virus triple threat

Early in the COVID pandemic, surges of other seasonal respiratory viruses such as influenza and respiratory syncytial virus (RSV) were well below normal levels. This may be due to masking and other precautions put in place to limit the spread of SARS-CoV-2. .

But in the third year of the pandemic, as the public largely abandoned masking and other measures, public health experts warned of the threat of a “triple disease” of COVID, flu, and RSV infections.

It’s still too early to finally tally up the tolls of each of these viruses, but so far each one has delivered strong results.

According to the Centers for Disease Control and Prevention (CDC), cases of RSV increased as early as May and peaked around the fall.¹

COVID-19 infections had been declining through most of 2022, but a highly contagious new variant of Omicron has changed that. XBB.1.5, the version of Omicron that swept the United States from late 2022 to his early 2023, has proven to be highly contagious, but not necessarily as many hospitalizations and serious illnesses as previous variants. It does not lead to²

Flu cases are still being reported in high numbers as of mid-January, but the CDC has revealed that infections appear to be on the decline. 41 million flu cases have been reported from³ The CDC reports that the total so far this year is about 24 million.^Four Although this total places the annual cumulative influenza burden at an average level, it is not uncommon for influenza cases to persist into early spring.

The good news is that despite warnings that the US is headed for a triple pandemic of influenza, COVID, and RSV this winter, each of these viruses appears to be peaking in turn. It may not seem like it for a family who has battled one disease after another, but the worst of the predicted “triple disease” seems to have failed to achieve its predicted goals.

Adam J. Ratner, MD, of Hassenfeld Children’s Hospital at NYU Langone and a member of the Infectious Diseases Board of the American Academy of Pediatrics, said these viruses were associated with higher-risk groups, including children with other comorbidities or comorbidities. said to have had the greatest impact on They had no available vaccinations.

“I think it’s been a really bad respiratory virus season nationally. We’ve seen different things in different areas,” Ratner said.

RSV and influenza accounted for the majority of infections. He adds that although hospitalizations are now down, there are still many children with these viruses who need hospital beds. A new variant of the novel coronavirus caused a spike in cases during the holidays, he said, but for a variety of reasons, severe illness from COVID is mostly confined to high-risk individuals. And it seems.

“Most people in the United States have had some immunological experience, which means they’ve had COVID, had one or more vaccinations, or both.” infected with COVID at some point during the pandemic, whether they knew it or not.

Ratner says there have been cases of people being infected with more than one of these viruses at once, but there really isn’t any data showing that co-infection leads to more serious illness. Complications like these can occur after initial infection with COVID, influenza, or RSV, he said.

Ratner adds that vaccination is still the best defense, if it’s available.Vaccines for COVID and flu are available, but effective RSV vaccinations are still in the testing phase. One of Pfizer’s maternal vaccines is promising, he adds, and there are good data on the efficacy of long-acting monoclonal antibodies.

Currently, oseltamivir remains the flu treatment of choice, and remdesivir is available for children requiring hospitalization for COVID-19 and those requiring oxygen therapy. Another COVID treatment option, Nirmatrelvir/ritonavir, is only approved for children over the age of 12, Ratner said.

RSV is perhaps the most difficult to manage beyond supportive care. Monoclonal antibodies are more of a preventative tool than a therapeutic option, he says. The therapy is used in premature babies and young children with congenital lung disease and is given monthly during his first RSV season, Ratner said.

The winter respiratory virus season isn’t over yet, but hospitalizations are trending down and the number of children requiring intensive care remains relatively low, Ratner said.

“Luckily for children, being hospitalized and needing that level of support is much rarer for them than for adults,” Ratner says.

reference

1. RSV molecular data from the US Centers for Disease Control and Prevention. Accessed January 15, 2023. https://www.cdc.gov/surveillance/nrevss/images/trend_images/RSV14Num_Nat.htm.

2. COVID-19: Weekly review of COVID data trackers. Centers for Disease Control and Prevention. Accessed January 16, 2023. https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html.

3. Disease burden of influenza. Centers for Disease Control and Prevention. Accessed January 17, 2023. https://www.cdc.gov/flu/about/burden/index.html.

4. Weekly US Influenza Surveillance Report. Centers for Disease Control and Prevention. Accessed January 17, 2023. https://www.cdc.gov/flu/weekly/index.htm.