COVID-19, RSV flu and other viruses are prevalent right now and pediatric hospitalizations for respiratory illnesses are on the rise. What can families do to prevent and prepare for these viruses? In this Q&A, we asked our experts Rebecca Bell, MD, a pediatric critical care physician at The University of Vermont Children's Hospital, and president of the Vermont Chapter of the American Academy of Pediatrics, and Tim Lahey, MD, MMSc, an infectious disease expert at UVM Medical Center.
Which illnesses do I need to look out for, especially with kids?
Dr. Bell: Respiratory illnesses are very common in children. I work in the pediatric intensive care unit (PICU) at UVM Children’s Hospital and we serve children in Vermont and northern New York. Each year we have more than 300 admissions to our PICU for children needing intensive care and about three times that number to our pediatric hospital floor. The most common reason for a child to be admitted to the hospital is for respiratory issues, most often caused by common viruses like Respiratory Syncytial Virus (RSV).
During the pandemic we saw a drop in our overall PICU numbers because COVID-19 prevention measures – such as masking, staying home when sick and social distancing – really helped reduce the spread of respiratory illness in the community. Now that those prevention measures have relaxed, we're seeing respiratory illnesses rebound to pre-pandemic levels. The number of admissions for pediatric respiratory viral illness is higher than what is typical for fall months and at the level of what we see during peak winter months. Almost all of the cases are due to RSV and rhinovirus, another common virus.
This influx of respiratory viral admissions is not unsurprising given that many children are now being exposed to RSV for the first time. We have not seen an increase in the severity of disease compared to what we have seen in the past. But the number of cases has put a stress on pediatric hospital systems especially in southern New England.
What is RSV?
Dr. Bell: RSV is a common virus that leads to cold-like symptoms in most people. Generally, everyone is infected by the time they are two years of age and reinfections are common throughout childhood and adulthood. Some children can have severe RSV disease and develop lower airway infection that may require hospitalization. Those most at risk are infants under 6 months of age, especially those born prematurely or with underlying lung disease.
How do I know if my child has RSV? Should I get my child tested?
Dr. Bell: No. There is no special treatment for RSV so there is no need to get your child tested. The management of viral respiratory illnesses in kids is the same regardless of the virus that causes it. We base our treatment on symptoms.
Call your child's doctor or seek care if your child is not feeding well and not making wet diapers, or if they are breathing hard and using neck and chest muscles to breathe. The vast majority of children, even young infants, can be managed at home and do not require hospitalization.
RSV and rhinovirus can also lead to asthma exacerbations in toddlers and school-aged children. If your child has ever been diagnosed with asthma, now is the time to talk with their doctor about what asthma medications they should be taking to keep them healthy this fall and winter.
How can I protect my child against respiratory viruses?
Dr. Bell: First and foremost, we should take the lessons we learned during the pandemic and remain vigilant about any symptoms of illness. If you’re sick, stay home. Even if you test negative for COVID-19, you could still be carrying a contagious virus that puts people at risk.
Frequent hand-washing is key to preventing spread of viruses like RSV. Transmission can occur through contact with surfaces or droplets. In addition to hand-washing, wearing a mask can reduce contact with droplets and minimize touching the mouth and nose after contact with the virus.
For parents of young infants, limiting contact with visitors during this time is recommended. Those with symptoms should be discouraged from touching or kissing the infant’s face or hands.
There is no vaccine at the moment for RSV, but we do have effective vaccines for other respiratory illnesses, and we recommend making sure all are up-to-date on immunizations. Children 6 months and older should receive their primary COVID-19 vaccine series if they haven’t already, and the updated COVID-19 bivalent booster is recommended for everyone 5 years old and older.
We are starting to see influenza cases and are worried about the upcoming influenza season. We are urging everyone 6 months and older to get the influenza vaccine now if they have not yet received it. Children can get their influenza vaccine at their doctor's office, pharmacies or through state walk-in clinics.
Can my child go to school if they’re sick but test negative for COVID-19?
Dr. Bell: Children and adults should stay home from work, school or childcare if they are feeling sick, regardless of the cause. Transmission to others is higher early on in the course of illness so staying home in the first few days will help limit spread. In many cases, a cough can linger past the point of being infectious. Frequent handwashing and mask-wearing can also help reduce transmission.
COVID Vaccines and Boosters
What is the difference between the original COVID-19 vaccines and the new bivalent COVID-19 vaccines?
Dr. Lahey: The new bivalent booster vaccines stimulate immune responses to more recent variants of the virus that causes COVID-19, as well as its original version. This helps the vaccines teach your immune system to recognize lots of different versions of COVID-19, in hopes that enhances protection from infection and severe disease.
If I received the original COVID-19 vaccine recently, am I still protected?
Dr. Lahey: Protection from infection is at its greatest for the first few months after vaccination. Protection from severe disease – which matters most – lasts longer but can weaken over months too. If it's been more than three months since your last shot, then it's a good time to get the bivalent booster shot, especially if you are over 60 years old or otherwise at risk of severe COVID-19.
If I had COVID-19 recently, how long do I need to wait to receive a COVID-19 vaccine?
Dr. Lahey: Infection (proven by a positive antigen or PCR test) boosts immune protection much like vaccination, and like vaccination that protection can wane with time. Some less-reputable websites say prior infection makes vaccination unnecessary – this is a dangerous myth. People should wait at least three months after infection before getting boosted, and especially people over 60 years old or otherwise at high risk of severe COVID-19 should get a booster even if they have been previously infected.
Can I get a COVID-19 vaccine and the flu vaccine at the same time?
Dr. Lahey: Yes, and since it's now COVID and flu season, it’s important to get vaccinated now. It’s common, safe and convenient for more than one vaccine to be administered together.
How important is it to keep up with your boosters?
Dr. Lahey: If you haven't had the newer bivalent booster, and it's been longer than three months since you've been vaccinated or infected, get the bivalent booster. We know the new bivalent booster shots increase antibody responses in humans, and we anticipate they will – like prior booster shots – lower the risk of hospitalization and death in people who are at high risk of severe COVID-19.
If I had COVID-19, do I still need to be vaccinated? Or am I protected?
Dr. Lahey: Don't believe the myth that COVID-19 infection means you don't need to get a vaccine. It’s true that if you get COVID-19, it does boost your immune response to the virus for a period of time, just like getting a vaccine. However, we know that people who have been vaccinated have much better protection from hospitalization and death than unvaccinated people who were infected.
I'm hoping that over time, we're going to get to this place where we've been exposed enough and boosted enough so that the frequency of boosting goes down, maybe eventually goes away. But for right now, the best thing that we know to do is to get boosted against the most recent variant or circulating virus.
What if I’ve never been vaccinated for COVID-19. Should I be concerned?
Dr. Lahey: There's definitely a group of people who, for various reasons, haven’t felt comfortable getting vaccinated against COVID-19 yet. I care about those patients, like all patients, and I want them to be well. That may be a done deal for them, in which case it makes sense to provide other forms of good medical care without judgment. Alternatively, if those individuals feel reassured that COVID-19 vaccines have saved millions of lives with a fantastic safety record, and now they’re interested in accessing those benefits, this could be a good time to revisit. What I hope for is high-quality, supportive, non-judgmental conversations about trustworthy science with clinicians they trust.
Beyond vaccine hesitancy, another (potentially bigger) challenge is complacency. Some are tired of hearing about the pandemic and say, ‘Ah, heck, this is boring! The death count is dropping so I don't have to worry about this.’ I see it differently. I see it like driving a car. I don't get in a car each time and say, ’Oh no, there’s huge risk! Will I be okay?’ Instead, I know the risk is small, but real, so I strap on my seatbelt and drive away. Vaccines are the same. They make the small-but-real risk of life-threatening disease smaller, and smaller risk of death sounds great to me!