This article was posted on MLive. Read more here.
Ahead of the holiday season, West Michigan doctors are urging parents to be aware of the high likelihood that children under 2 years old will contract a respiratory illness with potentially serious consequences.
Respiratory syncytial virus, or RSV, typically presents as mild, with symptoms similar to the common cold for adults and older children. However, it can cause more severe illnesses in young children and elderly individuals when their airways are constricted.
West Michigan doctors at Grand Rapids-based Corewell Health said in addition to regular preventative measures, parents can take advantage of several vaccination options for children under 2 and adults over 65.
Dr. Derek Bair, a neonatologist at Corewell Health, said “we anticipate it to be as bad this year as it’s been in the past, but we’ve got some new armor this year.”
Dr. Dailya Khuon, a pediatric infectious disease physician at Helen DeVos Children’s Hospital, said RSV will affect about 90% of children by the time they’re 2 years of age.
“The honest truth is that your kid will almost certainly get RSV in the first two years of life,” she said. “The likelihood of severe disease is there.”
The virus is also the leading cause of emergency room visits and hospitalizations in infants less than 2 years old, and is the most common cause of bronchiolitis and pneumonia in children under 1 year old in the United States.
It typically leads to between 58,000 and 80,000 hospitalizations among children younger than 5 years old, according to the Centers for Disease Control and Prevention (CDC), along with between 100,000 and 160,000 hospitalizations among adults 60 years and older.
So far this year, Corewell Health reported a few patients testing positive daily across the health system, with a handful of hospital admissions, which is very typical for this point in the season.
Lynn Suftin, a public information officer for the state Department of Health and Human Services (MDHHS), said RSV is not a required reportable condition, so the state doesn’t have data on it similar to the numbers reported with COVID-19.
A total 880 cases have been reported through the Michigan Disease Surveillance System (MDSS), which is a constantly updated system using current reports to MDHHS by local health departments.
As of the week of Oct. 19, there were 0.1 hospitalizations per 100,000 people in Michigan associated with RSV.
Khuon said this year, RSV infection patterns are starting to return back to normal, after several years of unusual summer surges.
She said Michiganders can expect a majority of cases to start appearing in mid-to-late November and early December.
What to know about RSV transmission and symptoms
RSV is transmitted through large droplets of airborne fluid passed by coughing or sneezing.
The virus typically causes cold-like symptoms, including a runny nose or nasal congestion, cough, sneezing and fever.
However, in very young patients the virus can cause lower airway inflammation and increased mucus production that can jam up the lungs and plug airways.
As babies and children under 2 years old have smaller airways than an older child or adult, this clogging can interfere with how gasses are exchanged in the lungs and lead to more serious symptoms.
“Also, RSV is one of those super snotty infections,” Khuon said, “and so all the mucus that gets produced, it plugs up those little airways and makes it very difficult for those babies to breathe.”
She said while many of the 90% of children under 2 that contract RSV won’t ultimately need to be hospitalized and will have a relatively mild infection, “even if a smaller percentage of babies has severe disease, that causes a lot of hospitalizations.”
Dr. Erika Nearpass, an internal medicine physician at Corewell Health, said adults over 65 can also be vulnerable to severe RSV symptoms, due to both chronic conditions like cancer, heart disease and diabetes, along with an aged immune system that may not respond as quickly as a younger person.
When to seek medical attention
Khuon said it’s difficult to differentiate early on between a common cold and RSV.
However, as RSV affects the lower airways, the common cold tends to affect more of the upper airways, meaning RSV is often accompanied by a faster respiratory rate or signs of respiratory distress, like grunting or struggling to breathe.
RSV also tends to get worse day by day until about day five, she said, slowly improving over the next handful of days.
“So on day one or two, they’re doing OK, but if it gets worse on day three, day four,” she said. “That’s when you want to seek your physician’s guidance and potentially take them to the ER if they’re really having a lot of distress.”
Khuon said for babies with congested airways, parents can also use saline rinses to help their children breathe better.
Importance of preventative measures
Nearpass said preventative measures to stop the spread of RSV can include the following:
- Washing your hands.
- Keeping countertops clean, and frequently washing commonly used spaces in the home.
- Coughing into a sleeve and not directly into your hands, and using tissues when sneezing.
- Staying home when you feel sick.
Dr. Derek Bair, a neonatologist at Corewell Health, said the best thing you can do to protect children is not expose them, and if possible avoid large groups during cold and flu season.
“If you’re going to the grocery store, go in the off hours,” he said. “Go when there aren’t a lot of people. If you know you’re having a family gathering, find out if there’s somebody there that’s ill. If they are, don’t go.”
However, Khuon said Michiganders now also have access to two vaccines that can help protect those in high risk groups.
For pregnant mothers, she said a vaccine given between 32 weeks and 36 weeks and six days can pass along antibodies to newborns and help avoid contracting RSV. This vaccine, which has been available for about a year, has been around 80% effective at preventing hospitalizations in infants, she said.
Khuon said pregnant mothers can only get this vaccine once.
“We don’t have the data yet to show that boosting is effective, so we aren’t recommending the vaccine for that second pregnancy,” she said.
The same vaccine available for the elderly is around 61% effective in preventing hospitalizations, she said.
For infants, Khuon said there’s also a monoclonal antibody injection that directly provides children with RSV antibodies. In the first year, it’s been shown to reduce hospitalization for infants by around 80%, along with reducing the amount of outpatient visits, or doctors visits that don’t result in hospitalization, by about 60%.
A single dose of the antibody injection will give an infant around five months of protection, covering one flu season.
Khuon said the vaccine was available in limited supplies last year, “but this year, I think we have a much better system in place.”
According to MDHHS, 520,977 Michiganders have received an RSV vaccine or antibody, based on vaccination numbers starting in May of 2023, when the vaccine was first authorized, along with antibody numbers administered starting July 1, 2024.
RSV immunity is short-lived, however, lasting only about a year after a vaccine is administered or a child contracts the virus.
Khuon said doctors are hopeful to raise awareness about the vaccine options available to parents and community members.
“I think that because it was brand new, people were a little bit worried about getting it, and I think that vaccine hesitancy is not a new challenge that we’re having, but it’s a worsening problem for sure,” she said.
“The uptake has not been brisk,” she said. “It could be a lot better, and it is the thing that we can do to keep kids out of the hospital.”
She recommended that Michiganders who are interested in learning more about it talk with their doctor about whether or not they’re a candidate, especially pregnant mothers and elderly adults with other underlying conditions.