RSV is a contagious respiratory virus that circulates from the Fall through the Spring. It overlaps with “Cold and Flu season”, and with COVID occurring year-round, it can be confusing for doctors and nurses to land on a definitive diagnosis. Rhinovirus, Adenovirus, Parainfluenza, Echovirus, Human Metapneumovirus (HMPV), Influenza, RSV, and Coronavirus can all present with symptoms of runny nose, watery eyes, fever, nasal congestion, coughing, sneezing, sore throat, headache, and general malaise. While it may be of some comfort to be able to definitively name the ailment, it often isn’t actionable and is therefore not advised to spend money on specific viral testing when the only medical recommendation is supportive care. That said, certain viral illnesses have prescription remedies: Paxlovid for COVID and Tamiflu for Flu. Diagnosed early enough in the course of illness, these medications can halt the progression of illness and even hasten its recovery.
Even better than resolving a head or chest cold is to avoid getting it at all. Flu and COVID both have preventative vaccines, and now RSV does as well. Beyfortus is the brand name for the passive immunization that is available to fight RSV. Beyfortus is available after October 1st for infants under 8 months of age and for expectant mothers in their third trimester who are scheduled to deliver during the RSV season. Getting the vaccine during pregnancy protects the unborn child just as well, making it unnecessary for the baby to need repeat vaccination with Beyfortus after birth. Unlike most vaccines that present a weakened form of the germ and ask the body to create antibodies, Beyfortus contains the antibody to RSV. This kind of passive immunization asks less of the body but only lasts for about 5 months. Luckily, this is about how long the RSV season runs.
RSV is unpredictable. About 90% of children will have had an RSV infection by the time they are two years old. Mostly it is manageable, but up to 40% of babies and toddlers who catch RSV will have complications like bronchiolitis or pneumonia, infections of the lungs. While RSV is notoriously dangerous for premature infants or those with chronic respiratory, cardiac, or immune disease, RSV’s clinical course can escalate rapidly, and can cause respiratory collapse even in healthy full-term infants. Statistics show that 2 out of 3 babies will get sick with RSV before they turn a year of age. RSV is the leading cause of hospitalizations in babies under one year old (in particular for infants under 2 months of age). Think about that— a germ that only circulates for half the year is the top reason for hospitalizations in children under one. Compared with the Flu, babies are 16 times more likely to be hospitalized due to RSV. And once they’re admitted to the hospital, their needs are more acute, often requiring breathing support and at least three nights in the hospital before they’re stable enough to be discharged home. Research has shown that kids who were treated in the hospital for RSV are more likely to wheeze and become asthmatic later in life. And sadly, over three million children under five years of age are hospitalized around the world each year with RSV and, in about 100,000 cases, the infection turns fatal. Most of these deaths are in developing countries.
Kids are going to get sick. In regions of the country where it’s so cold outside that many months in a row are spent indoors in enclosed spaces, these germs are going to be shared. While some of these viruses cause a week or so of cold and cough symptoms, others have the potential to do much more harm. RSV is one of the meanest respiratory illnesses, especially in young children. Be vigilant and prepared.
Written by Dr. Carly Wilbur, UH Pediatrician and PSI Medical Director.
