RSV

This past week, my 4 y.o. C. became very unwell with high fevers and cough.  Despite having asthma, he actually didn’t have much trouble breathing or wheezing.  I took him to the urgent care when he developed rigors – that is a shaking associated with high fevers.  Rigors are usually concerning in children that there is more than a usual winter virus going on. He tested positive for RSV and was treated for a secondary bacterial infection over a few days in CHI Crumlin.  Huge thank you to the absolutely wonderful care he received at both CHI Connolly and then Crumlin.  He’s absolutely fine and flying around the house a the moment.  I asked this week for questions on RSV, and I got loads of responses, including queries on masks and flu. 

What is it?  RSV stands for respiratory syncytial virus.  It is a common respiratory virus that usually causes cold-like symptoms for most people.  But RSV can be serious, especially for children under age 4 and older adults. RSV is a common cause of “croup” or bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs.

What are the symptoms?

You start showing 4 to 6 days after getting infected. These are usually runny nose and sneezing, fevers, off food, coughing.  Some children or adults may also get a wheeze.

What do you do?

Almost all children have been infected once before the age of 2.  Many children do not need any special care, and just need fluids, rest, and medication (like Calpol) to help with fever and keep them comfortable. You do not need always need to get an RSV test (it is often done as part of a respiratory virus swab for children admitted for hospital. This swave usually also includes influenza and covid.)

When to worry?

If you are concerned, if your child has trouble breathing, is dehydrated, or has high temperatures that aren’t settling, you should ring your doctor, out of hours GP service, or urgent care/ED.

How to prevent it?

Wash your hands, avoid people who are ill.  Be kind:  Cover your coughs/sneezes with your elbow (teach your child the same) clean your hands, and stay home from school or work if you are ill. There is no vaccine for RSV.   Missed your best bet on staying healthy this winter?  Catch up on Crechitis and Immune-boosting (which lots of mythbusting)   If you haven’t gotten the flu vaccine, there is still time (better late than never).  The annual flu vaccine is free to children ages  2- 17 (and lots of other people, too!)  It’s particularly important for people with underlying conditions, pregnancy, and healthcare workers (to protect their patients!) The child flu vaccine is free from your GP surgery and is nasal spray (no needles!)  It is 40-60% effective (depending on strains of flu circulating).  The flu vaccine should ideally be done by Halloween but if you haven’t done it, still better late than never.

What to know for 2022?

Rates of flu and RSV are already high in the community (you can go to the HPSC website for more on the current data). This is part of a global surge of what is being termed “tripledemic” this winter of RSV, flu, and covid.

Because you asked:  What about masks?

Let’s be honest. It works. That’s why we are still using them in healthcare settings.  The public health advice still recommends masks on public transport.  And this winter it just makes sense.  Our quick move away from masks is cultural and political. If we look many countries in Asia, they had a courtesy of masking on public transport and crowded indoor spaces during winter viral season for years.  It is quite effective way to protect themselves and others.  I mask, my family masks, and I recommend that my patients who are vulnerable (by the way, that includes my #longcovid patients!) No one will make you do it, but it’s something to think about if you have vulnerable people at home (or just hate being sick).

Is this all because of “immunity debt”?

Probably not. This theory became heavily politicised recently globally but there is no solid evidence for it yet.  There are multiple factors that account for the surge.  What does this theory say?  This theory says that the public health measures during the pandemic meant children weren’t exposed to viruses and so now they are all being exposed at once.  It sounds like it makes sense except we are seeing these same surges in areas globally that did not have lockdowns or mask mandates.  We are also seeing surges in populations over age 65 who were definitely exposed pre-Pandemic.  One competing theory – that makes more sense – is immunity amnesia.  That is, a serious virus can wipes out some of your immune system’s memory of other viruses (we saw this after measles, for example, but not so much any more because of effective vaccines!) We know covid infections can affect, for example, interferons that have a critical role. The third factor is the dramatic drop in vaccination.  There has been a global downturn in uptake of flu vaccination (and childhood vaccination overall)  due to multiple factors that include a surge in medical and vaccine misinformation during covid.  However, it is all a theory:  this is all an area of intense study by virologist, infectious disease specialists and epidemiologists.