“It’s worse than the flu. It’s worse than COVID for your babies,” says Flor M. Muñoz, MD, a pediatric infectious diseases physician at Texas Children’s Hospital and an associate professor of pediatrics and infectious disease at Baylor College of Medicine in Houston.
A Common Virus Can Sometimes Be Dangerous
RSV spreads easily by coughs and sneezes and can infect those who touch contaminated surfaces or objects; a baby can get RSV from a contagious sibling or a contaminated toy. The virus is so widespread, nearly all children will be infected by the time they turn 2, the Centers for Disease Control and Prevention (CDC) says. Most children recover on their own without complications, but for some, the virus can cause tiny airways in the lungs to swell and fill with mucus (bronchiolitis) or result in lung infection (pneumonia), according to the CDC. In the United States, about 58,000 children under age 5 are hospitalized and an estimated 500 die from the virus each year. Worldwide, about 33 million cases of RSV occur in children under age 5, with about three million hospitalizations and an estimated 120,000 deaths annually. A 2015–16 National Institutes of Health study published in July 2020 in Pediatrics found that 35 percent of children hospitalized with acute respiratory illness tested positive for RSV. Of those children, 87 percent were under 2 years old and 67 percent had no underlying conditions or premature birth. “Parents should be aware that these viruses are out there, and know the risks for children at different ages,” Dr. Muñoz warns.
Which Children Are at Greatest Risk From RSV?
While children and adults of any age can get an RSV infection, Muñoz notes those facing the highest risk of complications are the elderly and very young children — especially those under 6 months — who have never been exposed to the virus. Premature babies born during RSV season, and before their lungs and respiratory system can fully develop, are at a high risk for severe disease, she says. Children under age 2 with heart, lung, or immune system diseases are also at increased risk for severe illness.
A Rise in RSV Cases and a Longer Season Threatens Children
RSV season usually occurs in late fall to spring, peaking in the cold winter months. But some physicians say this year has been different. Aditya Shah, MBBS, an infectious-diseases specialist at the Mayo Clinic in Rochester, Minnesota, says that after a two-year lull during the COVID-19 pandemic, he’s seeing a longer RSV season and an increase in both RSV and influenza cases. “An ease in masking restrictions has led to a disruption in the typical season pattern,” Dr. Shah says, causing RSV to begin spreading in warmer months and fueling RSV transmission rates. Infants and children who did not get as much exposure to the virus earlier in life because of COVID-19 safeguards are now contracting RSV.
Signs and Symptoms of RSV in Babies and Older Children
For most children, as well as adults, RSV infections can feel like the common cold. Symptoms start about two to five days after contact with the virus, according to Cedars-Sinai Medical Center. Early RSV symptoms in babies and infants are similar to those of COVID-19 and the flu. The virus can give children a runny nose, cough, and fever, Muñoz says, with nasal congestion making eating so uncomfortable that babies may refuse the breast or bottle. If the virus moves into the lungs or breathing airways it can result in wheezing. Some children develop severe lung infections from the virus, causing respiratory distress, Muñoz says, noting a telltale symptom: “They might look like they’re working hard to breathe and are actively moving their chest up and down.” That’s what Melanie Rogers, a Chicago-area mom of four, recalled seeing the morning her 4-month-old daughter, Reagan, woke up with RSV symptoms that landed her in the hospital for 10 days. “She was breathing quickly, very deeply, and it was scary,” said Rogers, who discussed her family’s experience with RSV in a video on the National Coalition for Infant Health’s Facebook page. In very young infants like Reagan, the only symptoms of RSV may be breathing difficulties and irritability or decreased activity.
What to Do if You Suspect Your Child Has RSV
“The moment a parent is having any concerns that a child is not able to keep up with their feeding or is having more difficulty breathing, it’s best to see a pediatrician to get tested,” Muñoz says. A healthcare worker can administer an antigen or PCR test to arrive at a diagnosis. A new home test can also help determine if a person older than 2 years has COVID-19, the flu, or RSV. The U.S. Food and Drug Administration (FDA) has authorized emergency use of a direct-to-consumer three-in-one respiratory PCR virus test from Labcorp. A parent can buy the home nasal swab collection kits online or in stores without a prescription. Labcorp sends test results in around one to two days through an online portal. Families can then follow up with a healthcare provider. “This is the first test authorized for flu and RSV, along with COVID-19, where an individual can self-identify their need for a test, order it, collect their sample and send it to the lab for testing, without consulting a healthcare professional,” said Jeff Shuren, MD, the director of the FDA’s Center for Devices and Radiological Health, in a statement.
Treatment and Prevention of RSV in Children
There is no specific treatment for RSV. Shah says parents should be sure a sick child rests and drinks plenty of fluids; over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen, can also help (parents should never give children aspirin, says the CDC). Symptoms of RSV in babies can last for a week or two. Those infected with RSV can usually spread the virus for three to eight days, but some babies are contagious for as long as four weeks, according to the CDC. To prevent severe RSV infection in premature and other high-risk infants, doctors may administer the medication palivizumab (Synagis). During RSV season, these babies receive a dose a month — for a total of five doses in all — to provide them with lab-manufactured antibodies (aka monoclonal antibodies) that can fight potential infection. Children with serious RSV-related complications may need to go to the hospital in order to receive treatment. Doctors may administer additional oxygen or, in the most severe cases, insert a breathing tube attached to a mechanical ventilator. Hospitalization typically lasts a few days, according to the CDC.
New Vaccines and Preventive Medications May Be on the Way
While no RSV vaccine currently exists, researchers are getting closer. Pfizer is developing a vaccine that can help pregnant women pass protective antibodies to their unborn babies. Results of a phase 2b study published in the New England Journal of Medicine in April 2022 showed that the vaccine was safe when given during pregnancy and led to higher antibody responses in mothers, with evidence it also protected infants. The phase 3 trial is underway. Also in phase 3 trials is the drug nirsevimab, a monoclonal antibody developed by AstraZeneca and Sanofi. An analysis published in the New England Journal of Medicine in March 2022 found that a single shot administered to healthy late preterm and term infants before their first RSV season led to a 75 percent drop in virus-related lower respiratory tract infections severe enough to require medical treatment.
What Can You Do to Prevent the Spread?
To help prevent RSV, the Mayo Clinic recommends that families with infants and young children wash their hands frequently, avoid close contact with sick people, cover coughs and sneezes, and disinfect toys and surfaces regularly. During RSV season, families should consider taking their child out of a daycare setting or limiting the number of visitors who come into their home. They might also cut down on trips to the grocery store and avoid large gatherings with kids in tow.
