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Respiratory virus season is nothing to sneeze about

COVID, influenza and RSV cases are on the rise ahead of cold and flu season, prompting fears of a tridemic.

CLEVELAND — Cases of respiratory syncytial virus, or RSV, are significantly on the rise in Northeast Ohio. 

Each year, RSV, is responsible for about 58,000 hospitalizations and 100 – 500 deaths among children younger than 5 years of age. It’s important for parents to know the signs, symptoms and when to take action.

Rainbow Babies and Children's Hospital says they're seeing a surge of RSV both in the ED and inpatient. Dr. Claudia Hoyen said today they are admitting about 4-5 kids each day with RSV and the pediatric ICU has treated about 40 kids just this month with RSV.

Both Rainbow and Cleveland Clinic Children's are also starting to see influenza cases. Cleveland Clinic Children's says it's mainly influenza strain A and the positivity rate is 3% overall. A little higher in school aged kids.

They've watched RSV cases rise for the last few weeks.  As of Monday,  RSV positivity rate for children aged 0-5 was 46%. Among elementary-age children (6-12 years old), the positivity rate for RSV was 28%.

Dr. Therese Linnon, a pediatrician at Akron Children's Hospital, says they've admitted about 80 children with an RSV diagnosis (either as inpatient or observation status) last week and they typically don't see that level of admissions until late December. 

The most frequent symptoms of respiratory syncytial virus (RSV) are similar to that of a cold, for example, a stuffy or runny nose, cough, sore throat, fever, and mild headache. You may also notice changes to behavior, which are just as important as the cold-like symptoms that may be present. For example, with infants, you may notice poor feeding, irritability, tiredness and not having as many wet diapers. With young children and older infants, you could see a decreased appetite a few days before a cough. This symptom is often followed by sneezing, fever and, in some cases, wheezing. 

RSV infections often happen in epidemics and usually last about a week. In some cases, the infections last longer. There are times where an RSV infection can lead to bronchiolitis and pneumonia (this situation is especially true with premature babies, infants under the age of one, and children with diseases that affect the heart, lungs, or immune system). RSV infections may also lead to dehydration.

Doctors typically diagnose RSV through an exam and by taking a medical history. For children who are otherwise healthy, it’s not usually necessary to distinguish between a cold and RSV. However, for kids with more serious symptoms or health conditions, doctors make a specific RSV diagnosis by testing nasal fluids. If that step is necessary, then they collect a sample for testing with a cotton swab or by suction with a bulb syringe. 

RSV is highly contagious because it spreads through droplets whenever someone sneezes or coughs. It can especially spread through childcare centers and schools. In fact, most children have had RSV at least one time by the age of two.

Generally, most cases of RSV are mild and don’t require any medical treatment. But RSV infections can be more serious for babies, and some may need to be treated in a hospital.

In cases that do not require medical treatment, RSV can be managed at home by:

  • Making sure your child is as comfortable as possible
  • Giving plenty of time for recovery
  • Ensuring your child is drinking plenty of liquids
  • Treating a fever with non-aspirin fever medicine like acetaminophen (if your child is older than six months, then you can treat their fever with ibuprofen)

In severe cases, like with babies, they may need treatment in a hospital where they can be watched closely, get fluids, and, if necessary, have treatment for any breathing problems.  

You should call your doctor or health care provider if your child has a high fever or develops a fever after having a cold; if your child’s symptoms worsen or has a cough; if your child is wheezing; if your child has thick nasal discharge; if your child has a cough that produces yellow, green or gray mucus; if your child refuses to breastfeed or bottle-feed; or if your child is showing signs of dehydration.

Immediate medical attention should be given if your child is having trouble breathing or is breathing very quickly, has signs of dehydration, is very drowsy, or has fingernails or lips that look blue.

"After dramatic COVID-related reductions in 2020 and 2021, we expect the 2022-23 season to be harsher than usual. Each year's RSV gives some background immunity for the next year. The mild 2020 and 2021 seasons have led to this. The good news is we know how to control this: In addition to the usual winter virus prevention steps (distance, handwashing, masks, stay home with symptoms, vaccinate if available), talk to your provider to see if your infant is in a high-risk category for severe RSV. There may be additional prevention measures available for your baby," says Michael Forbes, MD, FCCM, FAAP, Chief Academic Officer at Akron Children's Hospital. 

He adds that preemies, babies with heart disease on meds, and those with complex or chronic lung disease can have a life changing/fatal outcome if infected with RSV.

Dr. Forbes notes that changes in infant behavior are just as important to notice as the cold-like symptoms of cough and runny nose the virus produces. In infants younger than 6 months, symptoms may include irritability, poor feeding, tiredness and not having as many wet diapers. In older infants and young children, decreased appetite may appear 1 to 3 days before a cough, often followed by sneezing, fever and sometimes wheezing.

As for fears of a twin-demic or tri-demic season, meaning someone is infected with COVID, flu and RSV, it may be possible theoretically, but there's not enough research to understand the scenario.  Basically you'll get what you're exposed to. 

But there are ways to protect yourself, and especially kids.  The flu shot and the COVID bivalent vaccines are easily available and can potentially make a bad season a little more tolerable according to local medical experts. 

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