What accounts for the increase?

We've learned sort of non-pharmaceutical interventions like social distancing, handwashing mask wearing have decreased the transmission of these viruses.

And now we're more involved in small groups and people getting together. Children are back at school, and these are the ideal conditions for these respiratory viruses to be transmitted from one individual to the next.

Many hospitals are being hit by the so-called "tri-demic": flu, RSV, even COVID. Is that the case with children's health?

It is. At least as far as the flu and RSV, we may be on sort of the back end of the peak.

We had a lot of activity with both of those viruses over the last 6 to 8 weeks or so. And the trends look like we're coming out of this. So, the numbers, when we look at percent-positive tests, are lower over the last several weeks than they have been in the past.

Meaning what?

This could be the virus running its course. More people getting immunized, more people getting infected. And after getting infected, they do have some immunity. There are all kinds of combinations. And of course, understanding that there's the "tri-demic" out there, people are maybe changing their behaviors somewhat.

Symptoms for these viruses can overlap. How do you know in the beginning, for instance, that you have flu as opposed to RSV?

At least in young children, particularly in infants, for RSV, the child or the infant starts with a cough that tends to get worse over several days, maybe low-grade fevers, a lot of congestion, and nasal discharge. Babies start to have difficulty feeding because they're spending a lot of time breathing. So typically when we see a child with RSV, they've been sick for a number of days if not longer.

Typically with flu, the onset of symptoms is quite rapid - maybe 12 hours, 24 hours or so - where somebody goes from feeling quite well to feeling quite sick. Of course, with influenza, there's always the risk of respiratory symptoms as well, but the cadence of the diseases is quite different. 

At what point do you seek medical attention?

So certainly any time your child's having difficulty breathing, you have to bring them to the hospital for RSV because the disease takes a couple of days before it really reaches high intensity in some children.

Contact the pediatrician if your child, particularly a young infant, is having a lot of coughs and you're finding that your child is having more and more difficulties with breathing, sometimes the infants who are infected with RSV don't feed as well. What the parents may recognize is not only the child, the infant is not feeling well, but they're producing fewer wet diapers, suggesting that there may be a dehydration component to this as well.

So, it's in the early stages of the disease that we encourage parents to reach out to the child's primary care provider and let them know what's going on. 

If you get either one, how do you treat it?

We really don't have any effective therapies for RSV, which is quite remarkable in that this virus was discovered in 1956. We don't have outpatient therapies and we don't even have a vaccine for RSV. It's mostly supportive care.

For the flu, we do have antivirals and, of course, we have a vaccine. There have been some difficulties getting one of the antivirals, Tamiflu, but we have other antivirals that are available, particularly for older children and adults.

There may be some limitations, although I haven't heard about that. 


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