Respiratory Syncytial Virus (RSV)

RSV - Respiratory Syncytial Virus

Across the United States, RSV cases have uncharacteristically surged along with the number of hospitalizations caused by the virus.

This surge has individuals rightfully concerned. People have not easily forgotten the stress, anxieties, and tragedies experienced during the COVID-19 pandemic that started in 2020.

Nearly three years later, just as communities nationwide are beginning to grow comfortable with the new normal of a post-COVID world, another virus has raised its ugly head.

Keep reading to learn about RSV, prevention, and the 2022 RSV surge.

What Is RSV?

RSV is a common respiratory virus. In most people, it causes mild, cold-like symptoms for one to two weeks. Some adults don’t have any symptoms. However, it can cause severe complications for infants and older adults.

In the United States, in children younger than one year, RSV is the most common cause of:

  • Bronchiolitis – inflammation of the small airways in the lungs
  • Pneumonia – infection in the lungs

How Can You Get RSV?

RSV is an airborne virus. You can be exposed to it when:

  • An individual coughs or sneezes, and those virus droplets get in your eyes, nose, or mouth
  • You have direct contact with the virus (e.g., kissing an infected individual)
  • You touch a surface with the virus on it and then touch your face before washing your hands

How Contagious Is RSV?

RSV is highly contagious. In standard cases, infected individuals are contagious for 3-8 days but may become contagious for 1-2 days before showing symptoms.

Infants and individuals with weakened immune systems can be contagious for up to four weeks after their symptoms dissipate.

RSV survives for many hours on hard surfaces (e.g., doorknobs, tabletops) but lives on soft surfaces (e.g., tissues, hands) for less time.

People are usually infected for the first time as an infant or a toddler. Most children are infected before their second birthday, and repeat infections can occur throughout life.

Who’s At Risk for Severe Disease?

Those at the most risk of developing severe symptoms or complications from RSV include:

  • Premature infants (born at or before 35 weeks)
  • Young children with congenital heart disease
  • Young children with chronic lung disease
  • Young children with a compromised immune system due to a medical condition or treatment
  • Children with neuromuscular disorders (e.g., muscular dystrophy)
  • Adults with compromised immune systems
  • Older adults, especially those with heart or lung disease

Infants & RSV

It’s estimated that 58,000 – 80,000 children younger than five years are hospitalized with RSV yearly and that 1-2 out of every 100 children younger than six months may need to be hospitalized.

When hospitalized, a child may require the following:

  • Oxygen
  • IV fluids
  • Mechanical ventilation (intubation)

Most children improve with this supportive care and can be discharged within a few days.

RSV Symptoms in Children and Young Infants

Symptoms usually appear in stages.

Early symptoms for most children include:

  • Runny noses
  • Decreased appetites
  • Coughs that may progress to wheezing or difficulty breathing

Symptoms in very young infants (younger than six months) include:

  • Irritability
  • Decreased activity
  • Decreased appetites
  • Apnea (pauses in breathing that last more than ten seconds)
  • Fevers

RSV Prevention

Individuals with cold-like symptoms should:

  • Cover their coughs and sneezes with a tissue or their upper shirt sleeve, not their hands
  • Frequently wash their hands with soap and water for at least 20 seconds
  • Avoid close contact with others (e.g., kissing, shaking hands, sharing cups and eating utensils)
  • Clean regularly touched surfaces (e.g., doorknobs, tabletops, mobile devices)
  • Avoid interaction with children at high risk for severe RSV disease

Parents with high-risk children should:

  • Avoid close contact with sick individuals
  • Frequently wash their hands with soap and water for at least 20 seconds
  • Wash their hands before touching their faces
  • Limit their time spent in daycare centers or other possibly contagious settings during high RSV activity periods

RSV Medication

Currently, no vaccine or medication can prevent an RSV infection or reduce how long an individual is ill.

Pediatricians can prescribe the drug SYNAGIS (palivizumab) to prevent serious lung diseases that RSV may induce in high-risk infants and children, such as those who:

  • Are born prematurely and six months old or younger at the beginning of the RSV season
  • Have a chronic lung condition that required treatment within the last six months and who are two years old or younger at the beginning of the RSV season
  • Are born with particular types of heart disease and are two years old or younger at the beginning of the RSV season

**This medication cannot cure or treat children already suffering from severe RSV disease and can’t prevent an RSV infection.

The 2022 RSV Surge

Like many viruses, RSV has a season. Before 2020, based on RSV data collected between 2014 and 2017, medical professionals could expect the RSV season in the United States to look a little like this:

  • Season onset – a sustained rise in RSV-positive tests between mid-September to mid-November
  • Season peak – regions reaching the maximum number of RSV-positive tests between late December and mid-February
  • Season offset – a sustained drop in RSV-positive tests between mid-April and mid-May

However, this year, by the end of October, the CDC reported an increase in RSV-positive tests and RSV-related ER visits and hospitalizations in multiple regions of the country, with some nearing seasonal peak levels.

Many children’s hospitals are experiencing the worst RSV year they’ve ever seen. But why is that?

What Is Causing the RSV Surge?

Many experts believe that the increase in cases and severe diseases are due to an “immunity gap” that was created due to non-pharmaceutical interventions (NPIs) during the COVID-19 pandemic (e.g., face masks, social distancing, school/daycare closures, quarantining when ill).

A 2021 journal published in Oxford Academic reported that during March and April of 2020, detection rates of many respiratory pathogens (including RSV) dropped below historical ranges.

During the pandemic, fewer people were exposed to RSV, giving their bodies no chance to build immunity to future infection. This population includes very young infants that can build immunity with maternal antibodies passed to them in utero and slightly older children the virus never infected.

The lack of immunity in susceptible populations and the relaxation of NPIs is allowing RSV to spread quickly. Thus, increasing the number of RSV-positive tests and those becoming severely ill outside the expected seasonal peak.

Explaining The “Immunity Gap”

Professor of Pediatrics at Vanderbilt University Medical Center, Dr. Clarence Buddy Creech, agrees that the NPIs during the pandemic impacted infants’ and children’s ability to build immunity to RSV. However, that does not mean that the NPIs were bad or that people should seek out infection.

“Immunity gap,” interchangeable with “immunity debt” and “immune debt,” does not imply that reduced exposure to viruses damages the immune system. Instead, medical experts use the concept to explain that a surge in viral infections is expected in populations whose immunity to viruses has decreased.

“Immunity Gap” Continued…

A commentary published in The Lancet in July 2022 explained that the “immunity gap,” created, in part, by NPIs during the pandemic, was evident by the spring of 2021.

Unlike previous years, in 2020, there was no typical RSV winter surge. But as communities reduced their use of NPIs, by the following spring, RSV outbreaks began affecting children older than the median childhood age associated with typical RSV infection trends.

The group working on the commentary warned hospitals to be prepared for “larger outbreaks occurring out of season.” And they were right.

The James Clinic

If you are concerned about your child’s health this RSV season, schedule a pediatric visit with The James Clinic. We’ll take every necessary step to ensure your child gets the care they need.

Our pediatric care includes access to advanced diagnostics, like the rapid RSV antigen test and respiratory pathogens panel, and a network of pediatric experts to consult on challenging cases.

Request a consult today, and a team member will get in touch to schedule an appointment.