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Worried about RSV on Thanksgiving? What parents should know

The holiday season is a time to get close to loved ones and people you haven’t seen in a while, but with these close encounters comes an increased risk of spreading infectious diseases such as respiratory syncytial virus or RSV to those more likely to get really sick .

According to data from the U.S. Centers for Disease Control and Prevention, a wave of RSV cases in children emerged earlier this year and is causing an unusually large number of hospitalizations.

“It looks like circulatory (RSV) has come on earlier than usual, and the number of cases is higher than typical,” said Dr. Mary T. Caserta, a member of the Committee on Infectious Diseases of the American Academy of Pediatrics. AAP report on November 17. “There has been a dramatic increase in the number of cases and the number of hospitalizations.”

Adding to the alarm over higher-than-normal RSV rates and a challenging respiratory virus season are other factors affecting pediatric healthcare, such as understaffing in the healthcare industry, disparities in hospital bed payments, and a mental health crisis in older children , Dr. Moira Szilagyi, president of the American Academy of Pediatrics, wrote in an opinion piece for CNN.

CDC chart showing the early and rapid rise in RSV infections across age groups. According to a study published in the Journal of Infectious Diseases, RSV was the leading cause of hospitalization in children under one year old between 2009 and 2019.

US Centers for Disease Control and Prevention

We have already been warned that we are likely to face a heavy flu season this year as public health measures such as wearing masks are phased out after several years of COVID-19 precautions. But RSV has become an additional concern as waves of infection have started earlier than usual and notorious reports of overcrowded hospitals flood the media.

RSV is a common virus – most children will have it before their second birthday. And while anyone can get it, infants, children under 5, the elderly, and those who are immunocompromised are at particular risk of severe illness that can cause pneumonia or bronchitis and require hospitalization.

While almost all children will have at least one RSV infection by their second birthday, and most will recover at home, it’s important to know the symptoms of a more severe infection so you can get the care you need. It may also be necessary (if sometimes awkward) to take simple preventive measures when it comes to other people holding or being around your baby.

Is it “COVID cough” or RSV?

Coughing is a common symptom of many respiratory viruses, including RSV, COVID-19, and influenza. So how do you tell what’s causing your child’s cough?

“From a clinical perspective, it’s hard to tell what makes a cough different,” Dr. Syeda Amna Husain, a pediatrician in New Jersey, wrote in an email. RSV, COVID-19, and the flu can all potentially cause bronchiolitis (lung infection)-like symptoms in children, which can make it hard for them to move their lungs to let air in, says Husain.

According to Husain, testing is the only sure way to find out which virus is responsible, and that may also narrow down some treatment options.

What is RSV? How does it spread?

Respiratory syncytial virus is a common respiratory virus, which means it is spread to other people through small droplets from the nose or throat of an infected person. You get it when these droplets get into your eyes, nose or throat, either by coming into contact with someone who is sick, or by touching a contaminated surface and then touching your eyes, nose or mouth.

According to the Centers for Disease Control and Prevention, the virus lives on hard surfaces (like baby beds) for hours. RSV does not live as long on soft surfaces such as skin or tissues. According to the CDC, it is the most common cause of bronchiolitis and pneumonia in children under 1 year of age.

Can adults catch RSV from children?

Yes. Children usually get RSV at school or daycare and bring it home to other family members. However, most adults will have mild or no symptoms of RSV.

Some adults, including the elderly, those with weakened immune systems, or adults with lung or heart problems, may have more severe illness or complications.

What are the symptoms in children and infants?

According to the CDC, symptoms usually appear about four to six days after infection or exposure. Common signs include:

  • runny nose
  • Sneezing
  • Decreased appetite
  • Coughing or wheezing
  • Fever

However, in very young infants or babies, the only symptoms may be irritability and irritability; decreased activity or feeling more tired than normal; or difficulty breathing, including pauses in breathing.

Philaendron/Getty Images

How to avoid RSV

Because RSV is a respiratory virus, many of the same precautions we take for other viruses will reduce the risk of infecting you or your baby. This includes avoiding contact with people who are sick or have symptoms, avoiding crowded indoor areas, and washing hands before eating or touching your face.

For infants and younger children, prevention may include not allowing others to kiss, hold or touch your baby if you are concerned about contracting the virus. (You can also ask them to wash their hands and wear a mask when holding a baby.) Ideally, the CDC says that people with cold-like symptoms should avoid being around children at higher risk for RSV.

How about minimizing the risk of RSV in a child who is active and tends to keep hands and toys everywhere?

“Try to keep your child’s hands away from the face, especially the nose and mouth,” Husain said, as this is a quick way for common infectious particles to spread. You can also disinfect surfaces that are touched frequently, such as toys, countertops, and doorknobs.

Signs that you should take your child to the hospital

According to the CDC and the American Academy of Pediatrics, symptoms to call your doctor or seek medical attention right away include:

  • Rapid breathing or wheezing
  • Breathing with flared nostrils or “head rocking” with each breath
  • Tummy tugging or breathing, as shown in a video on the AAP site (may feel like the chest is collapsing)
  • Your child cannot drink or is showing signs of dehydration (less than one wet diaper every eight hours)
  • Your baby’s lips, skin or tongue are grayish or blue in color

Very young infants (less than six months), premature babies and children with a weakened immune system, neuromuscular disorders (problems with swallowing or clearing mucus) and other health problems are at higher risk of severe illness from RSV. If your child has only mild symptoms, additional treatment outside the home is unlikely to be necessary. But according to The Cleveland Clinic, your child may need intravenous fluids (have an IV) if their rapid breathing prevents them from drinking and staying hydrated. According to the clinic, around 3% of children with RSV will require a stay in hospital and most will be able to go home within two to three days.

If you are an older adult, immunocompromised or have an underlying medical condition, you may also be at higher risk of severe illness from RSV. In fact, older adults have a greater burden of dying from RSV. According to CDC surveillance, RSV is expected to cause at least 6,000-10,000 deaths in adults 65 and older, compared to 100 to 300 deaths in children under 5 in the United States.

If you or anyone around you has difficulty breathing, always seek emergency or medical attention immediately.

RSV treatment

RSV is a viral infection, which means antibiotics don’t work. Treatment for RSV is usually supportive, and over-the-counter medications (but never children’s aspirin) can help relieve common symptoms such as coughing or congestion. Before giving your child any medicine, even without a prescription, you should consult your doctor, because not all ingredients of medicines are safe for children and their smaller, growing bodies.

Severely ill, high-risk children are sometimes treated with the antiviral ribavirin and intravenous immunoglobulin. Treatment may also be considered in severely ill, immunocompromised adults. The vast majority of patients do not require these interventions.

Preventive strategies are available for high-risk infants and children; a monoclonal antibody called palivizumab is available. It is given in monthly injections during the RSV season and is for children who are at higher risk of hospitalization. Some of the eligible babies are infants who were born very early (before 29 weeks) and young children who are immunocompromised or have other conditions such as heart disease or neuromuscular conditions. In November, the AAP updated its guidelines and suggested doctors consider giving high-risk patients more than five consecutive doses of palivizumab.

If you think your child is at high risk and may be eligible for treatment, see your doctor.

Is there a vaccine?

There is no vaccine against RSV yet, but scientists are working on one. Pfizer this week announced promising results from its global study, which showed that its RSV vaccine given to a pregnant person was approximately 82% effective in preventing serious illness in their babies after birth, within the first three months of life. It was about 69 percent.