The kids are back in school, holiday events are ramping up, and we’re around more people in general —which also means we’re seeing a rise in viral illness. Respiratory syncytial virus (RSV) is one that’s spreading in our community and nationwide. While it usually causes symptoms similar to a common cold in most people, it can be very dangerous for infants and even older adults.
We’re catching up again with Dr. John Prpich, BayCare Kids Pediatric Pulmonologist and Medical Director of Pediatric Respiratory Care at St Joseph’s Children’s Hospital, to learn more about RSV and a groundbreaking new medicine just approved for use in all infants to prevent RSV infection.
Meet the Expert: Dr. John Prpich, pediatric pulmonologist from St. Joseph’s Children’s Hospital.
What is RSV (respiratory syncytial virus)?
Dr. Prpich: RSV is a very common respiratory virus and almost all children will have had it once if not twice by the age of 2. It is a virus that can cause in some children, more significant lower respiratory tract symptoms. RSV bronchiolitis is the most common reason from a respiratory standpoint for infants and children to be admitted to the hospital during the viral season.
As opposed to other respiratory viruses that cause upper respiratory tract symptoms like the common cold, RSV causes infections where the cells kind of mesh together —that’s where you get that weird word ‘syncytial’ because it causes these respiratory cells to form a kind of mesh or network.
It also causes some sloughing and death of respiratory epithelial cells, so you even slough some of the upper lining of the airway. Because of that, the body makes a lot of mucus and there’s a lot of inflammation, so that’s a big part of why babies and younger kids have problems—because it obstructs their airways.
Is RSV super contagious?
Dr. Prpich: It’s very contagious because. Before you have significant symptoms, even as an adult, you don’t feel that bad, but when you are sneezing and you are coughing, the virus is in those respiratory droplets. Droplets drop on a solid surface and the virus can live there for hours. A toddler comes along, touches that virus, touches their nose, touches their mouth … and that’s how they get sick.
That’s where the wiping down of solid surfaces and the hand washing really makes a difference. But it is really hard. It’s hard to keep toddlers from exploring their environment, and that’s why it’s so contagious in that population.
How can you tell if your infant has RSV?
Prpich says to look for fast breathing, “like a puppy.” If the child is coughing excessively and working hard to breathe, you want to intervene before you see a change of color. In babies 2 months and below, RSV can cause episodes of apnea, when the baby will turn “dusty” or blue, especially around the mouth or fingernails. A high fever is another sign.
When should you bring your child in to see a doctor?
Dr. Prpich: Bring your child in if you are worried about specific symptoms. Breathing fast, retracting, the sucking in between the ribs, nasal flaring—all of those signs of work of breathing. Also if there are signs of dehydration—not wetting diapers like normal, crying with no tears.
Is there a test for RSV?
Dr. Prpich: There are two ways: A rapid antigen-based test and PCR testing where we’re looking for the DNA fragments.
RSV seasonal patterns changed after Covid. What has it been like so far this year?
Dr. Prpich: This is the first season we’ve seen a more typical spike that we usually see around this time in September through October. It’s a little bit early, and I think that’s why there’s been news coverage and blasts from the CDC. It has been a bit early in the southeast. Usually, our season is September through March and we expect that to be the case as far as we know.
The Food and Drug Administration (FDA) recently approved a new medicine for infants. What can you tell us about it?
Dr. Prpich: It’s exciting—it’s not available yet. It’s approved, and it’s there, not sure where it is in terms of the rollout so the pediatricians don’t have it yet (as of the end of September when the interview was conducted). It’s going to be the first time really ever we’re going to be able to give term infants a way to prevent them from getting RSV.
It’s not a vaccine, although it is an injection. It’s a monoclonal antibody. It’s there to prevent or block some part of a pathway.
We have had SYNAGIS (palivizumab) that would block RSV from being able to bind to the cells and cause infection, but these medicines are expensive, so historically it’s been indicated for high-risk kids born prematurely, or with congenital heart disease, and other chronic lung diseases. That was given once a month during the RSV season.
But it wasn’t available to all kids because of the high expense. So, this new medicine Beyfortus (nirsevimab-alip), it’s a similar idea, but it’s a monoclonal antibody that blocks the virus from causing infection. You get one shot and it lasts five months. And on average, the RSV season is about five months.
NOTE: Talk to your pediatrician to find out when this new medicine will be available.
Can you get RSV more than once in one season?
Dr. Prpich: You can get it more than once in one season. Also, children who get a very significant case when they’re under 6 months may be at increased risk of other viruses, chronic lung disease, congestive heart disease, and wheezing problems in their teen years and older.
Common RSV Symptoms:
- Runny nose
- Apnea (short periods without breathing)
- Poor feeding
- Retractions (pulling in) of the chest wall
- Rapid breathing; turning blue around the lips
Tips to protect your infant from RSV:
- Newborns need bubble care. Everyone wants to touch the baby, but encourage visitors to touch baby’s feet rather than her face.
- Wash your hands—constantly!—with soap and water.
- Wash your infant’s toys and bedding often.
- Do not smoke near your child, and do not let others smoke near your child. Exposure to tobacco smoke increases the risk of RSV.
- Make sure countertops are clean in the kitchen and bathrooms, especially when someone in your family is sick. Discard used tissues right away. The virus can live for 8-12 hours on a surface.
- Use antibacterial wipes at the grocery store to wipe carts.
*Presented by BayCare | Originally published in October 2023 of Tampa Bay Parenting Magazine.