Bigger, earlier, and older than the previous year

Respiratory syncytial virus (RSV) emerged early at the start of the 2022-2023 viral season and also increased significantly in numbers. The rate is 1.1 per 100,000 and the pre-pandemic rate is about 0.5 per 100,000.^1.2 RSV numbers declined in late November, but RSV detection and hospitalization rates are still higher than in previous years.^1.2 And certain features of this season’s outbreak clearly set it apart from previous years.And the RSV, COVID-19, and flu trifecta continued into his December, prompting the Centers for Disease Control and Prevention to re-infect. encourage Wearing face masks indoors and on public transport by the general public, especially in areas with high community rates of COVID-19.

Unprecedented surge in RSV cases

Children’s hospitals are overrun with children with RSV, well above peak rates during pandemics or typical spike years, said a pediatrician and American College of Thoracic Physician. “Every two to three years there is a season when the virus hits hard, and more children are hospitalized with RSV than in a normal year.” It was several times higher than in 2008,” added Dr. Carroll. A typical boom year. ”

Respiratory syncytial virus is a common cause of respiratory infections for which there is no FDA-approved vaccine. In most people, its effects are limited to cold-like symptoms. In some people and/or those with a weakened immune system, the virus can cause serious consequences such as pneumonia. and bronchiolitis. In a typical year, RSV causes 60,000 to 120,000 hospitalizations among adults over the age of 65, 6,000 to 10,000 deaths, and 58,000 to 80,000 hospitalizations in children under the age of 5 years. 100 to 300 deaths in the age group.³

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This year’s surge in RSV has been most notably affected by children. The early winter hospitalization rate for children aged 0 to 4 years old rose to 61.5 per 100,000 in mid-November and peaked in early winter on December 11, 2021 in her 100,000. significantly higher than 13.3 per As of November 26, 2022, she had fallen to 17.9 per 100,000, but the rate is still above the rate for about the same time last year.²

Patients over the age of 65 have much lower hospitalization rates, but follow a similar trend to that for young children. In 2022, the hospitalization rate for adults over the age of 65 rose to 3.6 per 100,000 in mid-November, a peak in early winter. Notably, this is higher than his early winter 2021 peak of 2.3 per 100,000, reported on December 11, 2021. Moreover, although hospitalization rates for older adults are currently declining (to 2.7 per 100,000 as of November 26), these rates are nevertheless high. than at about the same time last year.²

older children With RSV

The age of patients affected by this year’s RSV outbreak sets this season apart from past seasons.In the past, many young children came to the hospital, but this year child More than five people have been hospitalized, well above the number from the previous season. As of mid-November, the rate of hospitalization due to RSV among children aged 6 to 17 years was 0.3 per 100,000, compared with a peak of 0.3 per 100,000 on 11 December 2022 in early winter last year. It reached an early winter peak of 2.2. On November 26, 2023, the hospitalization rate for this age group fell to 0.5 per 100,000 he).²

Why are RSV hospitalization rates increasing among older children? Then there were mask mandates and other protective mitigation protocols. Among children who were infants during the pandemic, he was exposed to RSV less than normal. Now those children are older, exposed to RSV, and actually quite sick when they get RSV. ”

Similarly, in the early stages of the COVID-19 pandemic, older adults who were quarantined or frequently wore masks were generally not exposed to RSV. Now these older people, especially those with a compromised immune system, in later life he either faces a more severe infection with RSV or has inadequate biological defenses.

Post-pandemic timing of RSV outbreaks

Not only are more people affected by RSV than usual since the outbreak of the COVID-19 pandemic. The seasonal timing of RSV has also changed.³ RSV usually starts rising in September and peaks between December and February. But in the spring of 2021, on the contrary, he began to see an increase in RSV cases, peaking in July. The number of cases increased again this year from late spring to summer.

The reason for this changed timing is unknown. “It is theorized^Four Tina Q. Tan, M.D., Ph.D., professor of pediatrics and primary care physician for pediatric infectious diseases at Northwestern University Feinberg School of Medicine, said: “Because COVID-19 was such a prevalent virus, it may have limited the amount of RSV and influenza that were in circulation. And with the lifting of mask mandates and other protective protocols, more people are being exposed to many other individuals, allowing these viruses to infect and many of the diseases we are seeing. is causing the

Triple epidemic of RSV, COVID-19 and influenza this winter

“In addition to people who only have RSV, there are some parts of the United States where influenza is endemic at very high levels and they also have RSV. In some parts of the United States, the number of people hospitalized for COVID-related complications is starting to rise again, so the combination of all these viruses is actually increasing the number of people needing hospitalization. They are.”

The RSV, COVID-19, and influenza trifecta have raised concerns about the resulting strain on healthcare systems, including hospital bed overcrowding and clinician burnout. Dr. Carroll warns: However, if the flu follows past patterns, it is expected to peak in the coming months. This could keep the current surge in cases and crisis in children’s hospitals into the spring. This can lead to delayed care and increased staff burnout. Dr. Tan added that such strains could also affect her ICU as an adult.

Education of people at risk of RSV and their families may reduce the burden on health systems from rising RSV and prevent excessive deaths. Dr. Carroll advises: Children who appear to have trouble breathing, have noisy breathing or exhaling moans, or who are unusually sleepy and difficult to wake should be evaluated by a clinician. Infants should be advised to keep them away from sick people. Dr Tan suggested that people heading to indoor gatherings or coming in contact with large groups of people should be advised to wear a face mask.

Dr. Carroll and Dr. Tang emphasized the importance of clinicians encouraging patients to receive influenza vaccinations and COVID-19 boosters. The more people who are vaccinated, the less likely those at risk will be exposed to those viruses. Doctors and nurses should also recommend vaccination against other vaccine-preventable diseases that tend to be epidemic in winter, such as pneumococcal pneumonia and whooping cough.

Such patient education and vaccination efforts are essential to avoid the kind of overload that the healthcare system has faced over the past few years, Dr Tan said. “Yes, there are contingency planning efforts hospitals are working on to really maximize the number of beds they can deploy to provide care. What we saw in the first wave of the pandemic that became – that’s what we’re trying to prevent.”

Disclosure: Dr. Tan is a member of Merck, Sanofi Pasteur, GSK and Pfizer/Weiss Vaccine Advisory Boards..

References

1. Centers for Disease Control and Prevention/National Respiratory and Enteric Virus Surveillance System. national trend. Updated December 7, 2022. Accessed December 8, 2022.
2. Centers for Disease Control and Prevention. RSV Interactive Dashboard. Updated 30 November 2022. Accessed December 8, 2022.
3. RSV Research and Surveillance | CDC. Published November 4, 2022. Accessed 7 November 2022. https://www.cdc.gov/rsv/research/index.html
4. Olsen SJ. Changes in influenza and other respiratory virus activity during the COVID-19 pandemic — United States, 2020-2021. MMWR Morb Mortal Wkly Rep2021;70.doi:10.15585/mmwr.mm7029a1

This article originally appeared on Respiratory Advisor