RSV Infection in Children Spikes: Prevention Tips

RSV, or respiratory syncytial virus, is a common childhood virus that affects the lungs and sinuses. It can sometimes lead to difficulty breathing and serious illness or hospitalization. This year, there has been an unusually high number of RSV cases early in the season, resulting in a surge of children needing care in a hospital. Benjamin Nelson, MD, a pediatric pulmonologist at Mass General Brigham, discusses how to prevent RSV, what warning signs to look out for, and when to contact your pediatrician. Seek medical care immediately if your child has trouble breathing, or cannot drink enough fluids. Dr. Nelson is the director of pediatric bronchoscopy at Mass General for Children.

What is RSV?

“RSV is a very common illness, and normally almost all children are infected with RSV at one point in their lives before age 2,” explains Dr. Nelson. You also can contract RSV multiple times in your life. Because people with mild symptoms usually aren’t tested for RSV, the rate of infection in the community may be higher than what’s reported.

What is causing the current surge in RSV?

While RSV cases typically rise each year during the fall and winter months, this year has seen an unprecedented surge in cases and hospitalizations.

“For 2 years during the pandemic, people were isolating, distancing, and wearing masks. We didn’t have the usual number of cases of common respiratory illnesses. This has led to lower overall immunity levels in the community,” says Dr. Nelson. “This year, we have more children who are being exposed to the virus for the very first time, and a more severe strain of the RSV virus circulating. This has led to the increased number of ER visits and hospitalizations we’re seeing.”

This year’s RSV season has also started earlier. “Usually we don’t see this level of cases until November,” Dr. Nelson says. “But we’ve been seeing increased cases for 2 months now. We’re seeing children admitted with RSV who also have rhinovirus (the common cold), adenoviruses, or the flu, multiple illnesses at the same time. Getting the annual flu shot this year is crucial.”

Who is at risk for more severe cases of RSV?

“Although any patient can have severe RSV, we tend to see it most frequently in certain groups,” Dr. Nelson says. Those most at risk include:

• Babies and children under age 2
• Babies born prematurely
• Children who are immunocompromised or have underlying heart, lung, or kidney conditions
• Adults 65 years and older
• Adults who are immunocompromised or have chronic health conditions

What are the symptoms of RSV?

Some patients might not have any symptoms at all, but most will experience what feels like a mild cold. Symptoms tend to peak between days 3 to 5 of illness, including:

• Fever
• Runny nose
• Sneezing
• Cough
• Wheezing

Severe symptoms can include:

• Labored or trouble breathing
• Trouble drinking or eating

When should you get medical attention for RSV?

If you or your child is having trouble breathing or is unable to drink enough fluids, you should seek immediate medical care. “Depending on the time of day or level of urgency, it could be the pediatrician’s office. If breathing has become especially difficult, you should go to urgent care, or the emergency room,” says Dr. Nelson.

What is the treatment for RSV?

For severe cases being treated in the hospital, children may receive:

• Oxygen
• Medications given with a nebulizer. In this treatment, a small machine (nebulizer) turns liquid medications into a mist that a child breathes in.
• IV fluids for dehydration

Parents can treat minor cases at home with over-the-counter medications to reduce fever, and by having children drink plenty of fluids. Many cold and cough medicines are not safe for young children, so talk to your health care provider beforehand.

How can RSV be prevented?

For the most part, people should go about their normal lives. “I don’t want people to be so scared of catching this virus that they don’t go out,” Dr. Nelson says. “The vast majority of people who get RSV will either never know it, or have a very mild case. The best way to prevent spread of disease is to stay home if you’re feeling sick.”

Other ways to stay healthy and prevent spread of illness include:

• Frequent hand washing
• Covering your mouth when sneezing or coughing
• Limiting your exposure to people who have symptoms

For certain high-risk patients younger than 24 months old with underlying conditions, doctors may recommend a monoclonal antibody injection called palivizumab. A provider can give young patients an injection once a month during RSV season to help immune system fight off the virus.

Is there an RSV vaccine?

There is no RSV vaccine available yet, but Pfizer has just completed a clinical trial. They will seek government approval next year, in time for the next RSV season. The vaccine is for pregnant patients during the last months of pregnancy. They can then pass antibodies the baby before they’re born so that the baby has protection at birth.