By Andrea Vosberg, Anna Tomotaki, Theresa Heines and Chukwudera Okolo

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. 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.

Prevention

The best way to prevent the spread of RSV is to cover coughs and sneezes, wash hands often with soap and water for at least 20 seconds, avoid close contact with others, and clean frequently touched surfaces such as doorknobs and phones. People with symptoms should avoid interaction with children who are at higher risk for severe RSV infection, including premature infants, children less than two years of age with chronic heart or lung conditions and children with weakened immune systems.

Treatment

Typically, the majority of RSV infections resolve and are cleared on their own within a week or two following the onset of symptoms. There are currently no specific medications on the market indicated to treat this virus. That being said, researchers are currently working towards developing both vaccines and antiviral medications to aid in the spread and control of RSV. While there are no current prescribed treatments, there are actions that can be taken to relieve the symptoms often experienced by children infected with RSV. A few steps recommended to help mitigate symptoms include using OTC fever reducers and pain relievers, and drinking plenty of fluids to prevent dehydration. It is important to consult with a child’s health care provider before giving a child OTC, non-prescription cold medications, as some medications may contain ingredients that are not well suited for children.

Outlook

Fortunately, RSV tends to have a positive outlook for the majority of children who contract the virus. Mild symptoms such as sneezing, coughing and runny nose are the typical inconveniences experienced by infected children. One of the most important actions a parent can take is monitoring their child’s symptoms to ensure their child does not get sicker. Some more serious symptoms to watch out for are severe lethargy and/or trouble breathing. Severe infections such as pneumonia and bronchiolitis can be caused by RSV, so parental vigilance is imperative in order to ensure their child has the best possible outcome. Despite the unprecedented increase in summer cases of RSV, it is important to remember that this is a relatively mild illness. The majority of children will contract RSV at some point and then will fully recover. The best way to keep children healthy is for everyone to practice good hygiene, cover coughs and stay home when sick.

References

Centers for Disease Control and Prevention. (2020, December 18). Rsv (respiratory syncytial virus). Centers for Disease Control and Prevention. https://www.cdc.gov/rsv/index.html.

Olsen SJ, Winn AK, Budd AP, et al. Changes in Influenza and Other Respiratory Virus Activity During the COVID19 Pandemic — United States, 2020–2021. MMWR Morb Mortal Wkly Rep 2021;70:1013–1019. DOI: http://dx.doi.org/10.15585/mmwr.mm7029a1

Agha, R., & Avner, J. R. (2021). Delayed seasonal rsv surge observed during the covid-19 pandemic. Pediatrics. https://doi.org/10.1542/peds.2021-052089

Pictured: UT Health San Antonio Long School of Medicine’s Pediatric Interest Group officers. Andrea Vosberg (second from left), Anna Tomotaki (center), Chukwudera Okolo (third from right) and Theresa Heines (second from right) are medical students at the UT Health Long School of Medicine.