At Peak RSV Season, Do You Know What to Watch For?

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Jan. 22, 2019 — You might have heard about respiratory syncytial virus (RSV) on your local news, or have friends with kids who are sick. Although this common virus spreads from fall to spring, right now — from late December to mid-February — is peak RSV season.

Sarah Ash Combs, MD, a pediatric emergency medicine doctor at Children's National Health System in Washington, D.C., has seen a spike in the number of RSV cases since the start of winter. "In November and December 2018, our numbers went from the high 400s to the mid-700s per month. That’s up from July, when we had only a hundred per month. It’s a seven-fold increase over the winter," she says.

Because the virus starts out with upper respiratory symptoms like a stuffed nose, cough, and low-grade fever, parents often mistake it for a cold. Yet RSV can be much more serious. When it moves into a child's lower respiratory tract, the virus inflames the bronchioles — the small branching airways in the lungs.

"In an infant, those airways are already tiny. If you add infection, inflammation, and pus, they become almost completely blocked, so it's really hard to get the air out," says Combs.

Each year, RSV sends more than 2 million kids under age 5 to the doctor, and more than 57,000 to the hospital.

Which Children Are at Risk?

Almost every child will be infected with RSV by age 2. Most kids get a mild case that improves within a few days. But in infants under 6 months or young children with chronic diseases, the infection can be much more serious.

"For some kids, RSV can develop into severe lower respiratory illness — pneumonia and bronchiolitis [a lung infection]," says Erica Bye, an epidemiologist and RSV surveillance coordinator for the Minnesota Department of Health.

Children who are at highest risk for severe illness from RSV include those who:

  • Were born prematurely (before 32 weeks)
  • Have chronic heart or lung disease
  • Have a weakened immune system
  • Have a nervous system disease such as Down syndrome

"For those very high-risk kids, there is a preventive drug called palivizumab (Synagis)," says Janet Englund, MD, a professor of pediatric infectious diseases at the University of Washington and Seattle Children's Hospital. "It's given once a month during RSV season." Synagis gives babies the infection-fighting antibodies needed to protect their lungs from RSV.

How to Spot the Signs of RSV

RSV often starts out like a cold, with a sniffle, runny nose, and sometimes a low-grade fever. But as the virus moves into the lungs, kids start to have trouble breathing. Usually symptoms are at their worst on the third day of the illness.

Look for fast breathing, pushing the belly in and out, or flaring the nostrils — signs your baby is struggling to breathe. Some kids will stop breathing entirely for a few seconds, called apnea. "Even a few seconds can be scary for a parent," Combs says.

Other RSV symptoms include a lack of energy and poor feeding. "With a breastfeeding baby, it can be difficult to tell how much they're eating," Englund says. "You want to see a wet diaper every 6 hours."

Call your child's pediatrician if you see any of these symptoms. Doctors can diagnose RSV with a nasal swab, although they don't usually test kids unless they're admitted to the hospital.

Treatments

No medicines can cure RSV. "What we offer is called supportive care," Combs says. "We need to get the child through the worst of the illness." Supportive care involves keeping your child comfortable while their body fights the virus.

To prevent dehydration, bottle feed or breastfeed your baby often. Clear out their nose with a bulb syringe to help them breathe. For a child over 6 months, you can give children's Tylenol or Motrin to bring down a fever and relieve discomfort.

If your baby struggles to breathe, isn't eating, or is very lethargic, they may need more supportive treatment than you can give at home. About three out of every 100 children with RSV will need to be treated in a hospital. There, they'll get oxygen to help them breathe and fluids to keep them hydrated.

How to Protect Your Baby

RSV is highly contagious. It spreads when an infected person coughs and sneezes, launching virus-filled droplets into the air. Those droplets also land on surfaces. "If you touch a contaminated surface and then touch your nose, eyes, or mouth, the virus can spread that way," Englund says.

"During peak season, it's really easy to get infected," Bye says. "Parents need to be on guard."

The best way to prevent your child from getting sick is with good hand hygiene. Wash your hands — and your child's hands — with warm water and soap or an alcohol-based hand sanitizer throughout the day. Also clean countertops and other hard surfaces where germs can linger.

Keep sick visitors away from your baby, and make healthy ones clean up before they get too close. "If family members or friends come over, they should be required to wash their hands or use a hand sanitizer before they touch your baby," Englund says.

Also practice good hygiene if you or your child is sick. With RSV, you'll stay contagious for 3 to 8 days.

Keep sick kids home from school or daycare to avoid infecting other children. Show them how to cover their mouth and nose with their hand or elbow whenever they cough or sneeze, and ask them to wash their hands afterward.

Finally, don't smoke around your baby. "Exposure to tobacco smoke in the home makes children more vulnerable to the virus, and to develop a worse case of the virus," Combs says.

There’s no vaccine to prevent RSV, but that could change in the next few years. "There are at least 20 different vaccines and possible antiviral [drugs] that are coming into the research pipeline," Bye says.

One study is testing a vaccine given to mothers during their third trimester of pregnancy. The hope is that it can protect their newborns from RSV infection. A new antibody-based drug is also being developed to prevent RSV in all infants — not just those who are at high risk.

WebMD Article Reviewed by Hansa D. Bhargava, MD on January 22, 2019

Sources

American Academy of Pediatrics: "RSV: When It's More Than Just a Cold."

American Lung Association: "Diagnosing and Treating RSV," "RSV Symptoms, Causes & Risk Factors."

Antimicrobial Agents and Chemotherapy: "Safety, Tolerability, and Pharmacokinetics of MEDI8897, the Respiratory Syncytial Virus Prefusion F-Targeting Monoclonal Antibody with an Extended Half-Life, in Healthy Adults."

Erica Bye, epidemiologist; RSV surveillance coordinator, Minnesota Department of Health.

CDC: "Protect Against Respiratory Syncytial Virus," "RSV in Infants and Young Children," "RSV Transmission," "RSV Trends and Surveillance."

Sarah Ash Combs, MD, pediatric emergency medicine doctor, Children's National Health System, Washington, D.C.

Janet Englund, MD, professor of pediatric infectious diseases, University of Washington and Seattle Children's Hospital.

Wesfarmers Centre of Vaccines & Infectious Diseases: "Maternal RSV Vaccine Study."

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