How Serious Is RSV?

By Dr. J. Michael Klatte

RSV has once again arrived early in the local community. We began to see cases of RSV in November at Baystate Children’s Hospital, with many children testing positive for the disease, a number of whom have required hospitalization.

But there is no reason to be overly concerned, though parents should be aware of the disease and its symptoms so your family can be adequately protected. Most children will have only minor symptoms, and only a small percentage of youngsters develop severe disease and require hospitalization. Those hospitalized often have severe breathing problems or are seriously dehydrated and need IV fluids. In most cases, hospitalization lasts only a few days, and complete recovery usually occurs in about one to two weeks.

According to the Centers for Disease Control and Prevention, most infants have been infected by RSV by the time they reach age 1, and almost every child will get RSV by the time they reach age 2. It is the most common cause of bronchiolitis, a disease of the lower respiratory tract that can cause children to wheeze, and of viral pneumonia in this age group. But it’s not just the young ages that are affected. RSV can also infect older children, teenagers, and adults.

Many of the first symptoms of RSV infection are similar to the common cold and can even mimic the flu, including runny nose or nasal congestion, cough, wheezing, reduced appetite, and fever. Low-grade fevers are common with RSV infections and may come and go for a few days. If a child is having increased difficulty with breathing (such as wheezing, grunting, or ongoing flaring of the nostrils) along with a runny nose and cough, then it’s a good idea to visit your pediatrician.

Those who have a higher risk for severe illness caused by RSV include premature babies; adults 65 years and older, 177,000 of whom are hospitalized and 14,000 of whom die each year in the U.S.; people with chronic lung disease or certain heart problems; and people with weakened immune systems, such as from HIV infection, organ transplants, or specific medical treatments like chemotherapy.

There is no specific treatment for RSV or vaccine to prevent the virus. It’s all about symptom management — making sure your child is hydrated, his or her fever is under control, and that they’re not having any trouble breathing. The severity of the symptoms can vary depending on the age of the child, and whether he or she has any chronic medical problems, such as asthma or premature birth. Bacterial infections such as ear infections and pneumonia may develop in children with an RSV infection.

Children under age 1 are most frequently affected by the serious symptoms of RSV. It can spread directly from person to person when an infected person coughs or sneezes, sending virus-containing droplets into the air, where they can infect a person who inhales them, as well as by hand-to-nose, hand-to-mouth, and hand-to-eye contact. The virus can be spread indirectly when someone touches any object infected with the virus, such as toys, countertops, doorknobs, or pens, and can live on environmental surfaces for several hours.

To help prevent the spread of RSV, cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands; wash your hands often with soap and water for 20 seconds; keep your hands off your face, as germs can spread by touching your eyes, nose, and mouth; avoid close contact with sick people, as well as kissing, shaking hands, and sharing cups and utensils with others; clean and disinfect surfaces; and stay home when you are sick.

The good news, however, is that most infants and children overcome RSV infections without any long-term complications, as RSV infections can often be relatively asymptomatic and even go unnoticed. –

Dr. J. Michael Klatte is a specialist in the Pediatric Infectious Disease Division at Baystate Medical Center.

Flu Shots for Pregnant Women Are Safe, Necessary

By Traci Gonzales

It is flu season, and a recent report suggests that one of the highest-risk groups has been neglecting to get this vital vaccine.

According to the CDC, pregnant women are more likely to develop severe illness or become hospitalized from contracting influenza. During some pandemic seasons, we have seen increased hospitalizations, increased respiratory problems, and increased risk of death with the flu for pregnant women. It makes sense considering the numerous changes a pregnant woman’s body has to undergo to accommodate a growing baby. Additionally, any infection caught while pregnant not only puts the mother at risk, but can actually cause problems for the unborn infant.

The flu shot has been proven to reduce the likelihood of hospitalization for pregnant women by 40%, and newborns younger than 6 months by an average of 72%.

Despite these facts, only about half of pregnant women age 18 to 49 reported getting a flu shot between August 2018 and April 2019. In fact, 24% to 34% of women hospitalized since 2010 between the ages of 15 and 44 were pregnant, even though only 9% of U.S. women in this age group are pregnant at any given time each year.

There has been a lot of research and investigation to ensure that flu shots are safe for pregnant women and their unborn children. Multiple studies have shown that, when compared to the general public, there is no increased risk for pregnant women or their child. It actually provides quite a bit of benefit. With the flu shot, the pregnant mother will develop antibodies, which are the tools needed to fight the flu. These antibodies will cross the placenta and provide protection for the baby. It is also present in breast milk, and breastfeeding mothers can continue to give their babies protection after they are born.

Effectiveness of the flu vaccine can vary due to changes in the virus each year. It is important to remember that the flu shot’s purpose is not only to try and prevent the flu, but also to help prevent complications if someone does get the flu. For example, a recent study showed that pregnant women who receive the vaccine were 50% less likely to develop respiratory illness with the flu.

As with any vaccine, no matter if you are pregnant or not, you may develop a few symptoms. Once you receive the shot, the body will begin to make what it needs to fight the virus. While the body is doing this, you can have a low-grade fever, achiness, or headache. Many people also experience some muscle soreness in the arm where the shot was administered. However, these symptoms usually last one to two days, and are much less severe than contracting the flu.

Ideally, we would like pregnant women to have the flu shot as soon as it is available each flu season, before the virus is increasingly active in the community. However, getting it later in the flu season is better than not getting it all. The flu shot can be given in any trimester.

For pregnant women, the flu vaccine has been shown to decrease the risk of complications during pregnancy, as well as provide protection for their baby.

As mothers, we strive to do everything we can to keep our children healthy and happy. The flu shot should be a regular part of that plan.

Traci Gonzales is a pediatric nurse practitioner with Texas Children’s Hospital and spokesperson for the American Lung Assoc.