Transcription:
Respiratory Syncytial Virus (RSV)

Melanie Cole (Host): There's no handbook for your child's health, but we do have a podcast featuring world-class clinical and research physicians covering everything from your child's allergies to zinc levels.

Welcome to Kids Health Cast by Weill Cornell Medicine. I'm Melanie Cole. And joining me today is Dr. Karen Acker. She's an Assistant Professor of Clinical Pediatrics at Weill Cornell Medicine, and she's here to talk to us about RSV and this winter. Dr. Acker, it's a pleasure to have you join us again. So, tell us about RSV. Have you seen an uptick recently in RSV and other respiratory illnesses this season? Because physical distancing, masks and such have gone by the wayside. Things have gotten back to I'm not sure if it's a new or more normal, but sort of a different normal.

Dr Karen Acker: Yes. The answer to both questions is yes. We've seen an uptick in RSV and we're seeing an uptick in other respiratory infections as well. RSV, it stands for respiratory syncytial virus. And RSV, it's a common virus that we see in children and adults, that causes common cold symptoms, most commonly runny nose and cough. And children are particularly vulnerable to getting RSV infections. Usually, most kids get infected by two years of life and you can continue to get multiple infections throughout your life. And children are more susceptible though to more severe disease. Twenty to thirty percent of children who get RSV can get lower respiratory tract infection, meaning that the lower airways get infected and cause something called bronchiolitis.

Melanie Cole (Host): Well, then explain a little bit for us about the difference between, I mean, obviously this is flu season, RSV, COVID. I'd like you to give us some similarities and some differences because I don't know how you doctors are able to discern which one our kids might have. And since you mentioned that this is, you know, more prevalent in our littler kiddos, that's even scarier for parents. Tell us the differences.

Dr Karen Acker: Yeah. So I mean, you've pointed out that these viruses, they cause very similar symptoms and they can be really tough to distinguish. But there are a few particularities about each virus that can look a little different. But ultimately to find out what you're infected with, you need to have a test. And we can test for influenza, RSV, and COVID. And that's really the only way we could truly distinguish.

But some differences that we see are, for example, with presence of fever. So, influenza is the virus out of the three that most markedly causes high fever. And it can start with a high fever initially up to 103 or 104 Fahrenheit and is associated with body ache, general malaise, and then also cough and your upper respiratory symptoms. Of the three, influenza causes the most and severe symptoms for a cold at home where I see kids really suffering from symptoms, not feeling well and being out of school for, you know, up to a week or more.

RSV really most commonly causes upper respiratory infections. It's really your runny nose and your cough and, in some cases, can cause fever, but it's not as much of a hallmark. And RSV additionally, as I had said before, can cause lower respiratory tract disease. And our younger children, particularly infants, are the most susceptible to getting what's called bronchiolitis, which can cause fast breathing and difficulty breathing and can lead to hospitalization, so we can kind of provide some respiratory support.

Our third virus COVID-19 or SARS-CoV-2 can also cause upper respiratory symptoms, runny nose, cough and fever. And generally though, we've been seeing less severe disease due to COVID compared to influenza and RSV.

Melanie Cole (Host): So then, what about the co-infection aspect of what we are seeing right now because it is flu season and COVID season and RSV season? Is there this tri-demic? Are we going to be seeing all three of these things?

Dr Karen Acker: We are seeing all three of these things currently with really RSV and influenza being much more common right now. We're starting to see an uptick in COVID, but it's really not as prevalent as RSV and influenza right now. And while we're seeing a lot of co-infections, I'm not seeing too many co-infections of RSV with influenza and COVID, but we are seeing co-infections with RSV and flu with other viruses. We have other respiratory viruses that we're also seeing currently. And whether co-infections with viruses result in more severe symptoms compared to an infection with just one virus is not so well understood. Generally from my experience, when I see a co-infection with RSV or with influenza, because those are generally more severe viruses compared to a lot of the other respiratory viruses, I attribute the symptoms to RSV or to flu. But the role that the other coinfecting infection plays is not so well understood.

Melanie Cole (Host): So, tell us a little bit about transmission and how long we're contagious, that sort of thing, because that's really what parents want to know if they've got their kids in daycare or the little ones starting kindergarten, that sort of thing. Tell us a little bit about transmission and contagiousness. How long does that go on?

Dr Karen Acker: All of these respiratory viruses, RSV, influenza, COVID, they're all spread by respiratory secretions. So, the secretions from your nose when you have a runny nose or when you cough, those droplets, those all contain virus and can result in transmission. And so with RSV, we think that transmission's really mostly due to kind of large droplets. So if you're touching your nose or your mouth and you touch someone else, or if you touch an environment after blowing your nose or coughed into your hands and someone else then touches that same environment and then touches their own face and mucus membranes, which could be your eyes, your nose, or your mouth, that's really the predominant mode of transmission for RSV.

Similarly for influenza, also spread by droplets, but little bit smaller droplets so that if you coughed in an area where there was someone else, the droplets that you coughed could get onto them and could result in transmission.

And COVID, we think of being transmitted by maybe even smaller droplets, which is why we are receiving a lot of transmission in areas where there were rooms with crowds of people and seeing transmission even across rooms. And really, the best way to prevent transmission, really number one way is through effective hand hygiene. We've seen that washing your hands properly with either soap and water and washing for at least 20 seconds or using a hand sanitizer is really the best way to prevent transmission because if you do that every time before you touch your face, you'll kill any virus that's lingering on your hands and that you could potentially infect yourself with.

Melanie Cole (Host): So if our little ones do get RSV or COVID or the flu, what can we do to help them feel better? I'd like you to speak first about when we should call our pediatrician and then really tell us about home care because there's so many products on the market for inhaling and to clear mucus and to help with the nasal and congestion, and we don't know whether we're supposed to be using those with our kids or not.

Dr Karen Acker: So for majority of the time, when your child has one of these infections, it's really going to be about supportive care. Making them feel better through helping to either clear their nasal passageways, keeping them hydrated and reducing their fever, if they have fever.

In terms of kind of the symptomatic management for respiratory symptoms, I find that's one of the toughest. Kids often have prolonged coughs with these infections. They have stuffy noses, they have runny noses, and we don't have great agents to treat these. Cough medications that older teenagers or adults can use are not considered safe or effective for children less than six years. So, we really rely on keeping them well hydrated, which will just overall help them clear their secretions and mucus. I am a proponent of using a humidifier, where you can put cold water in the humidifier and it releases just kind of this nice, cool steam that helps your child clear the secretions from their respiratory tract. I would keep it in their room overnight and it helps with their cough and nasal congestion.

Another option that you can give that turns out is effective in cough is a simple antidote of honey. You can give kind of a spoonful of honey to your child, and has been shown to have some effect on cough. Of course, I have to always point out that you cannot give honey or should not give honey to any infant that's one year or younger due to the risk of botulism. But for older children, that is something you can try.

For their fever, which generally makes kids quite uncomfortable. It gives them body aches, headaches. You can give either acetaminophen or ibuprofen. And ibuprofen should only be given if they're six months or older. But those are very helpful in managing their symptoms. And for the most part, it's just kind of letting them rest at home and getting through it.

If your child ends up getting sicker and needs to come to the emergency room or to the hospital, we will help support them, keeping them hydrated, supporting their breathing, and treating them as indicated.

Melanie Cole (Host): Well, I think one important point you made was keeping them home, because too many people are too quick to send their kids back to school or daycare or any of those other things, and that just spreads it all around anyway. Those places are full of germs as it is, but this makes it a lot worse.

I remember, Dr. Acker, that my kids used to like Vapor Rub and those kinds of things because they liked the smell, but it also helps to clear out that respiratory just a little bit, a little bit of a help. Now, you said that one of the ways to protect ourselves and our children is hand washing. What about other things? Do masks help with this? I mean, so many people don't want to go back to masking, but is this anything that would help with this? Or it's just kind of an inevitability and we have to wash our hands?

Dr Karen Acker: We have many measures that we can do to help prevent. And while I mentioned hand washing as number one, we do have other ways. And as you said, Melanie, that keeping kids home from school when they're sick is going to help transmission. That being said, I've seen that during the pandemic, kids have really suffered by not going to school. So, there certainly is a balance. So, really the recommendation that most schools have is that if your child has a fever, they should not be going to school. This is when they're most contagious. And also, they're likely not going to be feeling very well, and so they won't be able to really do much at school if they're not feeling well with fever. And once they've been 24 hours without fever, they can return to school. And whether you keep them home outside of the setting of fever is dependent on your school's policy and how your kid is feeling.

Other prevention methods, as you mentioned, are masks. You know, we used masks heavily during the pandemic and we saw that they were associated with decreased transmission of COVID-19 in schools. And so if your kid is having symptoms such as cough, runny nose, and they are good at wearing a mask effectively where they keep it on and they're not playing with their mask and face all the time, then it's a great measure. And so, I see that many parents will give their child a mask to wear if either they're having some symptoms or if the parent wants to protect that child from getting sick at school. So, masks are another measure that we certainly can use for prevention.

Really a mask and hand hygiene are our primary means of prevention, but I almost forgot to mention actually our number one method of protection, which is vaccines. And while we don't have vaccines for all respiratory viruses, we do have vaccines for COVID-19. And we have vaccines for influenza. And so, I highly recommend that all children are up-to-date on their COVID vaccine and boosters based on their age and that all children receive an influenza vaccine as early as they can during the season, and that's usually around the end of October that I recommend that all children get the flu vaccine. Unfortunately, we don't currently have an RSV vaccine. It is being investigated. And if they were to become available, I will likely be recommending that highly as well.

Melanie Cole (Host): This is great information, Dr. Acker. You're an excellent guest. You have so much knowledge and this is really for parents because we do get nervous, especially when it's a respiratory virus. Those seem somehow to be a little bit scarier than when the kid has a cold and a stuffy head. So, I'd like you to just summarize your best bits of advice about symptom management, RSV, this whole co-infection aspect that we might be seeing this season, and especially around holiday times and afterward. Please tell us what you would like parents to know about keeping our kids safe and really our families too.

Dr Karen Acker: Thanks, Melanie. It's been great talking to you about this because this is certainly a big issue right now. As I said before, we are seeing an uptick in these viruses, particularly in RSV and flu. And we think it's related to the last two years that our children weren't exposed to these viruses during the COVID pandemic. And now, they're much more susceptible. So, we're seeing a huge uptick. But for the most part, our children are going to fare well and have relatively mild colds, and we can continue to support them at home with good hydration with various measures to help with their congestion and cough. And keeping them at home from school when they're febrile and they're most contagious.

When our children are sick or even not sick, we should encourage good hand hygiene. Just having that hand sanitizer on you, so we're always kind of cleaning our hands. It should become really part of your regular routine, and putting our children in masks when we think they could be symptomatic or if we're concerned that they could be exposed to other infections. But really, I couldn't emphasize more the impact of vaccination in preventing our kids from getting severe disease due to the viruses, particularly for influenza and COVID.

So if we get anything from our chat today, I really want to make sure that parents understand that we do have these tools that we've developed to help prevent severe disease to many respiratory illnesses. And so if your child is vaccinated, I am quite reassured that their risk for severe influenza or COVID is very low. And then for RSV, we can implement the measures that we just discussed with hand hygiene, masks and avoiding areas where we think that they may be more likely to be exposed.

Melanie Cole (Host): Yes, we do have vaccines. And the American Academy of Pediatrics has let us know time and again they are safe and effective. If you have questions, please don't hesitate to ask your pediatrician. We love our pediatricians. That's what they're there for. Thank you so much, Dr. Acker, for joining us and really giving us such great information.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Kids Health Cast. We'd like to invite our audience to download, subscribe, rate, and review Kids Health Cast on Apple Podcast, Spotify, and Google Podcast. And for more health tips, please visit weillcornell.org and search podcasts. And don't forget to check out our Back to Health. I'm Melanie Cole.

Promo: Back to Health is your source for the latest in health, wellness, and medical care for the whole family. Our team of world renowned physicians at Weill Cornell Medicine are having in-depth conversations covering trending health topics, wellness tips, and medical breakthroughs. With the spotlight on our collaborative approach to patient care, this series will present cutting edge treatments, innovative therapies, as well as real life stories that will answer common questions for both patients and their caregivers. Subscribe wherever you listen to podcasts. Also, don't forget to rate us five stars.

Disclaimer: All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions.

Weill Cornell Medicine makes no warranty, guarantee or representation as to the accuracy or sufficiency of the information featured in this podcast. And any reliance on such information is done at your own risk.

Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech, or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures. And Weill Cornell Medicine does not endorse, approve, or recommend any product, service, or entity mentioned in this podcast.

Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.