Respiratory infection affecting small children makes an early appearance

A child with RSV lay in bed at the Sarah Bush Lincoln Health Center in Matoon, Ill.LaRanda St. John/Associated Press

A common respiratory infection that usually surges among children in wintertime has made an early appearance this year, surprising hospitals with dozens of coughing and wheezing infants and toddlers at the height of summer.

Cases of respiratory syncytial virus, or RSV, have been rising nationally since the spring, and doctors in Massachusetts started noticing the trend in the past two to three weeks. But unlike hospitals in the South that are also coping with a surge in COVID-19 cases, children’s hospitals in Massachusetts say the illness is not straining capacity. It’s just unexpected.

“Normally we hardly see any RSV during the summer months,” said Dr. Ben Nelson, a pediatric pulmonologist at MassGeneral Hospital for Children.

Doctors say the illness is soaring now because pandemic precautions prevented children from interacting and becoming exposed to RSV over the previous fall and winter. In typical years, nearly all children become infected with the virus before they reach age 2, with a small fraction requiring hospital visits. But many born in the past 18 months encountered RSV for the first time this spring and summer as restrictions eased.

“We have an entire 18 months’ worth of small children who have no immunity,” said Dr. Kristin Moffitt, a pediatric infectious diseases specialist at Boston Children’s Hospital. The hospital has seen about a dozen cases in each of the past two weeks, she said.

RSV infection is typically mild, indistinguishable from a cold in most cases. But it can inflame the small airways in the lungs, and the smallest children — especially premature babies, children with heart or lung disease, or those with weakened immune systems — can become severely ill, sometimes needing supplemental oxygen or intensive care stays. Children often get reinfected with RSV, but the subsequent illnesses tend to be less severe.

Among children under age 5 in the United States, RSV typically leads to 2 million doctor-office visits each year, 58,000 hospitalizations, and up to 500 deaths — higher than the estimated toll on kids from COVID-19.

“We have admitted over the weekend a number of children to the hospital, including some who had to go to the ICU,” said Dr. Lauren Rice, chief of pediatric emergency medicine at Tufts Children’s Hospital. She estimated that “a handful” of RSV cases have been coming to the hospital each day over the past couple of weeks, although most don’t need to be admitted.

There is no treatment or cure for RSV. Certain highly vulnerable premature babies get an injection of monoclonal antibodies once a month during RSV season to prevent illness. Otherwise, patients receive supportive care, such as supplemental oxygen and suctioning mucus, and usually recover within one to four weeks. RSV is rarely fatal.

The RSV cases are coming in addition to the injuries, trauma, and drownings that are more common in the summer, Rice said.

Still, she said, “We haven’t had to go to any special surge capacity. It is certainly something we’re mindful of. We regularly meet now to make sure that we’re prepared for any surge that may come our way.”

The US Centers for Disease Control and Prevention issued a health advisory on June 10 about an increase in RSV cases across parts of the South. Cases have appeared in many other states, too, and doctors in Massachusetts were waiting for the surge to reach here.

But some other states have had to contend with COVID-19 at the same time, a problem not seen in Massachusetts because of the state’s high vaccination rate. On Friday, a doctor tweeted about the challenges in Texas.

“COVID admissions in our medical center are up 500 percent,” wrote Dr. Heather A. Haq of Texas Children’s Hospital. She noted that she’s seeing more cases of COVID pneumonia in younger children. “But the difference this time compared to previous surges is we are simultaneously dealing with an unheard of summertime #RSV surge—creating a ‘surge upon surge’ situation.”

RSV also affects adults, and can be serious in the elderly. Among adults aged 65 and up, the virus can lead to pneumonia and causes almost 180,000 hospitalizations and 14,000 deaths yearly.

The summer spike probably won’t prevent the illness from resurfacing on its usual schedule in the winter, said Moffitt, of Boston Children’s. “I do expect that we’ll see a typical RSV surge this winter,” she said.

“We’re going to see a surge in all viruses this fall and winter,” Nelson, of MassGeneral, predicted. “All the viruses are going to come back with a vengeance.”

The doctors urged parents to be aware that cold symptoms this summer could signal RSV; they should keep sick kids home and monitor their symptoms. And they should be sure to wash their hands often, especially after blowing noses or touching the face.

“Don’t be afraid to come in to see us,” added Rice, of Tufts. “We want people to come in when their kids are not feeling well. The hospital is a safe place to come to and we’re ready.”

Material from the Associated Press was included in this report