RSV: Expert Answers to Your Questions

Respiratory syncytial virus, or RSV, is a common virus with cold-like symptoms that can be dangerous for infants or for those compromised due to other chronic illnesses or conditions. Because it is one of the most common illnesses in early childhood, new parents need to arm themselves with information to protect their children. We asked Dr. Donna Tyungu, chief of pediatric infectious diseases with Oklahoma Children’s Hospital OU Health, to answer questions about the virus.

Q:  What is RSV, and how is it dangerous for infants?

Dr. Tyungu: RSV is respiratory syncytial virus. It is a respiratory virus that infects the breathing passages and can sometimes cause a severe lung infection in very young patients called bronchiolitis. It can cause respiratory problems for people of all ages but is one of the most common diseases of early childhood. Unfortunately, each year, up to 80,000 children in the USA under the age of 5 are hospitalized for RSV, and, tragically, 100-300 may die from this infection.

For very young children, one concern is the amount of secretions produced by the body in response to the virus. The nasal passages are small, and since young babies predominantly breathe through the nose, excess nasal secretions can impact breathing. Most infants with RSV will experience upper respiratory tract symptoms. Up to 30% can develop the lower lung disease with their very first RSV infection.

Factors that increase risk of severe RSV include prematurity, chronic lung disease, congenital heart disease, being immunodeficient, neurologic and/or neuromuscular disease. We do know that children with asthma do worse overall with any viral infection comparatively. Also, children who experience severe RSV early in life are at risk for developing asthma later on.

Q:  Do health care professionals expect high numbers of RSV patients this year? Why or why not?

Dr. Tyungu: All we can do at this point is make predictions. The past few years with public masking and a new pandemic virus circulating, the typical course of RSV was altered.  We saw very unusual summertime RSV spikes, as well as earlier waves of cases in the fall.

This year, I anticipate that we may have an RSV season similar to those of the past, and mostly in the winter months. This is because nationally the rates are currently relatively low, and I would have expected a summer spike to already be underway. This is concerning because we will likely have influenza and COVID spikes this winter again as well, which could strain our hospital systems again. That being said, it’s still just a hypothesis at this point.

Q:  What can parents do to prevent their infants from getting RSV? Is there a vaccine available to the general public?

Dr. Tyungu: RSV is highly contagious and spread through droplets. Parents and other adults can easily spread the infection to young children, so parents can discuss vaccination with close eligible family members.

In May of 2023 the U.S. Food and Drug Administration (FDA) approved a Respiratory Syncytial Virus vaccine for those 60 years and older, which is expected to be available this fall. The data showed that those older adults who had the vaccine lowered the risk of developing lower respiratory tract disease from RSV. The risk of severe disease decreased by 94%. This is important in pediatrics because newborns will frequently encounter respiratory viral infections from their immediate family, so if individuals around them such as grandparents have the ability to increase their level of protection, it may help cocoon the newborn at least until they are a little older when the virus is more tolerated.

In this trial, they did immunize pregnant mothers as well. Maternal antibodies can protect newborns after delivery and may be enough to get them through their first winter without contracting the virus or, if they do contract RSV, it may prevent hospitalization. The data show that the vaccine reduced the risk of severe lower respiratory tract illness in infants up to 3 months of age by 81%, with continued reduced risk of 69% by 6 months of age. This was good news, but there is still a question about post-vaccine premature delivery that is being debated. The FDA will meet in August to discuss whether or not to approve the vaccine for pregnant women.

Q:  Health care professionals are talking about the “triple threat.” What does that mean? Can children younger than 1 year get a COVID vaccine? What about a flu vaccine?

Dr. Tyungu: A triple threat would be an RSV, influenza and COVID-19 surge at or around the same time. This is of concern as it could potentially stretch hospital resources again. Multiple respiratory viruses in circulation simultaneously will also result in a patient being infected with more than one virus at the same time, which is a threat to individual patient health.

Children can be vaccinated against influenza and COVID-19 after the age of 6 months. Parents should discuss these vaccinations with their child’s pediatrician and pursue vaccination to help mitigate the risks of infection.

Q:  What about adults? What preventative vaccines should they get, and when should they get them? What vaccines should pregnant women get?

Dr. Tyungu: There are a slew of vaccinations available to adults, and these vary by patient condition and health, so everyone should speak with their own primary care provider when deciding on vaccinations. In general, COVID-19 vaccine and/or a booster is available for those who are not up to date. The CDC has worked to simplify what up-to-date means. Find information at cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html

Generally, everyone 6 years of age and older are up to date when they have one updated Pfizer or Moderna vaccine. Those who choose not to get Pfizer or Moderna do have another option to consider, the Novavax vaccine.

The influenza vaccine will become available in the fall. Typically, we advise people to get an influenza vaccination in late fall (September or October) so that immunity is in place before the virus is fully circulating within the community.

Q:  Is there anything else parents, pregnant women or caregivers should know about preventing these illnesses as we head into the fall and winter months?

Dr. Tyungu: Some practical things that parents can do is have a winter hygiene plan that includes taking extra care to clean hands and surfaces especially if working with young children or breast feeding. It’s always okay to ask people to first wash their hands before touching your baby. Avoid kissing your baby on the face if you have cold symptoms, keep the baby away from crowds, wash toys and the baby’s environment regularly.

Also, limit the time high-risk babies and young children stay in day care, particularly from late fall to early spring when RSV is most prevalent. If possible, keep your baby away from anyone, including older siblings, with cold symptoms, avoid environments with smoke and stay up to date on childhood vaccines. Finally, if your child is sick – keep them home and don’t send them to day care.