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“Long ago, long before COVID, and long before this recent surge in cases, Respiratory Syncytial Virus (RSV) took away our son’s ability to breathe as the virus took hold of his already compromised lungs,” Catherine Casamento, a mom of preemie twins, wrote on LinkedIn.

“RSV is serious, and potentially fatal to infants and young children. Despite the precautions we took, our son was hospitalized with RSV.” Casamento vowed to help spread awareness about RSV and help as many families as she could. 

What is RSV?

Respiratory syncytial virus  is a common respiratory virus that can cause a spectrum of mild upper-respiratory to severe lower- respiratory tract disease in young children. The highest risk population is children less than six months, said Dr. Mina Hakim, a pediatrics specialist at South Central Family Health Center in Los Angeles, at an Nov 18 EMS briefing on RSV. The Mayo Clinic reports that respiratory syncytial virus (RSV) is so common, that most children have been infected with the virus by age two. 

But sometimes the infection takes a turn for the worse.

“RSV symptoms are mild and typically mimic the common cold. For us, our virus can be just a mild cold but in babies they can get bronchiolitis and other complications,” said Dr. Manisha Newaskar, Clinical Assistant Professor of Pulmonary Medicine at Stanford Medicine Children’s Health. 

Who is at risk of RSV and why?

What is RSV? (image: UK Health Security Agency)

Respiratory illness is the most common reason hospitalization in children and adults. Infants, especially premature infants or babies who are 6 months or younger are at increased risk of severe or sometimes life-threatening RSV infections.

The morbidity and mortality attributable to RSV infection appear to be higher in infants less than three months, and in those with known risk factors such as prematurity, chronic lung, and congenital heart diseases.

“For children less than six months of age, the hospitalization rate can be up to 2 percent,” said Dr. Hakim, who sees more RSV patients in January or February.

In the United States, according to the Journal of Pediatric Infectious Disease, the incidence of lower respiratory tract infections (LRTIs) among children under 5 years of age is high, contributing to 19% of hospitalizations in the general population of children.

Yet there are fewer RSV deaths in high-income countries, reports a study in the Lancet Respiratory Medicine. The impact of RSV on global child health is much higher. The study estimates that one out of every 50 deaths in children younger than 5 years globally, is attributable to RSV.

Why Are Infants at Risk?

Physicians at the briefing explained why infants are at risk, especially during the flu season.

Children who have heart disease that’s present from birth (congenital heart disease) or chronic lung disease are at risk during the flu season that runs November through March, the traditional “viral season,” said Dr. Priya Soni, a Cedars-Sinai pediatric infectious disease specialist.

RSV spreads like the flu—from tiny droplets that are inhaled, unwashed hands, or from hard surfaces where the virus can live up to six hours, said Dr. Soni.

Babies get ill because they have smaller airways and they’re not able to clear secretions like older adults, she added.

Where Did The Virus Originate?

RSV has been recognized as a major cause of acute respiratory tract infection and hospitalization in children since its discovery  61 years ago.

The virus was originally isolated and identified from chimpanzee populations in the late 1950’s, said Dr. Soni. “Researchers soon realized that this virus was caught from infections of their caretakers. In 1957, they then realized that the same virus was a cause of respiratory illness in children. So, it is well documented to be human pathogen – though we don’t know the exact origins, likely it has been circulating for much longer than we discovered it.”

What You Do When Your Baby Has RSV 

Dr. Newaskar advised parents to keep a close eye on their baby if an infant less than six months old has symptoms of cough, congestion, or fever, and to see a pediatrician if the baby gets worse. Though all three viruses have similar symptoms, the flu comes on quickly, while RSV appears in stages. A diagnostic test could help determine if the baby has the flu, RSV, or COVID. For RSV, doctors advise the same preventative measures used to avoid COVID, she said.

“The most common symptom is a stuffy nose and babies breath through their nose and that makes them struggle.” There also is a grave risk of RSV babies getting dehydrated. What does help is suctioning mucus from the nose with a bulb and using a humidifier to keep airways moist. 

Babies who have a fever can use Tylenol to help reduce it.

 “Studies have found that kids who are exposed to smoking at early stages are more likely to be in the hospital due to RSV, as are babies who have not been breastfed,” said Dr. Hakim. “Three months of breastfeeding can decrease your risk for severe bronchitis from RSV”.

Ways to prevent RSV (image: NJ Department of Health)

“Self-care measures are usually all that’s needed to relieve any discomfort,” said Dr. Newaskar. The Mayo Clinic reports that most children and adults recover in one to two weeks, although some might have repeated wheezing.

“There is no treatment or therapeutic antiviral for RSV virus,” remarked Dr. Soni.  She urged adults and children alike to isolate when sick. “Stay home when you are sick, so you won’t spread whatever respiratory illness you have.”

Is A Vaccine In The Works?

Several pharmaceutical companies have released promising data from clinical trials on an RSV vaccine. Nick Taylor in Fierce Biotech writes that Pfizer and GSK are readying for battle as they race into the new respiratory syncytial virus (RSV) market. Having kept its phase 3 results under wraps, recently released data from GSK’s trial reveals it could be a genuine challenger for a market targeted by Pfizer, Johnson & Johnson and Moderna.

Taylor reported that the Pfizer shot targets pregnant women, opening up a potentially different market.

Dr. Manisha Newaskar stated that doctors give the Synagis vaccine to preemies and other high-risk infants to prevent severe RSV disease.

‘Tripledemic of Covid Flu and RSV

Dr. Ashish Jha, the White House’s COVID-19 response coordinator, called the confluence of RSV, COVID-19 and the flu a ‘tripledemic.’

“We’re seeing the rise of three respiratory viruses, all of them going up around the same time—that’s concerning. The good news is for two of the three, we have vaccines that are highly effective at preventing serious illness: COVID and flu.”

Getting youngsters those shots “takes two of the three issues off the table,” said Jha. “It also creates more capacity in the healthcare system, and it just makes it better for everybody.”

However, the emergence of a new hybrid virus evades the immune system was reported by Dr. Priyabrata Patnaik on LinkedIn.

“The flu virus and respiratory syncytial virus (RSV) can fuse together to create a virus that can evade the human immune system.”

Co-infections in which the RSV and the flu virus infect someone at the same time has resulted in a fused virus that looks like a palm-tree-shaped hybrid, which could infect new cells even in the presence of flu antibodies. This kind of hybrid virus has never been described before,” added Jha. 

 Coinfections by more than one virus represent between ~10–30% of all respiratory viral infections and are common among children.

“The disease, which affects very young children, currently has no cure.”

Photo by Jenna Norman on Unsplash

Ritu Marwah

Ritu Marwah is an award-winning author ✍️ and a recognized Bay Area leader in the field of 🏛 art and literature. A California reporting and engagement fellow at USC Annenberg’s Center for Health...