Your questions answered about what RSV is, how it spreads, what vaccines are on the way and who is most at risk
As flu season picks up and experts weigh concerns about another possible COVID surge, children’s hospitals are already filling with patients with another viral threat: respiratory syncytial virus, or RSV. Even though many people haven’t heard of RSV, pretty much everyone has had it, probably multiple times, says Anthony Flores, chief of pediatric infectious diseases at the University of Texas Health Science Center at Houston and a physician at Children’s Memorial Hermann Hospital.
The good news is that RSV vaccines are on the way. In fact, Pfizer just announced this week that its maternal RSV vaccine—given during pregnancy so that antibodies are transferred through the placenta to the fetus—was 82 percent effective at preventing severe RSV in babies through three months old. But until the U.S. Food and Drug Administration approves a vaccine, RSV will be one of the unavoidable viruses people encounter each year.
But infants under six months old, and especially those under two months old, have a harder time with RSV. “That’s where we see our highest hospitalization rates [in children]—maybe three or four times higher in that age group than in others,” Flores says. The reason is basic physics. “It has everything to do with the size of their airways,” he says. Their airways simply aren’t wide enough yet to allow airflow with all the inflammation caused by the immune system’s response to the virus.
Another population at higher risk for complications from RSV are people who are immunocompromised, whether because they have an underlying condition that weakens their immune system or because they take a medication that suppresses it. Those who have had organ transplants, for example, take medications that dampen their body’s immune response to avoid rejection of the new organ. And many of the drugs used to treat autoimmune conditions also weaken the immune system.
On one hand, current pediatric hospitalizations aren’t much higher at Flores’s hospital and many other hospitals than they would be during a typical RSV peak in midwinter. But the problem is that it’s not midwinter yet. With flu cases rising, pediatricians and public health experts are asking themselves the same question: “Are we going to see another surge with COVID later this year and then see a ‘tripledemic’?” Flores says. “That’s the big worry.
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