UNSEASONAL BUG
Cold-weather virus RSV spreading during the summer, baffling doctors, worrying parents
The emergence of a virus that typically sickens children in colder months has baffled pediatricians and put many infants in the hospital with troublesome coughs and breathing trouble.
RSV, or respiratory syncytial virus, is a common cause of cold-like symptoms but can be serious for infants and the elderly.
The number of RSV cases dropped dramatically last year, with people staying home and social distancing, but it began cropping up as pandemic restrictions eased.
“I’ve never seen anything like this before,” Dr. Kate Dutkiewicz, medical director at Beacon Children’s Hospital in South Bend, Indiana, said after recently treating two RSVinfected infants who needed oxygen to help their breathing. ‘’I’ve never seen cases in July or close to July.’’
The U.S. Centers for Disease Control and Prevention issued a health advisory on June 10 about an increase in RSV cases across parts of the South. Cases have appeared in many other states, too.
LaRanda St. John worried when her 6-week-old son, Beau, developed a bad cough a few weeks ago. The downstate Mattoon mother has a medical background and suspected RSV when she opened his sleeper and saw his chest heaving as he labored to breathe.
“The doctor’s office couldn’t get me in because they were flooded with people calling” about kids with similar symptoms, St. John said.
A positive test at a hospital emergency room confirmed RSV. The infant developed a rapid heart rate and had to be hospitalized overnight. His 16-month-old sister Lulabelle also contracted the virus but wasn’t as sick and didn’t need hospitalization.
St. John said she wondered whether it might be COVID-19 because it’s the wrong season for RSV.
“I can’t say I was relieved because I know RSV is just as bad,” she said.
Children infected with either virus usually develop only mild illness. But, for some, these infections can be serious. Among U.S. kids under age 5, RSV typically leads to 2 million doctor-office visits each year, 58,000 hospitalizations and up to 500 deaths — higher than the estimated toll on kids from COVID-19.
Among adults 65 and older, RSV can lead to pneumonia, and it causes almost 180,000 hospitalizations and 14,000 deaths yearly. Cases in kids and adults usually occur from fall through early spring.
Off-season cases in Australia were a tipoff that the same might happen in the United States, said Dr. Larry Kociolek, an infectious disease specialist at Lurie Children’s Hospital.
Typically, infants are exposed to RSV during the first year of life, often when older siblings become infected in school and bring the virus home. But Kociolek said, “There were a lot of kids and babies who were not exposed to RSV in winter of 2020 and winter of 2021. That just leaves a much larger proportion of susceptible infants.”
In infants, symptoms can include fussiness, poor feeding, fever and lethargy. Children might have runny noses, decreased appetite, coughs and wheezing.
In very young infants and those born prematurely, the virus can cause small airways in the lungs to become swollen and filled with mucous. Babies who develop this condition, called bronchiolitis, might need hospitalization and oxygen or ventilator treatment.
There’s no approved treatment for RSV, though a once-monthly injection of an antibody-based medicine is sometimes prescribed before and throughout RSV season to help prevent severe RSV lung problems among premature infants and other babies at risk for serious disease.
Reinfections are common but typically cause milder symptoms.
Kociolek said the recent unusual surge in cases could be partly due to more testing because of COVID fears.
RSV spreads through contact with airborne droplets from an infected person, but it’s much more likely than the coronavirus to linger on skin and other surfaces, including toys, which also can be a source of transmission.
RSV is among reasons daycare centers and preschools often have strict policies about keeping kids with coughs home from school.
“A lot of parents think, ’Oh, well, it’s just a cold, they’re fine to go to school,’ ” said Diana Blackwell, director of children’s programs at Auburn University-Harris Early Learning Center in Birmingham, Alabama.
Despite strict cleaning measures, several children at her center have become sick with RSV in recent weeks, including her own 4-month-old son.
“It didn’t even cross my mind that it would end up being something like RSV,” Blackwell said.
Dr. Mary Caserta, a member of the American Academy of Pediatrics’ infectious diseases committee and a professor at the University of Rochester, said parents should seek medical care if babies appear very ill or have trouble breathing.
RSV is one reason pediatricians caution parents of young babies to avoid crowds in winter cough-andcold season.
“COVID has made people so hungry to be with other people that it would be hard now” to make the same recommendation, Caserta said.