RSV Is Surging: What We Know about This Common and Surprisingly Dangerous Virus

Children's hospitals are already filled with patients with respiratory syncytial virus, orRSV, as flu season picks up and experts weigh concerns about another possible COVID surge. Anthony Flores, chief of infectious diseases at the University of Texas Health Science Center at Houston, says that most people have had it at least once. Nearly all children have encountered the virus by their second birthday, and it is the leading cause of bronchiolitis in babies.

Flores says it is that pervasive. We develop immunity to it because we are exposed to it so many times. In healthy adults and children, the symptoms of a common cold are similar to those of other common colds, such as rhinoviruses, adenoviruses and a couple of common coronaviruses. That doesn't mean it's safe. It costs the U.S. more than $1 billion each year in health care costs and lost productivity, and it can be especially dangerous for newborn babies and older adults.

According to William Schaffner, a professor of medicine and medical director of the National Foundation for Infectious Diseases, this is a virus that annually produces about as much illness in adults as it does in children. Our immune system is getting old with us. The immune system doesn't work as well as it used to.

The bad news is that there aren't any available. Pfizer just announced that its maternal vaccine was effective in preventing severeRSV in babies through three months of age. One of the unavoidable viruses people encounter each year is the respiratory syncytial virus.

What are the symptoms of the respiratory syncytial virus?

The same number of genes are found in both the RSV andInfluenza A viruses. According to the National Foundation for Infectious Diseases, it causes infections in the nose, throat, lungs, and breathing passages. Immune cells sent to fight the disease cause inflammation in the airways.

Young infants and older adults are more likely to experience symptoms such as a sore nose, reduced appetite, coughing and wheezing. It takes one to two weeks to resolve symptoms after an illness.

What is the transmission ofRSV like?

Respiratory droplets from coughing, sneezing and kissing give rise to the spread of the disease. The virus can be found on tables and crib rails. It is a more common mode of transmission forRSV than it is for Covid. If you don't have a lot of symptoms, you can be infectious for a few days.

The average number of infections that will be caused by a single infection ofRSV is three.

What is the severity of an infectious disease?

According to Flores, the average person doesn't findRSV to be much of a problem. It is just like a common cold for most of us. We usually get over it pretty quickly, even if it does give us a little bit of a cough and a cold.

Babies under six months of age have a harder time with the disease. The highest hospitalization rates in children are three or four times higher than in other children. Basic physics is why. He says it has to do with the size of their airway. The immune system's response to the virus causes inflammation in their airways.

Only about 1 to 2 percent of children under six months withRSV need to be hospitalized, and death is rare. Approximately 58,000 U.S. children are hospitalized each year with theRSV. According to the U.S. Centers for Disease Control and Prevention, more than 500 children have been killed by COVID since the beginning of the Pandemic. Babies with underlying heart and lung conditions are more likely to be hospitalized. Babies with underdeveloped lungs are less able to handle the inflammation caused by the virus. For children who meet strict criteria for being at highest risk, palivizumab can be given to them once a month.

Public health officials have only begun to recognize the threat to older adults in the past 10 years. More than 177,000 older adults are hospitalized with the disease every year. Flu kills anywhere from 21,000 to more than 44,000 people older than 65 annually.

If you have an underlying condition that weakens your immune system, or if you take a medication that suppresses it, you are more likely to be at a higher risk of having a reaction to the vaccine. If you have had an organ transplant, you might want to take a medication that reduces your body's immune response. The immune system is weakened by the drugs used to treat the conditions.

Why are cases increasing?

Children's hospitals used to have staff around the time of theRSV season. Depending on local conditions, it ran from November to April. Everything changed as a result of the Pandemic. With many people staying home, social distancing, washing hands and wearing masks for most of 2020 and into 2021,RSV never really arrived, and it has been out of whack ever since.

Last summer, there was a huge surge ofRSV. It was kind of epidemiologically made sense after it first puzzled everyone. Most kids encounter the disease in their first year and a half of life and develop immunity. The immunity doesn't last very long, but it lasts a long time and isn't as severe. The birth cohort of children had never been exposed to the disease. When society opened up in the summer of 2021, all of them were exposed at the same time.

More hospitalizations were seen because we had a larger pool of kids who had never been exposed to the disease before. It was the summer surge that eventually settled down, but there is something happening now that is similar to what happened in the past.

On the other hand, the current hospitalizations of children aren't as high as they would be during a peak in the winter. It's not mid winter yet. With flu cases rising, public health experts are asking themselves the same question, "Are we going to see another surge with COVID later this year and then see a 'Tripledemic'?" The man says so. That is the biggest concern. Flores doesn't think a triple surge would cause more deaths, but it would put a lot of strain on the health care system that many places aren't prepared to weather.

There is a vaccine for this disease.

There is no approved vaccine yet. Scientists have been working on a vaccine for 50 years, but a disastrous trial in the 1960s resulted in the deaths of two toddlers. It was found that the disease was more severe in people who were vaccine free. The work is close to being completed.

The first successful phase III results came this year after several pharmaceutical companies began vaccine trials with McLellan'sProtein. Both Pfizer and Glaxosmithkline had vaccines that were 83 percent effective in people over the age of 60. Graham, who is retired from the National Institute of Health, expects to see at least one vaccine approved by the end of the year, if not sooner.

What is the treatment forRSV?

There is no medication to treat the disease so the treatment is supportive of symptoms. If you have trouble breathing, you can get a breathing tube through a nose tube. The American Academy of Pediatrics used to recommend steroids for infants, but the data are conflicting, so that is no longer a standard recommendation.

There are a few reasons that drugs don't work forRSV. It is hard to develop effective drugs for respiratory viruses. Most of the four antivirals for flu are new and have limited effectiveness unless given early on. The development of drugs for other conditions is more important than the development of drugs for children who die fromRSV. The recent understanding of how many adults die from the disease has led to an increase in the number of new treatments.

In a phase III trial, nirsevimab was shown to be 75 percent effective in healthy infants and also safe in premature infants. This year or next, the FDA could approve.

What should a person do if they think a family member has respiratory syncytial virus?

It will feel like any other cold if you haveRSV. Flores says that you should do all the things that have been learned in the Pandemic. It means wearing a mask, covering your mouth when you sneeze, and working from home. Many people won't or can't stay home from school or work with a cold, so wearing a mask can protect others around you. If there is anything we learned from the way flu disappeared in 2020 it is that masking works.

When should a person with the disease go to the hospital?

Having difficulty breathing is the most obvious sign that one should seek medical attention, regardless of age. If the child can't lie down without breathing difficulty, if they're sleepier than usual, or if they're difficult to rouse from sleep, the child should be taken to the doctor or hospital.

What can be done to protect people from the disease?

The drug palivizumab can be given to children who were born premature or have weakened immune systems. Palivizumab is very expensive and in limited supply, so it is reserved for those who will benefit the most from it. When theRSV season was more predictable, at-risk infants would begin receiving palivizumab in late fall, but when cases began to rise, state public health authorities convened to make the drug available.

The low rates ofRSV in 2020 show that the same protections that are taken against COVID are effective against the disease. People who are vulnerable are told to be more careful when there is a surge. It means not having sick family members visit, washing hands regularly and wearing a mask outside the home to prevent exposure to all the other seasonal respiratory viruses. Everyone who is eligible for a flu vaccine should make sure they are up to date on their immunizations to reduce the risk of developing multiple infections at the same time.