Cold and flu viruses aren't parents' and physicians' only concern this time of year. Cleveland Clinic Children’s Hospital reports it has seen a significant rise in cases of respiratory syncytial virus (RSV), an illness that causes respiratory tract infections in infants. And they're not the only institution reporting a spike in cases. "So far this season, hospitals around the country have been reporting an increased number of cases compared with previous years, even tripling in some regions," says Whitney Casares, M.D., M.P.H., F.A.A.P, author of The New Baby Blueprint: Caring for You and Your Little One.
As RSV sends 60,000 kids under age 5 to the hospital every year, parents would do well to understand the current threat and the warning signs.
What the Current Outbreak Looks Like
The virus usually begins circulating in the fall and peaks in January or February, so we're in the midst of prime season for RSV. And as of this December, visits to the Clinic’s pediatric emergency department for flu and RSV were up 20% over December 2018, according to Camille Sabella, M.D., head of the Center for Pediatric Infectious Diseases at the children’s hospital, according to Cleveland.com. Most of the children hospitalized for RSV at the Clinic have been less than 2 years old, and some are as young as 6 months.
At the same time, the Clinic says they've seen a rise in flu cases. Between RSV and flu, this means more hospitalizations and emergency department visits, Sabella told Cleveland.com.
Meanwhile, several Chicago area hospitals, including Lurie Children’s Hospital in both Chicago and DuPage County, Edward Hospital in Naperville and others, are reporting a "high" number of RSV. Oishei Children’s Hospital in Buffalo has seen an increase in cases. Norton Healthcare in Kentucky reports 651 cases of RSV since September, a number that has more than doubled since Thanksgiving and tripled from this time last year. And Children's Healthcare of Atlanta has also seen more children with RSV or bronchiolitis. "This year has seemed more severe," confirms William Linam, M.D. pediatric infectious disease specialist at Children’s Healthcare of Atlanta.
But experts aren't sure why this year is worse than others. "RSV is an episodic disease; it flares in some years and is less prominent in others," says Dr. Casares. "This seems to be a particularly bad year but, at this point, it’s unclear why."
1. Cases spike during cold and flu season. RSV tends to circulate in late fall, winter and early spring. "Like influenza, the exact timing and severity varies year to year," notes Dr. Linam.
2. RSV is the most frequent cause of bronchiolitis. This is an inflammation of the small airway passages entering the lungs in infants and young children. According to an American Academy of Pediatrics study, the illness accounts for approximately 125,000 hospitalizations and 250 infant deaths every year in the U.S.
3. RSV spreads through direct person-to-person contact. It can live on surfaces, notes the Mayo Clinic. Unlike the flu virus, the RSV virus does not survive in the air.
4. There is no vaccine for RSV. The best way to guard against it is frequent hand-washing, disinfecting surfaces and shared toys, covering coughs and sneezes with an elbow, and avoiding touching the face and eyes.
5. RSV can be mistaken for the flu. "Both RSV and influenza can present with cold-like symptoms—fever, runny nose, cough, nasal congestion, sore throat—and often can be difficult to tell apart," says Dr. Linam. "Both RSV and influenza can result in severe respiratory illness in young children, the elderly or those with underlying medical problems."
For either virus, parents should watch for signs of dehydration, labored breathing, extreme irritability or tiredness, says Dr. Casares.
But if an infant or young child's runny nose and cough turns into more serious breathing trouble, the problem could be RSV. "There are tests available that can distinguish between RSV and the flu," Dr. Linam says.
Signs to Look For
In general, the Mayo Clinic notes that the following signs and symptoms are reasons to seek prompt medical attention:
Audible wheezing sounds
Breathing very fast—more than 60 breaths a minute (tachypnea)—and shallowly
Labored breathing—the ribs seem to suck inward when infant inhales
Sluggish or lethargic appearance
Refusal to drink enough, or breathing too fast to eat or drink
Skin turning blue, especially the lips and fingernails (cyanosis)