This blog is mainly based on an article published online by Jennifer Abbasi in Jamanetwork on Nov. 11, 2022. It is a publication of the American Medical Association.
The U.S. is facing a significant outbreak of RSV (respiratory syncytial virus) infections that began earlier than usual this year. This is bad enough, but the flu has also begun early this year.
In fact, there is now an outbreak of several viral illnesses that are overloading pediatric hospitals. These virus include RSV, influenza, parainfluenza viruses (viruses that mimic the flu), COVID, rhinoviruses (main cause of the common cold), and enterovirus D68 (can rarely cause acute flaccid myelitis).
Acute flaccid myelitis is a rare disease of the spinal cord caused by a virus. It results in weakening of the muscles and reduced reflexes. It usually goes away in a matter of days but can very rarely cause permanent paralysis. Again, the vast majority of people recover.
RSV is in the news because we are experiencing a more severe outbreak than usual. This may partly be due to the fact that precautions to prevent COVID (such wearing a mask in public) also prevented RSV infections. There were virtually no cases in 2020, but the virus re-emerged in the summer of 2021.
Usually, children get RSV infection before the age of two. Most do well, but others develop an infection of the small lung passages (bronchiolitis) or even pneumonia. They can get re-infected as they get older, but they have some immunity so it is just like a regular cold.
Because kids under age 2 did not get infected in the last couple of years, they now lack immunity, and a number of them have gotten sick enough to require hospitalization. Some have needed to be on a respirator. This situation is overwhelming pediatric hospital emergency rooms (average wait time in many is 8 hours) and ICU beds.
High-risk infants can receive preventive treatment with 5 doses of an antibody given a month apart. High -risk includes babies born prematurely.
Adults are also experiencing an increase in RSV infections. It is usually mild with cold-like symptoms. However, in a minority of cases it can cause pneumonia and worsen respiratory illnesses such as asthma. These infections are more risky among the elderly due to age-related weakening of their immune system.
Treatment is symptomatic because there is no curative treatment for RSV infection at this time.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
