With RSV cases on the rise, here’s what Lynchburg-area parents need to know

Hospitals across the country—including Lynchburg General—are seeing a surge in a common respiratory illness that can cause severe breathing problems for babies.

RSV cases fell dramatically two years ago as the coronavirus pandemic shut down schools, day cares and businesses. As restrictions eased in summer 2021, doctors saw an alarming increase in what is normally a fall and winter virus.

RSV stands for respiratory syncytial virus. It is a common virus of childhood that can seriously impact the health of infants.

Dr. Travis Engel, chair of the Pediatric Department at Centra Health, said the virus infects the cells lining the airway all the way down to the lungs.

“When a child becomes infected with RSV, they can develop a condition called bronchiolitis where the small airways become inflamed and significant congestion develops because of the infected cells,” he said.

At Centra’s hospitals, the number of pediatric patients has steadily increased from 39 in February to 82 thus far in November, with one-third to half of those patients testing positive for RSV, according to information provided by the hospital system.

Kim Foster, population health manager for Virginia Department of Health’s Central Virginia Health District, said RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Symptoms can include fever, cough, congestion, runny nose, sneezing, and in infants, fussiness and poor feeding. It can progress to more severe symptoms such as fast or short breathing or wheezing. RSV can be more dangerous for young infants or those who are immunocompromised.

The most seriously ill children tend to be those up to 6 months old, although RSV is a major reason for admission in children all the way up to 2 years old, especially during the winter months.

“Infants who were born prematurely and those with underlying heart or lung conditions are the highest risk for needing hospitalization,” Engel said. “One thing we are seeing this year is that children who normally fall outside of the typical high risk age groups are being infected with RSV and a second virus, in many cases influenza.”

Engel said this places them at higher risk for a significant disease that requires hospitalization.

Adolescents and adults can, and often do, get RSV with the same seasonal frequency as younger children — even if they have had it before.

Older children and adults have stronger coughs and larger airways, and they tend to have less severe disease since they can manage the mucus and secretions better and keep their airway clear, he said.

“Prevention of RSV focuses on minimizing exposure for children in the high-risk groups. This means good hand-washing and staying home, trying to minimize contact with young children when you are sick,” he said. “This can be difficult when living in a household with multiple children and in many cases the virus gets ping-ponged around to all the individuals in the house.”

In some instances, individuals in the same house can recover only to be reinfected by another family member.

Engel said there is a medication called Synagis that is used to prevent RSV. It is generally only available to patients at the highest risk of having the most severe disease.

“In general, if you have a child who is less than 12 months of age and born prior to 32 weeks gestation, you should have a discussion with your pediatrician to see if this medication is right for your child,” he said. “It is not a vaccination and requires an injection each month during the peak RSV season, generally October through March.”

Engel said it is worth noting many respiratory viruses cause the disease process called bronchiolitis and RSV tends to be the major cause. Oftentimes the terms will be used interchangeably.

The major signs of bronchiolitis caused by RSV include congestion, fever, decreased feeding, a lower number of wet diapers and trouble breathing, sometimes with wheezing.

He said it often starts fairly mild and peaks on day four to six of illness.

“Because of this, many parents will have been seen in their pediatrician’s office, urgent care, or the emergency department early in the course of the disease, when it was fairly mild and did not require hospitalization,” he said. “As the disease progresses, they reach a point where the symptoms may become so severe that the child requires admission to the hospital.”

Most children with bronchiolitis caused by RSV will not require hospitalization, he said. They will be given instructions for supportive care. This includes suctioning the nose, providing medication for fever control and comfort and making sure the child does not become dehydrated.

There are four main reasons children will require hospitalization with an RSV infection: they have a low oxygen saturation and require extra oxygen, they are working so hard to breathe that doctors have to give them extra support that they would not have available at home, they are so congested that they require frequent suctioning by specially trained nurses and respiratory therapists, or if they are not able to stay hydrated and require IV fluids.

“Usually it is not just one of these reasons, but rather a combination of them,” Engel said. “In some cases, the pediatric hospitalist and the emergency room doctor will talk and make the decision to observe a child overnight to make sure they do not get worse. This great teamwork between the pediatrics department and the emergency department helps make sure every child gets the care they need.

“Some children may need breathing treatments, but this is not always the case and not every child benefits from this,” he said. “Some children may also develop a secondary bacterial pneumonia which requires antibiotics, but this is also not always the case. We make sure to monitor for all of these things so that each child gets the care they need.”

There is no specific medicine used to treat RSV and all of the care provided by Centra simply supports the patient while their body does the work of fighting the virus, he said.

Engel said most children are well on the road to recovery seven to 10 days after symptoms first started. Children less than three months old, those with underlying heart or lung disease and those who were born prematurely often take longer to get better. The cough is usually the last thing to resolve and can last two to four weeks in some cases.