chicago.

Coates has new published research showing greater damage to the cells lining the nose correlated to longer says in the pediatric intensive care unit.

 Dr. Tina Tan is a professor of pediatrics at Northwestern University Feinberg School of Medicine and an attending physician in infectious diseases at Lurie Children’s.

Dr. Benjamin Singer is an associate professor of medicine in pulmonary and critical care at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician.

Dr. Coates: “RSV is overwhelming pediatric hospital systems right now. Normally at this time of year, you should not be seeing this much RSV. Usually it surges from December onward, the worse months being in deep winter in Chicago. However, the pandemic has interrupted the pattern of respiratory viruses in children, so we are now seeing record numbers of young infants presenting with respiratory distress. 

“We don’t fully understand why there is such a big surge, but people are hypothesizing that with previous masking and kids being home from school during COVID-19, there was a period of time in which children were not being exposed to these viruses. Now that these mitigation efforts have been lifted, and kids are back in school, viruses are circulating again.

“Historically, by the time kids are two years old, they have been exposed to RSV and will start to build up immunity. You are susceptible to reinfections throughout life, but, in theory, they should be less and less severe. That hasn’t happened, which may be why we’re seeing more children spreading the virus. Unfortunately, with the virus circulating so aggressively, it is reaching the most vulnerable populations, including young infants, children born prematurely, and children with chronic lung disease.  

“This is running rampant through our schools now. My kindergartener was sick for a couple days last week. When she went back to school, there were only six kids in her class of 25.”  

What is the treatment? 

 Dr. Coates: “There are no therapies. It’s all supportive care at this point. We make sure kids can breathe, and if not, we give them extra oxygen or a breathing tube and a ventilator. 

“Children at high risk of severe disease — premature babies, children with congenital heart disease or chronic lung disease — can take palivizumab, an antibody traditionally given prophylactically during the winter months. But if you don’t know when RSV is coming, it makes it more difficult to make sure those kids receive it at the right time.” 

Several vaccines also are in clinical trials, Coates said.  

How serious is it?

Dr. Tan: “It can be serious, especially for the younger infants in the first two to three months of life, and very severe in premature infants, younger children with chronic lung or heart disease, or any young baby or child with a weakened immune system or a child with a neuromuscular disorder. RSV tends to produce a lot of mucous, and they may have trouble clearing their mucous secretions.”

When should a parent seek medical care for an infant?

Dr. Coates: “See a doctor if a baby is not able to eat and drink normally or take a bottle or breastfeed normally, if they have decreased numbers of wet diapers, if they are less interactive, if they are breathing fast and you can see their ribs move when they breathe, or if they are struggling to breathe.”

Can adults get it?

Dr. Tan: “RSV disease may occur in persons of any age. In the adult population, it’s more common in adults 65 years and older and in those with chronic underlying cardiopulmonary disease. A lot of times it will present as a really bad cold, but these individuals can develop pneumonia and severe respiratory distress.”

Dr. Singer: “Many adults have had RSV before, but that immunity wanes and you can become infected with it again. Adults are getting it, but there are not many in the intensive care unit. In most healthy adults, RSV does not tend to cause severe disease; it’s either asymptomatic or presents with mild cold symptoms. But for adults who are elderly, immunocompromised, undergoing chemotherapy or who have underlying lung problems, RSV can become severe.”

How do you get RSV?

Dr. Singer: “Droplets of virus get out into the environment in the same way people pick up flu or the cold. People are contagious for three to eight days after they start developing symptoms.