Hospital pediatrician Dr. William Ching talks with nurse Emily Dumolien about patient care on the pediatric floor at UnityPoint Health-St. Luke’s Hospital. (Photo provided)
After largely avoiding spikes in cases over the past two years, pediatric clinics and hospital floors are seeing a sharp rise in RSV – respiratory syncytial virus – among children.
The latest numbers from the Iowa Respiratory Virus Surveillance Report showed 938 cases of the virus, a sharp increase from the 155 cases in the first week of October.
In Cedar Rapids alone, rising positivity rates and childhood hospitalizations have given doctors a new cause for concern with a virus that’s been around for decades, with trends to spike in the winter.
“We had very high numbers, like just about every pediatric unit in the state,” said Dr. William Ching, hospital pediatrician at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids. “We are seeing higher severity, especially in toddlers. I think the season is going to be long. »
When he started noticing the increase in cases in September – earlier than usual – the RSV positivity rate was below 10%. In early November, it soared to 43%.
Usually, RSV peaks begin to appear around December and January. But equally concerning for Ching is the fact that he is seeing more children over the age of 2 getting bad cases of the virus, which disproportionately affects young children. This year, it admitted about twice as many patients over the age of 2 compared to previous years.
Pediatricians are also seeing an increase on the clinical side. As parents battle COVID-19 and the flu, RSV is just another concern piled high as the holiday season approaches.
“We have a lot more children who are showing virus-like symptoms,” said Dr. Amy Schumacher, a pediatrician at Mercy Pediatric Clinic in Cedar Rapids. “It definitely makes our clinics busier.”
Recognize the symptoms
As a respiratory virus, RSV symptoms overlap with many general cold and flu symptoms – fever, congestion, runny nose, decreased appetite, coughing, sneezing and wheezing.
But unlike these other symptoms, there are a few critical symptoms that indicate respiratory distress that parents should watch out for in babies and young children: flared nostrils, audible grunting while breathing, and bobbing of the head. Other warning signs, such as a child’s belly rising and falling as they breathe, indicate that the child is having trouble breathing because the body is using the accessory muscles of the diaphragm.
Dehydration is a risk with RSV, and children who don’t feel well usually don’t eat as much or can’t keep food down. For babies, a rule of thumb that dehydration is less than three wet diapers in a 24 hour period – or less than one approximately every eight hours.
When to consult a doctor
In addition to the symptoms of respiratory address listed above, fevers that do not improve or that last longer than five days are an important reason for a child to see a primary care provider.
“To be admitted, you must have significant respiratory distress. We assess children based on how fast they breathe and if they have any retractions, oxygen saturation, use of stomach muscles,” Ching said.
Instead of using pulse oximeters to measure breathing, he recommends paying attention to breathing patterns and changes in skin color as a more reliable indicator – children whose skin takes on a gray or blue tint should be evaluated immediately. .
For children with milder symptoms, home support measures will be helpful. Nasal aspirating of saline can clear the nose, acetaminophen or ibuprofen can relieve pain, and a cool-mist humidifier can reduce discomfort. Most typical symptoms peak within three to five days, although a cough can last up to six weeks in children and longer in adults.
“Once they get sick, there’s nothing we can do to change the course of the disease trajectory,” Schumacher said.
Ching said the hospitalization rate for RSV and influenza is much higher than for COVID-19 in young children.
How to reduce your family’s risk
As families gather for the holidays, Schumacher recommends a simple rule that can go a long way: get loved ones to refrain from kissing babies.
“It’s such a simple way to spread a virus that can be very dangerous for a baby and mild in adults,” she said. “It’s an easy step to prevent their child from being hospitalized with RSV.
Also, keep babies as far away as possible from adults with mild cold symptoms, such as a runny nose.
Another easy step is to make sure each family member gets the flu shot as soon as possible from a doctor or pharmacy.
Other preventive measures are taken directly from the COVID-19 playbook: keep your distance from sick people, wash your hands frequently and remember to wear a mask. Avoid touching your eyes, nose and mouth and cover your cough.
Parents of children in child care should be prepared for a higher risk.
“If they’re in daycare, they’ll almost certainly get it because of its prevalence in the community and the difficulty of separating children,” Ching said.
It’s hard to say for sure why RSV is coming back strong this year, Ching said.
Over the past two winters, pandemic mitigation measures have worked against RSV in addition to fighting COVID-19. People masked more and avoided large gatherings during the holidays before much of the population had access to a COVID-19 vaccine.
University of Iowa conducts vaccine trials
Soon, an RSV vaccine may be available. The University of Iowa is currently participating in a Pfizer vaccine trial with 140 participants.
Pfizer and GlaxoSmithKline have reported efficacy rates high enough in vaccine trials to seek U.S. Food and Drug Administration approval, according to Dr. Pat Winokur, executive dean of the University’s Carver College of Medicine. from Iowa.
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