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A pediatrician explains: What’s behind the spike in RSV and how to help
August 23, 2021
Patient with RSV

About RSV in children

Respiratory syncytial virus (RSV) is a common respiratory virus that typically impacts young children in the winter months. Like other children’s hospitals across the country, we’re seeing a large number of RSV cases outside the normal peak season. Why are we seeing this increase? Is it related to COVID? How can you keep your little ones healthy?

Dr. Tiffany Kimbrough, pediatrician and mom of two, answers your questions and provides top tips for staying healthy during this unseasonal RSV season.

What is RSV?

The highly contagious virus can cause respiratory illness in people of all ages, but is more severe for infants, kids under 5 and children who were born prematurely or with lung or heart conditions. RSV is typically a very predictable virus, with the peak of RSV season occurring in the winter.

Why are we seeing a spike in cases over the summer and into fall?

The COVID-19 pandemic altered the impacts of RSV in 2020 and early 2021. A recent report in Pediatrics, the Journal of the American Academy of Pediatrics, showed a 98% reduction in RSV cases during the beginning of the pandemic.

During the initial COVID-19 surges, kids were largely staying at home and people of all ages were practicing infection prevention measures like masking, improved hand hygiene and social distancing. These efforts lessened the impact of RSV. As spring turned into summer, prevention measures were loosened, and children were more likely to be exposed to the virus. People gathered in large numbers for family outings, birthdays and other social events, creating the opportunity for the virus to spread.

More than 80 percent of the positive RSV cases at CHoR have been in children between the ages of 2 and 5. We’re currently seeing an RSV testing positivity rate of 22 percent, meaning 22 percent of children who have RSV symptoms and are tested for the virus test positive. The rate is typically zero this time of year!

Parents and caregivers don’t need to panic, however. Most kids fight off the virus at home and are only sick for a short period of time. Only a small number of children are severely impacted by the virus.

Who can get RSV?

RSV is a highly contagious virus and anyone, including healthy adults, can become sick. Cases of RSV are most severe in children under the age of 6 months, children born prematurely and those with health complications like weakened immune systems, lung conditions, heart conditions and neuromuscular diseases.

What are the symptoms of RSV?

The symptoms of RSV are like the common cold or flu. They include:

  • Congestion or runny nose
  • Loss of appetite
  • Cough
  • Fever
  • General malaise (not feeling well)
  • Mild headache
  • Sore throat
  • Wheezing

How is RSV diagnosed and treated?

Because RSV is generally mild, diagnostic testing is not always required. If the doctor does test, it will likely be by a nasal swab.

RSV normally lasts a week or two and can often be managed at home, especially in older children. Care is like any other respiratory virus or cold. Children need to get plenty of rest. Over-the-counter medications (acetaminophen or ibuprofen) can be used to reduce fever. Be sure to give your child plenty of fluids too. A humidifier can help relieve some of the symptoms, and a nasal bulb or nose Frida can help suction mucus in infants. It’s a good idea to talk to your child’s pediatrician or primary care provider before giving non-prescription cold medicines, especially to a young child.

When should I be concerned?  

Serious cases of RSV can turn into bronchiolitis, an inflammation of the small airways in the lungs, or pneumonia, an infection of the lungs. These can be serious, especially in infants, when not treated.

Call a health care provider if your child:

  • Has a high fever (above 100.4) and is under 3 months of age
  • Shows signs of dehydration (not urinating regularly, no tears with crying, etc.)
  • Has a cough that gets worse or causes trouble breathing
  • Uncharacteristically refuses to eat/drink/breastfeed/bottle-feed

Seek medical attention right away if your child has:

  • Trouble breathing or blue lips/fingers
  • Extreme lethargy or drowsiness
  • Stridor (a high-pitched whistling sound when breathing)
  • Respiratory distress (looks like pulling between the ribs, fast breathing, belly heaving, nostrils flaring)

Is there a vaccine for RSV?

No vaccine exists for RSV, but an antibody shot called Synagis is available in some circumstances. The shot is only given to infants with compromised immune systems or babies that were born prematurely. Synagis is normally only given during the winter months but pediatricians are authorizing the shot immediately for high-risk babies. Virginia Medicaid has approved coverage of doses due to the recent spike in RSV cases.

What can I do to keep my family healthy?

We need to use many of the same prevention measures as COVID to prevent RSV, including washing hands thoroughly throughout the day. Children age 2 and up should wear masks indoors other than in their homes (school, grocery store, play dates, etc.) and avoid large crowds.

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