PEDIATRIC HEALTH
Summer Surge:
Off-Season Spike of RSV in Children By Andrea Vosberg, Anna Tomotaki, Theresa Heines and Chukwudera Okolo
Introduction When walking through the halls of a pediatrician’s office during the cold and flu season, one is sure to be met with the unrelenting sound of coughing children. During the fall and winter months, children are commonly brought into the doctor’s office for cough, fevers, runny noses, sore throats, and, in rare cases, trouble breathing. Most of these childhood illnesses are mild and clear up with over-the-counter (OTC) medications, rest and warm chicken soup. In typical years, when the warm weather hits, cases of these viral illnesses dramatically decline until the beginning of the next peak season. Due to the COVID-19 pandemic, masking and social distancing were in place, school was largely virtual and many children avoided sick visits to the doctor. These changes led to a much lower number of childhood viral respiratory illnesses in the winter of 2020. As everyone knows, the COVID-19 pandemic has presented the world with many unique challenges, and the current summer season is no exception. Starting in May of 2021, pediatricians noticed a large number of babies coming into the office with viral illnesses that were not COVID-19. Instead, most of these sick children were dealing with common winter viral illnesses, most notably Respiratory Syncytial Virus (RSV). What is RSV? Respiratory Syncytial Virus (RSV) is a common viral illness that almost all children get within the first two years of life. The virus usually causes mild, cold-like symptoms such as runny nose and fever. Most kids will recover on their own within a week or two without any major complications. However, it can be serious, particularly for infants and older adults, as well as for people with weakened immune systems. RSV is the most common cause of bronchiolitis (inflammation of small airways in the lung) and pneumonia (infection in the lungs) in children younger than one year of age in the United States. These more serious complications are important to keep in mind when caring for a child with this illness. 14
SAN ANTONIO MEDICINE • September 2021
Transmission RSV is typically spread through respiratory droplets. When an infected person coughs or sneezes and the droplets get into the eyes, noses or mouths of others, the virus spreads. The viral particles of RSV can survive for many hours on hard surfaces and thus can be transmitted this way. The act of touching a surface that has the virus on it (such as a table top) and then touching one’s face without engaging in proper hand washing practices in between can also result in viral spread. Direct contact with the virus, such as kissing the face of a child with RSV, is yet another way that the virus can be transmitted. People can typically spread the virus for 3-8 days after contracting RSV, however, the infected person can be contagious for up to four weeks in infants and people with weakened immune systems. Why is it surging? RSV typically presents in a seasonal pattern, peaking in the fall and declining by early spring. With the COVID-19 pandemic and the subsequent widespread use of masks and social distancing, many of the typical seasonal viruses did not hit their usual peak. There was a substantial 98% decrease in cases of RSV, specifically, during the pandemic. While this initially presented as an unexpected positive outcome of the pandemic, the lifting of mask and social distancing requirements over the past few months has brought with it an off-season increase in RSV cases. This is a highly transmissible virus, so typically infants and young children are exposed to it within the first two years of life, and almost all of them catch the virus. Because of this initial exposure, children are able to build immunity to the virus if they encounter it again. However, since most children were less likely to be exposed to the virus this past year, they have a lack of immunity that most young children typically have by the end of the traditional RSV season. This increased susceptibility has caused the uptick in cases we are seeing this summer.
