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Dr. Stanley Martin, Geisinger’s director of infectious diseases, poses for a photo at Geisinger Medical Center.

LEWISTOWN — Excuses, excuses, excuses. It seems there’s no shortage of reasons people offer to avoid getting an annual flu shot.

Dr. Stanley Martin, Geisinger’s director of Infectious Diseases understands that there are myths out there about flu shots – and that many people naturally worry about vaccines.

Martin has heard most of the excuses a thousand times. He understands that there are myths out there about the shot and wants to separate fact from fiction.

Are there side effects from flu vaccinations?

Possibly, but there are potential side effects with any medication. Getting a flu shot in the arm commonly causes aches and soreness. Sometimes people get a low-grade fever or feel tired and run down. These are side effects that only last a day or so.

Can the flu spread from one person to another?

Yes, absolutely, Martin said. In fact, it’s how most people get the flu. It starts as a respiratory virus with coughing, sneezing and difficulty breathing. Typically, the person infected with the flu has spread it to the next person before they even show any signs of sickness. People can try to be diligent about not spreading the flu, but they can do it without even knowing it early on.

What’s the difference between a cold and the flu?

Martin said influenza, or flu, and the common cold are both contagious respiratory illnesses, but they are caused by different viruses. Flu is caused by influenza viruses only, whereas the common cold can be caused by a number of different viruses, including rhinoviruses and parainfluenza.

Because the flu and common cold have similar symptoms, it can be difficult to tell them apart based on symptoms alone. Generally, the flu is worse than the common cold, and symptoms typically are more intense and begin more abruptly. Colds are usually milder than the flu. People with colds are more likely to have a runny or stuffy nose than people who have the flu.

If you have been vaccinated against COVID, does that help fight against the flu?

Probably not. Martin said vaccines are pretty specific, such as the ones that battle COVID, so they don’t fend off other illnesses like the flu. There are vaccines in the works against co-infections. They would be more likely to fight off COVID and the flu. Martin cautioned if you really want to prevent yourself from getting the flu: Get a flu shot. The shots to measles, mumps and rubella have been combined in the “MMR” shot. He added it’s also “perfectly safe” to get the flu shot and COVID vaccine or booster at the same time.

If you have not gotten a flu shot yet this year, is it too late?

Absolutely not, Martin said. Despite being past its peak, flu cases will continue to pop up over the next few months. The flu is especially problematic for the elderly (age 65 and over), children ages 5 and under) and pregnant women. Those groups are much more likely to be affected by influenza if they have not been vaccinated.

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As temperatures fall in winter and people gather indoors more frequently, respiratory illnesses rise, including COVID, Respiratory Syncytial Virus (RSV), Influenza (flu), rhinovirus (common cold), and various other respiratory viruses. Many respiratory symptoms overlap, making it difficult to know whether to carry on as usual, stay home, or seek medical attention.

Malaika Stoll

Dr. Malaika Stoll

Dr. Malaika Stoll, senior medical director at Blue Shield of California advises, “Pay attention to symptoms. You might not know the cause, but serious symptoms such as difficulty breathing, or prolonged high fever – in adults 101.4 F - require an assessment from a medical professional.”

Dr. Stoll shares five tips to help you address respiratory symptoms this season.

  1. Prevention! Protect yourself and others

    • Get vaccinated for COVID, booster, and yearly flu.
    • Wear a mask, isolate when sick, and engage in frequent hand washing.

  2. Treat mild symptoms

    • Self-care, including over-the-counter medications, can be applied for mild symptoms, such as a stuffy nose or mild cough.

  3. Test at home

    • If you are experiencing respiratory systems, take a COVID-19 test at home. Even if you are unsure whether you have been exposed, positive or negative test results can help your doctor diagnose and treat you.

  4. Schedule a Virtual Care Visit

    • Virtual care visits are conducted via phone and or video call with healthcare providers. Consider a virtual care visit with your provider or if your plan allows, a Teladoc visit to explain your symptoms and to get medical guidance. There are tests and treatments available for many of the viruses discussed. They are a great way to get medical advice while staying safe at home.

  5. Seek immediate care

    • If you have difficulty breathing, dehydration, or persistently high fever, seek immediate care, possibly from an emergency or urgent care facility.

Get more tips from Dr. Stoll on staying healthy this season

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Dear Dr. Wong: Our daughter is 15 months old. In the last few months, she has been sick a lot after she started going to daycare. Every time, she started with a cold, and this invariably progressed into a bad cough that lasted for weeks. She would finally get better, and then pick up another cold and get sick again. 

The last time she coughed so much that she vomited up mucus and became lethargic. I was thinking about taking her to emergency room. Fortunately, I was able to reach a nurse practitioner who suggested that she might be somewhat dehydrated from vomiting and advised me to nurse her for longer periods of time. After a few hours of nursing, she perked up and gradually recovered. 

I grew up with pretty severe asthma, and her cough reminded me of my cough when I was young. I am much better now, although I still have exercise-induced asthma, and I use an inhaler from time to time. How can I tell whether my daughter has asthma or not?

Answer: I am very glad that your daughter improved after she got more breastmilk from you. When she was sick and coughing, she was breathing faster, coughing and vomiting up mucus. All of these can contribute to dehydration that made her lethargic. You did get good suggestion from the nurse practitioner.

Because of the COVID-19 pandemic, many children stayed home and had few contacts with other children. Once the pandemic rules were relaxed, children started going to school and daycare. Respiratory viruses naturally circulate among children who have little exposure and immunity to common respiratory viruses, including rhinoviruses that cause common cold, influenza viruses and respiratory syncytial virus (RSV), not to mention the COVID-19 virus and others.

When your daughter was exposed to any of these viruses, she would develop cold-like symptoms with stuffy and running nose, sore throat, fever and cough. Most children are sick for a few days with each cold, their cough is usually not too severe. Some may develop complications like ear infections, sinus infections or pneumonia.

It is not easy to tell if a young child has asthma. As you may already know, asthma is a genetic condition; usually one or both parents have a history of asthma. Adults can take a lung function test; those with asthma have narrowing of their bronchial tubes. These bronchial tubes can relax after taking a bronchodilator inhaler. However, it is very difficult to do this test in young children. A few centres can perform a modified lung function test in young children for research purposes only.

Some of the symptoms of asthma in young children include a prolonged and severe cough when they get colds. Very often, their cold symptoms can last for weeks, and they can cough and vomit up mucus. Sometimes parents can hear a wheezy noise when they breathe. If it is severe, these children can breathe very rapidly, and parents may see their chest sucking in between the ribs or under the ribcage. These are all signs of respiratory distress.

Not infrequently, doctors cannot tell whether a child has asthma or not when they are young. Listening to the chest with a stethoscope may not tell anything. Sometimes physicians have to rely on the patterns of cough when they are sick, as well as how frequent and how long each of these episodes lasted. They may prescribe a course of inhaled bronchodilator and steroid to see how the child responds.

Since you have a history of asthma, it is possible for your daughter to develop asthma. You may want to eliminate some common indoor triggers, like dust mites, moulds and certain household pets. You can also watch whether she starts to cough when she runs, even when healthy. Asthma symptoms are also more common in spring and fall.

In the meantime, if she has not received influenza or COVID-19 vaccines as yet, you should consider immunizing her against these viruses. Both of them can get her quite sick, whether she has asthma or not.

Dr. David Wong is a retired pediatrician in Summerside and recipient of 2012 Distinguished Community Paediatrician Award of Canadian Paediatric Society. His columns are in The Guardian on the last Tuesday of every month. You can see a collection of his previous columns at If you have a question for Dr. Wong, please mail it to Prince County Hospital, 65 Roy Boates Ave., Summerside, P.E.I., C1N 2A9.

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There are three viruses that are bringing children and adults to Italian emergency rooms this winter: they are those ofinfluenzaof Covid-19 he was born in RSV. Not only is the coronavirus making a comeback thanks to its new variants, the Australian flu and the respiratory syncytial virus are also making converts. The pandemic has meant that there are fewer influenza viruses and other pathogens that affect the respiratory system. The result is that for two years we “only” had to deal with the Covid-19: our immunity to these viruses may have declined and many babies born during the pandemic have never had any immunity, especially if they have not been vaccinated. The consequence is that a more people are vulnerable to common winter virusesespecially now that the obligation to wear masks no longer exists and that travel is allowed almost everywhere in the world.

flu symptoms

Many gods symptoms caused by flu, covid and RSV they overlap and can even look similar to those of the common cold, which is caused by a variety of viruses. You may develop a cough, fever, headache, or runny or stuffy nose with any respiratory viruses. What makes the difference is how quickly the symptoms get worse or worse. Flu symptoms come on rapidly, often within a day of contact with a sick person, and can be felt throughout the body with bone pain and muscle weakness. People with the flu often describe feeling like they’ve been hit by a truck. With a cold, symptoms can appear in two or three days and are much milder.

symptoms of covid and rsv

Covid and RSV have even longer incubation periods. It can take an average of five days from exposure to the coronavirus for the first symptoms of Covid-19 to develop, although newer variants can result in an active infection as early as three days after exposure. RSV lasts four to six days. With Covid and RSV, symptoms also develop slowly and at different times: for example with the initial loss of taste and smell, then with a slight headache and on the third day with fever. Another factor that makes the difference is the body temperature: with theflu fever rises rapidly and remains high (even over 39°) for 4-5 consecutive days, while in the case of the latest covid and RSV variants it remains around 37°-38°. People with respiratory syncytial virus are less likely to experience the full-body fatigue and body aches that result from the flu or COVID-19. On the other hand, they can develop a very heavy and strong cough, with a high production of mucus in the upper respiratory tract. In general, RSV leads to shortness of breath and a characteristic wheezing, especially in children. The important thing, for all 3 viruses, is to contact your doctor or emergency room for the most serious cases, and keep the mask on to avoid contagion.

tests and swabs

The only way to tell if your symptoms match flu, covid or RSV is through a test. If a swab can be carried out at home or in a pharmacy for Covid, a laboratory test is necessary for influenza and RSV, which takes two or three days. In fact, the usefulness of a test in this case is superfluous: the management of symptoms for both viruses is almost identical and, unlike Covid-19, self-monitoring is not mandatory. Rather, the vaccine is recommended, both for Covid and for the flu, which acts as a preventive measure.

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Nicole White plays an exhausting "what if" game before her family ventures into public, running through scenarios that could be risky for her daughter, who is immunocompromised. 

Addison, who has underlying health issues stemming from a brain injury she experienced in utero, is at a higher risk for severe illness from COVID-19 and other viruses. Since Addison also uses a ventilator to help her breathe, she can't wear a mask for added protection, White said.

Even in the absence of a pandemic, an infection could take a serious toll on Addison, but this winter's uptick in the number of COVID, flu and respiratory syncytial viruses, or the "tripledemic," has put families of children with chronic health conditions or compromised immunity on higher alert. Parents remain vigilant, constantly assessing the risk of exposure when even the sniffles could potentially land their children in the hospital, while also struggling to provide a sense of "normalcy"  when vaccines are readily available and mask mandates are removed, families told Newsday.

“It’s so hard to always make those decisions,” said White, 38, of West Islip. “We’re always assessing. It’s like risk management. … It’s always that checklist in your brain.” 


  • The "tripledemic" has created an additional layer of fear for parents whose children have chronic conditions that make them vulnerable to respiratory illnesses. 
  • Parents said they are constantly struggling to keep their children safe while also attempting to provide a sense of normalcy. 
  • Even pre-pandemic, an infection could take a serious toll on immunocompromised children but the triple threat of RSV, flu and coronavirus poses a heightened risk.

Nicole White and husband Ryan with their 18-month-old daughter, Addison, whose underlying...

Nicole White and husband Ryan with their 18-month-old daughter, Addison, whose underlying health issues put her at an increased risk for getting very sick from COVID or other viruses.
Credit: Newsday/Steve Pfost

'Medically complex' kids most at risk

Even the common cold poses a risk for 22-month-old Addison. 

A cold she caught in October led to pneumonia and fluid around her lungs. She was hospitalized three times. When her brothers caught the flu, White sent her sons to a grandparent’s house to keep Addison safe. When White's husband and sons became ill with COVID, she and Addison temporarily moved out of their home. 

Such are the extreme measures the Whites take to protect Addison, who has cerebral palsy, which makes her vulnerable to respiratory complications.

“Any sort of virus hits her very hard on her respiratory system,” said White, adding that Addison lives on a separate floor of their home to reduce exposure to germs. “You do fear that if she gets something like that, it means an extended hospital stay. It means scary moments. It means her stopping breathing.”

The children most at risk from the “tripledemic” are those who are “medically complex," said Dr. Joan DeCelie-Germana, medical director of the Pediatric Cystic Fibrosis Center at Cohen Children’s Medical Center. The coronavirus is inflammatory and can produce mucus, and can worsen lung function. She said staff has reviewed safety protocols with families in an effort to minimize the likelihood of getting sick this winter.

“Keeping them well and trying to help them avoid getting sick because of no longer [having a] mask mandate is very challenging,” the doctor said. “We have to sometimes pull kids out of school so that they don’t keep getting sick."

RSV, flu and coronavirus cases have been trending downward in New York over the past few weeks, but state health officials continue to emphasize the importance of taking precautions against the illnesses, including getting vaccinated and wearing a mask, especially those with underlying health conditions. Doctors also recommend that immunocompromised children wear masks to school and use hand sanitizer, among other measures. 

Typically, RSV peaks first and is followed by the flu, but the illnesses overlapped this winter, said Dr. Sharon Nachman, the pediatric infectious disease division chief at Stony Brook University Hospital. She said her patients' parents run the gamut in terms of taking precautions, from opting to "cocoon" their children to encouraging their inner circle to get vaccinated. 

Any respiratory illness poses a major risk to Alfonso, known as Allie,...

Any respiratory illness poses a major risk to Alfonso, known as Allie, said his mother Erin Fiero. Next to Allie is his sister, Genevieve, or Gennie, at their Garden City home.
Credit: Howard Schnapp

'I’m trying to be calm'

Safeguarding their son's health is the primary concern for the Fieros of Garden City. 

Alfonso, known as Allie, had two surgeries and multiple ICU stays to treat and repair his trachea, said his mother, Erin Fiero. Even pre-pandemic, any respiratory virus posed a major risk to Allie, now 10. 

“Every normal respiratory illness that he got had the potential to send him to the ICU, and the majority of them did,” Fiero said. “It could’ve been anything, it could’ve been the sniffles.” 

The family was under lockdown during the initial waves of the pandemic. The perpetual need to stay on guard is exhausting, Fiero said. The isolation affected the family's mental health, but the family slowly began reintroducing in-person activities to their routine after they were vaccinated. The family is somewhat back to "normal," Fiero said, but she remains cautious.

“I can’t lose that vigilance,” Fiero said. “When I hear a cough or I see a runny nose, I’m trying to be calm, but a lot of times what I see is a potential two-week hospital stay praying by the bedside of my child.” 

Finding that balance

For parents trying to strike a balance between keeping their kids safe and providing a sense of normalcy, there is no one-size-fits-all approach, doctors told Newsday. 

"I think there are some parents who are very overly protective, but I think the pandemic has also taught them ... to find that balance of allowing their children to socialize and yet not throwing caution into the wind," said Dr. Maria T. Santiago, the chief of pediatric pulmonary at Cohen. 

Verlin Obilet Ramos said her family still isolates to protect her daughter Samantha,...

Verlin Obilet Ramos said her family still isolates to protect her daughter Samantha, 2.
Credit: Debbie Egan-Chin

Verlin Obilet Ramos, 37, said her family still sometimes wears masks and isolates to protect her daughter Samantha, 2, who required open heart surgery as an infant. In November, Samantha caught RSV, an easily transmissible upper respiratory infection, and was very sick, her mother said. 

“Every time she has a cold or some type of illness, we get scared,” said Obilet Ramos, of Inwood. “The risk is always there.” 

Despite that, Obilet Ramos said she has tried to give her daughter a normal life fearing that isolation could affect her. Samantha recently started going to a babysitter while her mother works. 

The pandemic, and now the triple threat of viruses, also has disrupted the lives of older children.

Agranil Das, 17, has Duchenne muscular dystrophy, which poses a risk to his heart and lungs. After remote learning for two years, he now attends school in person, but still wears a mask. 

The Selden teen's family tries to mitigate any potential threats. His father quit his job during the early waves of the pandemic to keep him safe, said Agranil's sister, Mrinaleni Das.

The family still takes precautions, she said, including changing their clothes and showering after coming home. “It’s just part of our daily life. It’s what we do and what we’ve been doing for three years.” 

Kimberly Booker's daughter, Zandra, who has a compromised immune system,...

Kimberly Booker's daughter, Zandra, who has a compromised immune system, has barely gone to school in person since the pandemic and learns virtually, Booker said.
Credit: Newsday/Steve Pfost

Kimberly Booker's daughter, Zandra, 14, has barely gone to school in person since the pandemic and learns virtually. She is cleared by her medical team to return to school in the spring, her mother said.

Zandra had a heart transplant as an infant, and her condition left her with a compromised immune system, including asthma, Booker, 34, of Coram, said. 

Respiratory illnesses make it difficult for the teen to breathe when sick. Booker, a nurse, sent her daughter to live with her grandmother during the first five weeks of the pandemic to avoid potential exposures. The separation was "devastating," she said.

The isolation also has worsened the teen's anxiety, Booker said, adding that the hyper-awareness of the virus has been "extremely overwhelming" for her, too. 

“It’s absolutely exhausting. It really is, truly,” Booker said of her constant vigilance. 

With Darwin Yanes 

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We have viruses all year round, Viruses don’t only appear in winter, what happens is that in winter there is a series of conditions that favor the appearance and transmission Viruses that cause respiratory infections.

Why do viruses appear in winter?

The first condition is that we spend more time inside because of the cold. insidewe gather more people and We ventilate the rooms less, This increases the chances of exposure to respiratory viruses.

unfortunately we didn’t notice measure as basic as ventilation Until the arrival of SARS-CoV-2, the virus that causes the coronavirus.

Our mothers and grandmothers have always told us “wrap up you are going to get cold”. Cold doesn’t really affect us by itself and neither is it the cause of the virus, What creates a cold is a series of circumstances that increase the transmission of viruses in winter.

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Published January 27, 2023

Stress refers to the body’s reaction to harmful situations, which can either be real or perceived. When you feel like you’re in a dangerous situation, a chemical reaction occurs in your body, allowing you to counteract the threat. This reaction is known as “fight-or-flight”, or an “adrenaline rush”. It is also called a stress response, during which your heart rate increases, breathing quickens, blood pressure rises, and muscles tighten. 

Different Ways Stress Can Affect Your Body


The word stress has a different meaning to different people. What may be a cause of stress to one person isn’t necessarily a concern for someone else. Some people are able to manage stress really well, while others aren’t. Our bodies are actually quite capable of handling it. Oftentimes, stress can make you productive and motivate you to accomplish your aims and goals. But, if it lasts for a long time, stress can be classified as chronic, having negative effects on your body. Symptoms of chronic stress include:


  •     Insomnia
  •     Headaches
  •     Irritability
  •     Depression
  •     Anxiety


If you are in a stressful situation and feel ill, visit the   Best General Physician in Lahore   as soon as you can. Here are 6 ways stress can wreak havoc on your body:


  1. Central Nervous and Endocrine Systems

The central nervous system (CNS) is responsible for releasing the stress hormones in threatening situations. These hormones raise your heartbeat and send blood to areas that need it most, such as your heart. When the threat is gone, the brain should signal the systems to go back to normal. But if this doesn’t happen, the response continues. This can cause the following problems:


  •     Drug or alcohol abuse
  •     Overeating, or not eating enough
  •     Social withdrawal


  1. Digestive System

If you’re under stress, your liver can produce extra blood sugar to boost your energy. In case of chronic stress, your body may not be able to keep up with all the extra glucose surge. This can increase your risk of developing type 2 diabetes. Other digestive problems triggered by stress include:


  •     Heartburn or acid reflux, due to an increase in stomach acid
  •     Diarrhea and constipation because of an upset digestive system
  •     Nausea
  •     Stomach-ache
  •     Vomiting
  •     Higher risk of developing ulcers


In case of such problems, visit a   General Physician in Islamabad   to seek treatment as soon as possible.


  1. Respiratory and Cardiovascular Systems

Stress hormones can affect your respiratory and cardiovascular systems adversely. During a stress response, you begin to breathe faster, and if you have breathing problems such as asthma and emphysema, stress can make them worse. Here are some other problems chronic stress can induce:


  •     High blood pressure; this is due to the stress hormones causing blood vessels to constrict and divert more oxygen to your muscles
  •     Increased risk of having a stroke
  •     Higher chances of getting a heart attack


  1. Muscular System

During the stress response, your muscles tense up to protect themselves from injury. When you begin to relax, they release. But if you’re always under stress, your muscles might not be able to relax. This can cause a number of problems:


  •     Back pain
  •     Shoulder pain
  •     Headache
  •     Body ache


One way to counter these problems can be by eating healthy, exercising and taking pain medications as prescribed by your general physician.


  1. Immune System

Stress activates the immune system, which is an advantage in case of situations that need immediate tending. This simulation can help in healing wounds and avoiding infections. But if you’re constantly stressed, your immune system can weaken over time. This can cause the following problems:


  •     Reduce your body’s response to foreign bodies and invaders
  •     Viral illnesses and infections like flu and the common cold
  •     Increased time to recover from injuries


  1. Reproductive System

Stress can impact both the body and the mind. It can also affect your sexual desires. Research shows that short-term stress can cause men to produce more testosterone, which is a hormone. But this effect isn’t long lasting. Constant stress can drop testosterone levels, which can cause problems such as:


  •     Low sperm count
  •     Erectile dysfunction
  •     Impotence
  •     Higher risk of infections for reproductive organs such as the prostate and testes


For women, stress can cause issues with their menstrual cycle, leading to irregular, painful or heavier periods.

The post 6 Ways Stress Wreaks Havoc on Your Body appeared first on Market O Graphics.

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There’s a respiratory virus making headlines this year that you’ve likely already had at some point in life. Nonetheless, it’s posing a threat to seniors. Respiratory syncytial virus, known as RSV, resembles the common cold. While most healthy adults and children get better within a couple weeks, the virus, which infects the nose, throat, lungs, and breathing passages of the upper and lower respiratory system, is very dangerous for babies under 6 months and adults 65 and older. Each year in the United States, 60,000 to 120,000 adults over age 65 and 58,000 to 80,000 children under the age of five are hospitalized. Up to 10,000 adults over age 65 and some 100 to 300 children die from the infection.

“RSV has already peaked in the U.S. this season, but I do think that there will be multiple RSV vaccines available for older adults in time for next season,” notes Dr. Amesh Adalja, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security.

Here’s a look at what’s known about the new RSV vaccines for older adults, what’s not and what lies ahead for 2023 to protect against the massive harms the virus causes.

Which drug companies are close to making an approved RSV vaccine?

Right now, RSV vaccine trials from drugmakers are still underway, and once they conclude, they will each need to go through a regulatory review and approval process by the U.S. Food and Drug Administration (FDA).


On January 17, 2023, Moderna announced their RSV vaccine was 83.7% effective in preventing RSV with two or more symptoms, in people ages 60 and older, and it was 82.4% effective at preventing lower respiratory tract disease with three or more symptoms. No safety concerns were identified during the phase III clinical trial, which enrolled about 37,000 people across 22 countries. The company plans to publish their data in a peer-reviewed journal and file an application for FDA approval of their vaccine in the first half of 2023.


On December 7, 2022, Pfizer announced the FDA granted priority review to their RSV vaccine for older adults 60 years of age or older. On August 25, 2022, the company released data showing the vaccine was 66.7% effective in preventing lower respiratory tract illness in people 60 and over and 85.7% effective at preventing severe disease. Additionally, Pfizer said there were no safety concerns, and that the vaccine was “well tolerated” among participants in the phase III clinical trial. The FDA is currently reviewing the data in the Biologics License Application (known as the BLA), which is tens of thousands of pages long. They are said to decide on whether the vaccine is ready to be marketed by May 2023. If approved, Pfizer’s RSV vaccine will likely be available by fall 2023 to the public. Pfizer is also developing a RSV vaccine for pregnant women, who would be immunized to protect their newborns after delivery.

GlaxoSmithKline (GSK)

On October 13 2022, GSK reported their RSV vaccine was 94.1% effective against severe RSV in adults age 60 years and older with overall efficacy at 82.6%. The vaccine was well tolerated in phase III clinical trial participants with adverse effects typically mild-to-moderate. An FDA decision on that filing, made by GSK in late 2022, is also expected in May 2023.

How do the new RSV vaccines work?

Different types of vaccines work in different ways to offer protection, but none of the RSV vaccine candidates referenced above are “live vaccines.” 

“One of the 11 proteins the RSV virus uses to infect our healthy cells is called the F glycoprotein,” explains Rob Swanda, who holds his doctorate in biochemistry and is a mRNA biochemist. The mRNA RSV vaccine designed by Moderna “gives our cells the instruction (via mRNA) to make the F glycoprotein ourselves,” says Swanda. This, he says, allows our immune system to recognize that this F glycoprotein is not one of our own proteins, create an immune response against it, and then, keep memory of what that protein looks like.

“It’s like receiving a cooking recipe that can’t be stored or saved,” explains Swanda, who is known for his whiteboard videos explaining vaccine science. “You use your own ingredients to make the dish, then you know what the product tastes like, and if you came across that same dish in the future you would remember that you tried it before.”

Researchers have been studying and working with mRNA vaccines for decades — long before the pandemic and the experience in developing the COVID-19 mRNA vaccine played a major role in getting these RSV vaccines close to the finish line.

What are the side effects?

The majority of side effects associated in the RSV vaccine trials included those, according to Swanda, common with any injection:

  • Pain
  • Fatigue
  • Headaches
  • Muscle pain
  • Joint pain

Marty Davey, 64, a registered dietitian from Yonkers, New York, and her husband, Jim Fitzpatrick, 72, are currently participating in one of the RSV vaccine trials. “We each got an RSV vaccine about six months ago, and so far, so good,” she says.

The couple initially saw an ad on Facebook recruiting seniors in good health to be a part of the two-year drug trial, which is run in their area by Drug Trials America in Hartsdale, New York. “We get a notification every Monday to let the researchers know how we are feeling, if we can work, and if we can do daily living activities, and were given thermometers to record our temperature the first two weeks after receiving the vaccine,” she explains.

Since the RSV vaccine candidates are using the same technology as the mRNA COVID-19 vaccines, Swanda said your health care provider should have appropriate information regarding compatibility of the RSV vaccination and any other medications you may be taking.

“The benefit of the vaccines is in preventing severe diseases for RSV and not of use once someone is already experiencing the disease.”


Can getting the RSV vaccine eventually help older adults hospitalized with the virus?  

If you or a loved one is hospitalized with RSV, it’s natural to want a magic cure or any kind of relief to help. Unfortunately, it’s not that simple.

There is no medication to treat RSV currently. “The RSV vaccine is a preventative vaccine, not a therapeutic vaccine,” Dr. Adalja points out. In other words, getting it while you’re in the hospital with severe RSV isn’t going to do you any good in terms of treatment. “The benefit of the vaccines is in preventing severe diseases for RSV and not of use once someone is already experiencing the disease,” he explains.

While Davey and Fitzpatrick didn’t report any immediate side effects after receiving their RSV vaccine in the trial, they both came down with COVID-19 at the start of 2023. “You’re bound to come down to something when you’re coming in contact with 300-400 people every day,” says Davey, who takes public transportation to work.

RSV is a different virus than COVID-19, and it is currently unclear if people with long COVID, a chronic condition where people continue to experience symptoms such as fatigue, shortness of breath and brain fog after recovering from COVID-19, are more at risk for RSV compared to those who have fully recovered from COVID-19.

It’s possible respiratory viruses in general (i.e., RSV, COVID-19, flu) may be more prevalent in certain regions or there may be more susceptible people due to increased travel, changes in the viruses themselves or disruptions to the usual preventive measures that were in place during the pandemic.

How to reduce your own and an older loved one’s risk of RSV right now

RSV spreads much more through contaminated surfaces, which makes hand washing and cleaning surfaces more critical. Dr. Adalja also recommends older adults who are high-risk “be cautious in crowded, congregated areas and think about wearing masks in those situations.”

As we age, so too does our immune system. Older adults are more vulnerable to other vaccine-preventable diseases like flu, COVID-19, pneumonia and shingles.

“In my experience, professionally, there are an awful lot of folks who say, ‘I’ll get a pill for that.’ But there are preventative things you could be doing to get healthier and have a better quality of life,” notes Davey. “We all lived through a pandemic and know about long COVID. Once you go on a respirator, your lungs are forever changed. Period.” 

Talk with your own and your senior loved one’s health care provider about risks for diseases and an immunization schedule that is best for you both. 

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Ayurvedic remedies for common cold and cough in winter Pic Credit Freepik

Ayurvedic remedies for common cold and cough in winter. Pic Credit: Freepik

A common cold might not seem like much to you, but it can leave you feeling exhausted and low on energy. When combined with symptoms such as sneezing or coughing, it can significantly reduce your productivity and well-being.

When bacteria or viruses get behind the eardrums, they frequently cause painful ear infections. Sometimes, the symptoms of asthma can worsen due to a cold. Long-lasting common colds can also result in acute sinusitis, which can cause sinus swelling and irritation. Other potential side effects of the common cold include strep throat, pneumonia, and bronchitis.

According to a recent Instagram post by Dr. Nitika Kohli, the Ayurveda specialist offers a few potent Ayurvedic nuskhe to treat colds and coughs."Colds and coughs are common during winter. Our body always tries to adapt to changing seasons but when we are in the process sometimes, we get affected and get up catching a cold,'' she wrote.

Put these Ayurvedic remedies to use to combat coughs and colds during the winter

Sesame oil

A few drops of sesame oil can help the nasal passages stay lubricated naturally and can soothe discomfort and sneezing. Sesame oil has a warming impact on the body and lessens coughing, colds, and aches in the muscles.

Inhaling steam

The warmth and moisture in the steam soothe the nasal passages and provide headache relief. By breathing in warm water, you can create steam.


A ritual to clear the nasal passages, this ayurvedic approach aids in nasal cavity cleansing by lowering nasal inflammation. For nasal clearing, the term "jalneti" refers to pouring water into one nostril and removing it from the other.

Keep your hydration game strong by drinking flavoured drinks in addition to getting enough water. Ajwain, cumin, ginger, and cinnamon added to boiling water help support the digestive fire and circulation.

Yoga and pranayama can be useful in clearing nasal massages.

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Common cold may not seem like a great deal to you but it may leave you fatigued and with low energy. Add to it symptoms like sneezing or coughing, and it can really affect your productivity and sense of well-being. In many cases, common cold can cause painful ear infections when bacteria or virus enters the space behind the eardrums. A cold can also sometimes make asthma symptoms worse. Prolonged common cold can also cause acute sinusitis which can lead to swelling and inflammation in sinuses. Strep throat, pneumonia and bronchitis are other common cold complications that people must be aware of. There is an array of common cold viruses and the most common of them are rhinoviruses. Common cold virus enters your body through mouth, eyes or nose and one can spread it through droplets in the air. (Also read: 5 reasons you are catching cold frequently this winter)

"Cold and coughs are common during winter. Our body always tries to adapt to changing seasons but when we are in the process sometimes, we get affected and get up catching a cold," says Dr Nitika Kohli in her recent Instagram post. The Ayurveda expert also suggests some effective Ayurveda nuskhe to tackle cough and cold.

- Sesame oil: Drops of sesame oil will support natural lubrication of the nasal passages and can relieve irritation and sneezing. Sesame oil has a warming effect on the body and helps to reduce muscle pain, cough and cold.

- Steam inhalation: The combination of moisture and warmth soothes the nasal area and also helps in headaches. You can take steam by breathing in heated water.

- Jalneti ritual for clearing nostrils: By reducing inflammation in the nasal area, this ayurveda technique helps you to cleanse your nasal cavity. Jalneti means to pour water in one nostril and take it out from the other to clear the nasal passage.

- Keep your hydration game stronger: Apart from sufficient intake of water, one can also drink spiced waters. Water boiled with spices like ajwain, cumin, ginger and cinnamon will support digestive fire and circulation.

- Yoga and pranayama also help to clear nasal massages and can be effective.

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Underlying these phenomena is an inflammation of the airways, accompanied by a narrowing of the muscles of the bronchi and an increase in bronchial secretion, all of which impede the flow of air.

These processes are almost always triggered by exposure to triggering factors that, while in non-asthmatic subjects they are harmless, in asthmatic subjects they can cause various problems, such as pollen, food, a simple laugh, a deep breath or a short run.

Doctors distinguish between two types of asthma: intrinsic (or non-allergic) and extrinsic (or allergic) asthma

The former is not sustained by an allergic process, while the latter is.

Generally, non-allergic asthma appears in adulthood, while allergic asthma can begin at any time in life, although it often appears as early as childhood.

Since sensitisation to allergy-inducing substances (called allergens) increases as the child’s exposure increases, the peak incidence of allergic asthma usually occurs at school age.

How to know if you have asthma

Symptoms of asthma vary from person to person: some people have attacks infrequently, some have manifestations only at certain times, for example when in a dusty environment or in the middle of a lawn or when exercising, and some have discomfort constantly.

In any case, the signs and symptoms of an attack may include:

  • Shortness of breath;
  • Sense of chest tightness
  • chest pain
  • coughing or wheezing attacks
  • wheezing during exhalation
  • sleep disturbances caused by shortness of breath, coughing or wheezing

These attacks can be greatly aggravated by the presence of viruses, such as those that cause the common cold or flu, which is a common sign of asthma especially in children.

Signs that asthma is probably worsening are an increase in breathing difficulty and the appearance of the symptoms described, manifesting poor control of the disease, which is measured at home with a device that checks the functioning of the lungs (peak flow meter), and the need to use a fast-acting inhaler more often.

For these reasons, people prone to asthma attacks should always carry a spray with bronchodilator substances, which are capable of rapidly reducing bronchial spasm (so-called ‘life-saving’).

When asthma attacks occur

For some people, the signs and symptoms of asthma occur in certain situations:

  • when they do sport. In this case, we speak of exercise-induced asthma, which can worsen when the air is cold and dry;
  • when carrying out one’s profession. We speak, in fact, of occupational asthma, a condition that is triggered by irritants breathed in at work, such as chemical fumes, gases or dust;
  • in the case of exposure to allergenic substances. In this case we speak of allergic asthma, a type caused by airborne substances such as pollen, mould spores, dust mites or pet dander;
  • during the night. This situation is referred to as nocturnal asthma;
  • when taking acetylsalicylic acid drugs, antibiotics, anti-inflammatory drugs in general, anaesthetics. In this case, other symptoms such as runny nose, sneezing, sinus pressure and coughing are also present, and we speak of drug-induced asthma.

The different types of asthma

Based on symptoms, doctors classify asthma into:

-intermittent mild, in which symptoms are mild and appear less than twice a week. Nocturnal symptoms appear less than twice a month;

-persistent mild, with symptoms present three to six times a week and nocturnal symptoms present three to four times a month. Asthmatic attacks may affect normal activities;

-moderate persistent, with daily manifestations and nocturnal attacks five or more times a month. Symptoms may affect the person’s activities;

-severe persistent, with symptoms persisting both during the day and at night, such that the person is forced to limit their activities.

Severe asthma attacks can be life-threatening, which is why they must be addressed promptly.

Signs of an emergency include: rapid worsening of shortness of breath or wheezing; no improvement even after using a quick-relief inhaler; shortness of breath at rest.


Asthma, the risk factors

Certain risk factors are thought to increase the chances of developing asthma, including:

  • having a relative with asthma, such as a parent or sibling;
  • suffering from another allergic condition, such as atopic dermatitis (which is characterised by the presence of symptoms such as red, itchy skin) or hay fever (which causes runny nose, congestion and itchy eyes)
  • being overweight;
  • smoking;
  • being exposed to second-hand smoke, exhaust fumes or other types of pollution;
  • being exposed to occupational triggers, such as chemicals used in agriculture and by hairdressers.

Asthma, when to go to the doctor

People who have a frequent cough and/or wheeze lasting more than a few days or other signs or symptoms that can be attributed to asthma should consult their doctor as soon as possible, who may then decide to refer them to a pulmonary specialist.

It is important not to underestimate the situation and not to wait too long: if treatment of the disease is started early, the risk of long-term lung damage and worsening of the disease over time is significantly reduced.

Good long-term control of the disease helps you feel better day after day and can prevent a life-threatening asthma attack.

To monitor asthma after diagnosis, it is important to work with your doctor, also because the disease often changes over time and changes to the prescribed treatment may be necessary.

Do not take more medication than prescribed without first consulting your doctor, as overuse of asthma medication can cause side effects and worsen the situation.

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Lack of exercise is a well-known risk factor for conditions such as cardiovascular disease, diabetes and certain forms of cancer. But some research also suggests that physical inactivity should be considered a risk factor for respiratory infections caused by the common cold, influenza, pneumonia and COVID-19. 

Studies show that regular exercise, of moderate intensity, is associated with a decreased risk of respiratory infections. More severe outcomes with COVID-19 also have been linked to low physical activity.

The latest study, published Tuesday, found that children with higher levels of daily physical activity are less susceptible to upper respiratory tract infections, such as the common cold. For every 1,000 average daily steps taken, children experienced 4.1 fewer days of respiratory symptoms. Children who played sports for at least 3 hours each week also tended to have fewer respiratory infections.

The study, which involved 104 children ages 4-7, did not establish a direct cause-and-effect relationship because it was observational. But the researchers had a few theories for their findings. Higher levels of physical activity reduce levels of inflammatory cytokines, which are associated with chronic inflammation and disease. They also promote stronger immune system responses. 

Another possibility is that additional immunity comes from small extracellular vesicles – small, cell-derived particles – released by the muscles after exercise, the researchers said. 

Still, health officials emphasize that vaccination and other preventive measures, such as frequent hand-washing, wearing a mask in high-risk settings, drinking fluids and getting enough sleep, are the most effective ways to reduce the risk of respiratory infection.

Too much exercise may have the reverse impact on the immune system. Some studies have suggested that too much physical activity increases the risk of infection. In one study, exercise stress was linked to an increase in influenza severity and risk of death. 

Another study found that 90 minutes of high-intensity endurance exercise can make athletes more vulnerable to illness for up to 72 hours after their workouts. Some researchers theorize that during intense physical exercise, the body produces hormones that may temporarily lower immunity. Additional research found that intense exercise before or during a respiratory illness can worsen the infection. 

National exercises guidelines advise that adults get 150 minutes of moderate physical activity each week. Moderate activities include walking briskly, recreational bicycling, gardening and vigorous housecleaning. The American Lung Association says that aerobic and muscle-strengthening activities can strengthen the lungs and tone breathing muscles, such as the diaphragm.

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Higher levels of daily physical activity are associated with reduced susceptibility to upper respiratory tract infections such as the common cold, suggests a study of 104 Polish children published in Pediatric Research.

Wojciech Feleszko, Katarzyna Ostrzyżek-Przeździecka and colleagues measured the physical activity levels and symptoms of upper respiratory tract infections of children aged between four and seven years in the Warsaw city region between 2018 and 2019. Participants wore a pedometer armband 24 hours a day for 40 days to measure their activity levels and sleep duration. Parents reported their children's symptoms of upper respiratory tract infections -; such as coughing or sneezing -; using daily questionnaires for 60 days. Using a second questionnaire, parents reported on their children's vaccinations, participation in sport, whether they had siblings, and their exposure to smoking and pet hair.

The authors found that as the average daily number of steps taken by children throughout the study period increased by 1,000, the number of days that they experienced symptoms of upper respiratory tract infections decreased by an average of 4.1 days. Additionally, children participating in three or more hours of sport per week tended to experience fewer days with respiratory tract infection symptoms than those not regularly participating in sports.

Higher activity levels at the beginning of the study were associated with fewer days with respiratory tract infection symptoms during the following six weeks. Among 47 children whose average daily number of steps was 5,668 during the first two weeks of the study period, the combined number of days during the following six weeks that these children experienced upper respiratory tract infection symptoms was 947. However, among 47 children whose initial average daily steps numbered 9,368, the combined number of days during the following six weeks that these children experienced respiratory symptoms for was 724. The authors did not identify associations between upper respiratory tract infection symptoms and sleep duration, siblings, vaccinations, or exposure to pet hair or smoking.

The authors speculate that higher physical activity levels could help reduce infection risk in children by reducing levels of inflammatory cytokines -; which are associated with chronic inflammation and disease -; and by promoting immune responses involving T-helper cells. They also suggest that skeletal muscles could release small extracellular vesicles that modulate immune responses following exercise. However, they caution that future research is needed to investigate these potential mechanisms in children. They add that the observational nature of their study does not allow for conclusions about a causal relationship between physical activity levels and susceptibility to upper respiratory tract infections.


Journal reference:

Ostrzyżek-Przeździecka, K., et al. (2023) Association of low physical activity with higher respiratory tract infections frequency among pre-school children. Pediatric Research.

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COVID-19 and common cold are respiratory illnesses that may differ in their degree of severity, but are transmitted in the same way. Both viruses can spread from one person to another through respiratory droplets released when someone breathes, coughs, sneezes, talks or sings. However, both these illnesses are different.

According to the Mayo Clinic, COVID-19 symptoms usually start 2 to 14 days after exposure to SARS-CoV-2. But symptoms of a common cold usually appear 1 to 3 days after exposure to a cold-causing virus.

"Unlike COVID-19, a cold is usually harmless. Most people recover from a common cold in 3 to 10 days. But some colds may last as long as two or three weeks," the health body adds.

Also read: Coronavirus: COVID XBB.1.5 more 'cold-like'; how to know if you have COVID or common cold

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Climate change is perhaps the greatest threat humans face today, with far-reaching implications for food supply chains, migration patterns, shifting habitats, extreme weather events, and human health. The average global surface temperature in July 2022 was the sixth warmest for July since 1880 when record keeping began,1 and global temperatures are expected to continue rising over the next several decades.2 As of 2016, global atmospheric CO2 concentrations have permanently crossed above 400 ppm, an important threshold with implications for further rising global temperatures and other climate impacts. According to the World Health Organization, climate change has both direct and indirect effects on health and disproportionately impacts vulnerable groups like children, the elderly, racial and ethnic minority groups, low-income populations, and citizens of developing nations.3 Some of the many climate-sensitive health risks include injury or death from extreme weather events, heat-related illnesses, increase in waterborne and vector-borne diseases, malnutrition, and respiratory illnesses. Similar effects of rising global temperatures on survival have been described in animals.4

Earth’s changing climate is primarily the result of human activity, namely the production of greenhouse gases due to our reliance on burning of fossil fuels for energy.5 Toxic pollutants like black carbon, sulfur dioxide (SO2), nitrogen oxides (NOx), volatile organic compounds (VOC), particulate matter (PM), and polyaromatic hydrocarbons emitted as a result of burning of fossil fuels worsen air quality and increase absorption of solar radiation that further increases temperatures.6 Higher temperatures accelerate formation of ground-level ozone (O3) from NOx and VOC precursors that increase risk of cardiopulmonary morbidity and mortality. Drought conditions leading to wildland fires and desertification effects increase air particulates that exacerbate respiratory conditions like asthma and COPD and increase the risk for emergency department (ED) visits and hospitalizations.7

Viral respiratory tract infections are most common illnesses in humans,8,9 with estimated 17 billion incident cases globally in 201910. Common viruses causing respiratory tract infection include influenza, respiratory syncytial virus (RSV), rhinovirus (RV), and SARS-CoV-2. Viral respiratory infection imposes a substantial burden on populations and health systems.11 Non-influenza viral respiratory infections were estimated to cost the US economy $40 billion annually.11 Viruses are also the primary trigger for acute asthma exacerbations12 and a major cause of COPD exacerbations.13 While most viral respiratory infections are mild and self-limited,11 they can lead to severe complications in susceptible patients, including pneumonia and even respiratory failure.14,15 The SARS-CoV-2 pandemic in particular has contributed to over 3 million deaths worldwide.16

More than 90% of the world's population is exposed to polluted air.17 Convincing epidemiologic data has linked air pollution exposure with increased incidence of viral respiratory infections like upper respiratory tract (URI) infections,18,19 bronchitis,20 and lower respiratory tract infections (LTRI)21,22 such as pneumonia23,24 and bronchiolitis.25,26 Similarly, temperature,27,28 humidity,29 and extreme weather events30–32 have also been directly and indirectly associated with respiratory infections.

Climate change, air pollution, and viral respiratory infection are highly interconnected, and without interventions to halt global warming, we can expect the burden of viral respiratory disease to increase worldwide. This review will summarize the epidemiologic and experimental evidence for a relationship between climate change/air pollution and susceptibility to viral respiratory disease as well as future research priorities (Table 1).

Table 1 Summary Points and Knowledge Gaps


We conducted a search for peer-reviewed studies pertinent to climate change, air pollution, and viral respiratory infection using PubMed and Google Scholar databases. We applied the keywords: climate change, air pollution, particulate matter (PM), nitrogen dioxide (NO2), O3, RSV, RV, influenza, SARS-CoV-2, COVID-19, asthma, COPD, viral respiratory infection. Studies were included if they were 1) relevant to the aims of this review, 2) published in peer-reviewed journals, and 3) written in English.

Climate Change and Respiratory Viral Infection

Temperature, humidity, and extreme weather events are linked with respiratory infection incidence (reviewed by33). In temperate climates, lower temperature was usually associated with higher infection incidence. A study conducted in Sweden observed that lower temperature and larger weekly drop in temperature were associated with higher influenza incidence the following week.34 Lower temperature was associated with higher incidence of influenza A, respiratory syncytial virus (RSV), human metapneumovirus, bocavirus, and adenovirus, while no association with temperature was observed for human rhinovirus and enterovirus infection incidence.34 A US study found that warmer winters were associated with more severe epidemics of influenza A and B during the following winter season.27 Specifically, a mild winter was followed by a more severe than average influenza epidemic 72% of the time, and this epidemic had a growth rate 40% higher and peaking 11 days earlier than average.27 A study of RSV seasons over 8 years in the Netherlands reported a negative correlation between minimum temperature and RSV incidence (r=−0.338),28 with others reporting similar findings.35 For RSV specifically, some experts have proposed that climate change and resulting warmer winters may be beneficial in terms of shortening RSV seasons.36 In contrast, Zoran et al observed a positive correlation between COVID-19 cases and air temperature (r=0.67), indicating high transmission during warmer temperatures, which may partially explain continued high levels of transmission of the SARS-CoV-2 virus observed even during the summer months.37

In tropical climates, increased temperature was associated with higher rates of respiratory infections. Phung et al reported that among urban children <5 years of age in the Mekong Delta region of Vietnam, rates of hospital admissions for respiratory infections increased by 3.8% (95% CI 0.4, 7.2) for every 1°C increase in 2-day moving average temperature.38 Temperature variability was also linked to viral respiratory infection incidence. Greater temperature variability, day-to-day and within the same day, was positively associated with greater frequency of healthcare visits for acute bronchitis39 and pneumonia in children.40,41 However, most analyses did not account for air pollution, socioeconomic status, or behavior factors, which could have influenced infection frequency.

The relationship of humidity to viral respiratory disease incidence is inconsistent and may vary depending on the specific respiratory virus. Chowell et al reported a strong negative correlation (r=−0.70) between relative humidity and peak incidence of H1N1 influenza during the 2009 pandemic.29 Similarly, an inverse relationship was observed between COVID-19 cases and relative humidity levels in the Lombardy region of Italy during early 2020 (r=−0.47), suggesting that dry air favors virus transmission.37 In contrast, RSV incidence was positively correlated with relative humidity,28,35 suggesting that higher humidity was associated with higher RSV activity.

Extreme weather events such as wildfires, heavy rainfall with flooding, and heat waves have been linked with respiratory infection risk as well. In addition to direct effects, these events can also have indirect effects on risk of respiratory infections, such as displacement of large groups of people from their homes, indoor crowding and increased time spent indoors, and inadequate food supply with malnutrition that enhance susceptibility to and transmission of disease. Increased time spent indoors may also increase exposure to indoor pollution sources such as burning biomass that contribute to respiratory symptoms.

A systematic review of air pollution exposure during natural disasters including wildland fires and volcanic eruptions concluded that PM generated by these events was associated with increased rates of acute respiratory infection, pneumonia, bronchitis, and bronchiolitis.30 A consistent association across multiple studies was observed between exposure to wildfire-related particulate matter less than 2.5 µm in diameter (PM2.5) and increased ED visits and hospitalizations for acute respiratory infection.31,42–47 Delfino et al found that during wildfires in Southern California, the number of hospital admissions for pneumonia increased by 1.3x (95% CI 1.17, 1.48) and admissions for acute bronchitis/bronchiolitis increased by 1.6x (95% CI 1.09, 2.29) among area residents.46 Rappold et al reported similar findings following wildfires in North Carolina, with residents from exposed counties experiencing an increased risk of ED visits for bronchitis and pneumonia (cRR 1.59, 95% CI 1.07, 2.34).43

Extreme rainfall and flooding were linked with acute respiratory infections as well. Phung et al reported a significant relationship between extreme river water levels in the Mekong Delta region and daily pediatric hospitalizations for respiratory infection (cRR 1.66, 95% CI 1.57, 1.74).32 A retrospective study from the Netherlands reported that exposure to floodwater and performing clean-up after flooding were associated with higher odds of acute respiratory infection (aOR 3.3, 95% CI 2.0, 5.4).48

Heat waves may also contribute to increased respiratory infections. In California, more ED visits for respiratory infections were observed among all age groups during the July–August 2006 heat wave compared to reference periods immediately before and after the heat wave.49 Similarly, a time-stratified case–crossover study conducted in China over a 2-year period observed that heatwaves increased the risk of outpatient visits for respiratory infection among all ages (RR 1.31, 95% CI 1.18, 1.45), with children (1.74, 95% CI 1.52, 1.99) and the elderly (1.41, 95% CI 1.11, 1.79) at particularly elevated risk.50 The contribution of unmeasured factors such as increased time spent indoors during periods of extreme heat is unknown. A mechanism by which extreme heat may directly contribute to increased risk of infection is unclear, though heat stress has been shown to impair airway innate immune responses in animal studies.51 Chronic heat stress in mice was associated with a reduced production of inflammatory cytokines IL-6 and IFN-β, increased viral load and increased mortality rate following avian influenza H5N1 infection.

Air Pollution and Respiratory Infection: Epidemiologic Evidence

Short- and long-term exposure to air pollution has been extensively linked with increased susceptibility to respiratory infection. Short-term exposure to increased PM was associated with increased susceptibility to respiratory infections including influenza24,52 and influenza-like illness,53–55 RSV bronchiolitis,25,26,56 and acute lower respiratory tract infections (LTRI)22 including pneumonia.23,24,57 Chen et al observed that across 47 Chinese cities, a 10 μg/m3 increase in PM2,5 was associated with an increased risk of influenza (RR 1.020, 95% CI 1.006, 1.034) at lag days 2–3, after controlling for seasonality and weather conditions.52 Croft et al examined data from 500,000 ED visits and hospitalizations from New York state and found that IQR increases in PM2.5 during the prior week were significantly associated with higher rates of ED visits for influenza (3.9%, 95% CI 2.105.6%; at 7 days) and culture-negative pneumonia (2.5%, 95% CI 1.4–3.6%; at 6 days).24 Similarly, in two studies in Italy, RSV infection incidence and risk of hospitalization for RSV bronchiolitis in infants were positively associated with concentrations of PM less than 10 µm in diameter (PM10) during the prior 1–2 weeks.25,26 Using both single and multipollutant exposure models to estimate the association between air pollutants and respiratory infection in preschool-aged children, Zhang et al observed a significant association between PM2.5 levels and respiratory infections in children 6 months of age and under (single pollutant model: OR 1.012, 95% CI 1.008–1.018) (multipollutant model: 1.019, 95 CI 1.012–1.026).58 Similar associations with viral respiratory infections were seen with O3 (1.025, 95% CI 1.018–1.033) in children ≤6 months of age, with smaller but significant associations in 7–12 month old and 1–3-year-old children. PM10 levels were associated with viral respiratory infections as well (1.025, 95% CI 1.008–1.042) but only among 3-6-year-old children.

NO2 exposure was also implicated to increase susceptibility to viral respiratory infections. Elevated NO2 concentrations were associated with increased hospital admissions for acute respiratory infections,19 including croup20,59 and viral infection-induced asthma exacerbation,60 pneumonia,21 and influenza.21 Exposure to increased O3 was also associated with hospital admission for pneumonia21,61 and influenza21 infection.

Further, in a systematic review and meta-analysis of ambient air pollution and pneumonia in children, Nhung et al reported an overall positive association between pediatric hospitalization for pneumonia and exposure to air pollutants, including PM2.5, PM10, SO2, O3, and NO2. The largest association observed was for SO2, with ER visits increasing by 2.9% (95% CI 0.4–5.3%) per 10 ppb increase. The authors noted significant effect modification by study location, with stronger associations observed in low- and middle-income countries compared to high-income countries.23 The same authors later reported that higher O3 and PM10 concentrations were associated with an increased length of hospital stay among children 5 years and under admitted for lower respiratory infection, with no relationship between PM2.5, SO2, or NOx and length of stay.62 Specifically, per IQR increase in O3, there was a 5% (95% CI 2–8%) decrease in odds of hospital discharge, and for PM10, there was a 6% decrease in odds of hospital discharge in the 2–5-year-old group only.

There is also convincing evidence suggesting that long-term exposure to air pollutants predisposes to respiratory infection, though it is unclear whether this susceptibility is a function of exposure during the prenatal period, postnatal period, or both. Within the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) birth cohort, Brauer et al observed that long-term exposure to traffic-related pollutants (PM2.5, NO2, soot) was associated with higher odds of ear, nose, and throat infections at 2 years of age63 as well as influenza and serious cold infections at 4 years of age.64 A meta-analysis of over 16,000 children from 10 birth cohorts from the ESCAPE project found that physician-diagnosed pneumonia during the first 2 years of life was significantly associated with annual average air pollution levels of PM10 (OR 1.76, 95% CI 1.00, 3.09 per 10 μg/m3) and NO2 (1.30, 95% CI 1.02, 1.65 per 10 μg/m3), but not PM2.5 (2.58, 95% CI 0.91, 7.27).65

Air Pollution and SARS-CoV-2

Many have hypothesized that air pollution contributed to the initial spread of SARS-CoV-2 during the early days of the pandemic66–68 and may also increase the risk of mortality.69,70 Air particulates from indoor71 and outdoor samples were shown to contain SARS-CoV-2 viral particles.72,73 In addition to having high levels of air pollution, densely populated urban centers like Wuhan and New York City were also hot spots for SARS-CoV-2 transmission and COVID-19-related mortality. Concentrations of PM2.5, PM10, NO2, and O3 in the prior 2 weeks were significantly associated with daily confirmed COVID-19 cases in an analysis of data from 120 cities in China between January and February 2020, with the largest association observed with per 10 μg/m3 increase in NO2 (6.94%, 95% CI 2.38%, 11.51%).74 Higher SO2 concentrations were associated with a decrease in new COVID-19 cases. Moderate correlations were observed between air pollutants and COVID-19 cases (Pearson’s r ranging from 0.41 for PM10 to 0.58 for PM2.5) in hard-hit regions of Italy.75 In China’s Hubei province, a significant correlation was observed between NO2 levels and SARS-CoV-2 transmission rate in 11 cities (r > 0.5), indicating that SARS-CoV-2 transmission was higher in regions with higher NO2 exposure.76 The same group reported a significant association between higher COVID-19 case fatality rates and higher levels of PM2.5 and PM10 in Wuhan, China.77 Ogen observed that over 80% of COVID-19-related fatalities in Europe during the first 2 months of the SARS-CoV-2 pandemic occurred in places with the highest NO2 concentrations, particularly the Lombardy region of Italy.69 In the majority of studies, potentially confounding health variables such as age and pre-existing disease could not be accounted for, limiting the ability to accurately estimate the impact of pollutant exposure on outcomes. Another uncertainty is the effect of length of exposure and whether short- or long-term exposure is more important in terms of risk of contracting SARS-CoV-2 infection, disease severity, and mortality risk. A recently published prospective study of residents in Varese, Italy, found that long-term exposure to airborne pollutants PM2.5, PM10, NO2, and NO increased the incidence of COVID-19.78 The largest effect was seen in single and bi-pollutant models of PM2.5, which was associated with a 5% increase in COVID-19 incidence (95% CI 2.7%, 7.5%). Further studies are needed to answer remaining questions about the relationship between air pollution and SARS-CoV-2 infection.

Summary of Epidemiologic Studies

The totality of the epidemiological evidence supports a link between air pollution exposure and increased susceptibility to viral respiratory infection. However, our review of the literature has several limitations. Population-level studies are limited in their ability to accurately estimate an individual’s pollutant exposure. Additionally, under real-world conditions, populations are exposed to a mixture of air pollutants. Differences in study outcomes were influenced by differences in study design, exposure assessment, and adjustment for potential confounders. Further work is needed to address important research questions about the causal pathway between air pollution exposure and viral respiratory infection, particularly for SARS-CoV-2 virus. It is currently unclear whether air pollutants predominantly influence transmission and susceptibility to viral infection or if they significantly impact disease severity and mortality risk. The impact of short- versus long-term exposure to pollutants on infection risk is another poorly understood area in need of high-quality research.

Air Pollution and Increased Susceptibility to Viral Respiratory Infection: Mechanistic Evidence

Since it is not possible to separate out the health effects of individual pollutants in epidemiologic studies, in vitro studies, animal model studies, and human controlled exposure studies have been performed to help establish the mechanisms of the apparent synergistic relationships between exposure to air pollutants and viral respiratory infection (Figure 1).

Figure 1 Proposed mechanisms by which air pollutants contribute to viral respiratory infection susceptibility and severity.

Altered Immune Response to Viral Infection

Exposure to air pollutants augments airway inflammatory responses to viral infection, through exaggeration or impairment of the innate and adaptive immune responses and/or skewing of the response from predominantly antiviral to an allergic, Th2-predominant response. In human bronchial epithelial cells exposed to urban PM, enhanced activation of the NLRP3 inflammasome was observed with increased production of interleukin (IL)-1β following influenza A infection, but not RSV infection, suggesting an exaggerated inflammatory response.79 Similar to PM, DEP exposure was associated with enhanced susceptibility and inflammatory response to influenza infection in primary human bronchial epithelial cells80,81 and mouse models.82

Primary human nasal epithelial cells infected with RV and exposed to NO2 or O3 showed enhanced release of the inflammatory cytokine IL-8 compared to RV infection alone or pollutant exposure alone, suggesting that epithelial-derived inflammation from viral respiratory infection is enhanced by exposure to air pollutants.83 However, other groups observed a reduction in virus-induced lung injury84 and mortality85 when mice were exposed to O3 during influenza infection, potentially owing to dampening of the immune response to infection.84 Similarly, alveolar macrophages exposed to O3 showed diminished cytokine production after infection with RSV.86 The effects of O3 exposure on respiratory viral infection may be virus-specific.

Mice exposed to ultrafine carbon black prior to RSV infection showed skewing of the immune response away from an antiviral Th1 milieu (IFN-gamma, IL-12, and IP-10) towards an allergic, Th2-predominant inflammatory milieu (RANTES, eotaxin, MCP-1, MIP-1a, MIP-1b, and IL-13).87,88 Ultrafine PM exposure in neonatal mice resulted in increased amounts of immunosuppressive T-regulatory (Treg) cells and IL-10 following influenza infection and showed decreased influenza-specific T-cell responses.89 Exposure to carbon black particles was associated with increased morbidity from RSV in these mice, including increased airway hyperresponsiveness.90 Similar Th2 skewed airway inflammation was observed after exposure of primary respiratory epithelial cells to diesel exhaust particles (DEP), a type of PM,80 which may increase susceptibility to viral infection. Chronic exposure to DEP was associated with decreased interferon production in response to influenza infection in mice; infection-specific antibody titers were also reduced compared to controls.91

Altered Epithelial Barrier Function

The epithelial barrier represents the first line of defense against inhaled pathogens. Integrity of epithelial junctions, mucociliary clearance, and antioxidant and antimicrobial protein composition of airway lining fluid are key defenses. Exposure to O3,92,93 NO2,94,95 and PM96 has been shown to alter airway epithelial permeability.66 Rats exposed to O3 and injected with an IV tracer showed increased presence of tracer in bronchoalveolar lavage fluid (BAL) compared to rats exposed to clean air, suggesting disruption of the airway epithelium induced by O3.93 Short-term exposure of hamsters to NO2 showed significant but transient disruption of bronchiole tight junctions (TJ) with as little as 6 hours of exposure.97 Experiments testing the effect of long-term NO2 exposure in hamsters showed significant, non-reversible TJ disruption.94 Liu et al showed that PM exposure of primary human bronchial epithelial cells infected with Pseudomonas aeruginosa resulted in oxidative injury with degradation of TJs and increased intracellular bacteria.96 PM was also shown to impair airway mucociliary clearance,98 and increase production of the pathogenic glycoprotein mucin MUC5AC.99 Exposure to O3100 in vivo and NO2101 ex vivo were associated with depletion of antioxidant proteins from lung lining fluid. Epithelial cell-derived defense proteins like surfactants SP-A and SP-D are important in the defense against respiratory viral infection.102,103 Ciencewicki et al observed that DEP exposure of mice increased susceptibility to infection with influenza virus by reducing expression of SP-A and SP-D.82 Interestingly, SP-D was previously shown to bind SARS-CoV-1 spike protein, which could suggest a defensive role against SARS-CoV-2.66,104

Altered Cell Surface Receptor Expression and Viral Entry

Pollutants may enhance susceptibility to viral infection by altering viral entry into respiratory epithelial cells. Exposure of rat lung epithelial cells to DEP resulted in upregulated expression of intercellular adhesion molecule 1 (ICAM-1), the receptor used by RV to gain entry into the cell, in a concentration-dependent manner, increasing opportunities for viral entry;105 similar effects were observed with NO2 exposure in vitro.83 Human nasal and bronchial epithelial cells exposed to DEP showed increased influenza virus attachment to epithelial cells and increased numbers of influenza-infected cells 24 hours after application of virus.80 Similarly, mice exposed to DEP had more severe influenza infection assessed by the presence of lung consolidation, increased viral replication and decreased antiviral interferon production compared to controls.91 Mice exposed to PM2.5 showed upregulation of ACE2 expression in the lungs,106 and it was suggested that PM-induced overexpression of ACE2 may impact susceptibility to SARS-CoV-2 infection and infection severity.107 The effects of O3 exposure on viral respiratory infection are less consistent. O3 exposure of human nasal epithelial cells resulted in increased expression of proteases that cleave influenza HA surface protein, an essential step in viral entry into the cell, thus promoting viral entry and enhancing viral replication.108 However, primary human bronchial epithelial cells exposed to O3 prior to RSV infection showed decreased viral production.109 Mice exposed to O3 and infected with influenza showed reduced severity of lung injury and reduced immune response to infection with fewer T and B cells recovered from the lungs and reduced influenza-specific antibody titers in serum.84

Impaired Cytotoxicity

Pollutant exposure may impact the ability of immune cells to engulf and/or kill viral-infected cells.110–112 Rose et al found that mice exposed to NO2 required 100-fold lower amounts of murine cytomegalovirus to become infected compared to mice exposed to clean air, and NO2-exposed mice also showed signs of decreased clearance of the virus by macrophages.112 Alveolar macrophages exposed to PM10 infected with RSV showed reduced activation, cytokine production, and uptake of viral particles, suggesting impairment of the antiviral response.110 Guinea pig alveolar macrophages exposed to PM10 and infected with RSV showed markedly reduced viral replication and infection-induced inflammatory cytokine production.111 Using a macrophage cell line, Renwick et al observed that exposure to ultrafine particulates significantly impaired phagocytic activity.113 Natural killer (NK) cells stimulated with polyinosinic:polycytidylic acid (pI:C) to simulate viral infection and DEP showed reduced production of IL-1β, IL-8 and TNFα and reduced expression of granzyme B and perforin. Cell-mediated cytotoxicity functional assay showed a significant reduction in cytotoxic activity with pI:C+DEP compared to pI:C alone.114 BAL fluid cells from volunteers with repeated exposure to NO2 showed reduced quantities of cytotoxic T cells and NK cells but intact phagocytic activity of alveolar macrophages.115

Direct Viral Transmission

In addition to increasing susceptibility to viral respiratory infection, PM may serve as a carrier for viral particles. Hsiao et al detected influenza virus within samples of PM2.5 and suggested that this could be a mode of direct transmission of virus to the airway epithelium.116 Multiple research groups have identified SARS-CoV-2 virus within PM2.5 from air samples supporting this conclusion, with the caveat that temperature, humidity, and other weather conditions can also affect the efficiency of viral transmission.71,73,117 However, the World Health Organization (WHO) has concluded based on properties of the virus that ambient air pollution is not likely to contribute to SARS-CoV-2 transmission.118


There is substantial evidence supporting the relationship between natural and anthropogenic sources of climate change, namely air pollution, and increased susceptibility to respiratory infections through several proposed mechanisms. Conversely, it is possible that climate change could have some positive effects on respiratory viral infection due to shorter, warmer winters, particularly in the case of RSV. However, this comes at the expense of increased exposure to toxic air pollutants and susceptibility to respiratory viruses whose transmission is not impaired by warmer temperatures (as appears to be the case with SARS-CoV-2, for example). Another important consideration is that climate change also alters animal migration patterns and shifts habitats such that humans and domesticated animals are in closer proximity to wild animals.119 These changes can be the catalyst for the emergence of new zoonotic viruses with potential to cause future pandemics. The need has never been greater for aggressive interventions to reduce emissions of greenhouse gases and toxic pollutants to mitigate the effects of climate change. The initial rapid fall in air pollutants around the world during the initial COVID-19 lockdowns showed us what is possible, though at a significant economic price. A report from a joint workshop between the WHO, the European Respiratory Society, and several other scientific societies noted that the COVID-19 pandemic has brought to light the vast interconnectedness between climate change and infectious disease.118 Without significant long-term strategies for phasing out fossil fuel use in favor of green energy, we will likely see an increase in the burden of respiratory viruses in human populations, particularly in vulnerable groups such as children, the elderly, and those with chronic respiratory disease.


The author has no conflicts of interest in this study to disclose.


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Dr Sangeetha Steevart, is clinical director, Warrington Together.

In the latest of our regular columns she talks about keeping your children safe this winter

In the colder months, children under the age of five are more at risk of respiratory tract infections as they haven't built up their resistance to the many viruses that can cause these infections.

Common respiratory tract infections include common cold, tonsillitis, sinusitis, laryngitis, influenza, bronchitis, pneumonia, and bronchiolitis.

Most of these infections pass without the need for treatment and you won't usually need to see your GP.

My advice is to treat your child’s symptoms at home by encouraging them to drink plenty of fluids and taking over-the-counter pain relief such as paracetamol or ibuprofen which can also help control fever.

In most cases, antibiotics aren't recommended because they're only effective if the infection is caused by bacteria.

This winter has also brought a rise in Strep A cases. Strep A is a common type of bacteria and most strep A infections are mild and easily treated, but some are more serious – this is called Invasive Group A Strep (iGAS).

Symptoms of a Strep A infection include flu-like symptoms such as high temperature or an aching body, a rash that feels rough, scabs and sores, nausea and vomiting, and pain and swelling.

It can be difficult to tell when a child is seriously ill, but the main thing to do is to trust your instincts.

You know better than anyone else what your child is usually like, so you’ll know when something is seriously wrong.

If your child is unwell and getting worse, is feeding or eating much less than normal, or is showing signs of dehydration, you should call NHS 111 or get an urgent GP appointment.

It is important to do what you can to reduce the risk of catching or spreading infection, which means practicing good hand hygiene, staying at home or away from others when sick, and ventilating your home so germ particles can blow away.

Remember, NHS 111 online can tell you where to get help for your symptoms if you're not sure what to do, how to find general health information and advice and where to get an emergency supply of your prescribed medicine.

If your child is having difficulty breathing, is floppy and will not wake up or stay awake, or their skin, tongue, or lips are blue or grey call 999 or go to A&E.

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A viral trifecta is sweeping the country this winter, with COVID-19, the flu and RSV (Respiratory Syncytial Virus) creating havoc in hospital emergency rooms, slamming all age groups but, in the case of RSV, hitting children especially hard. Here in Florida, the Department of Health has documented a higher number of pediatric emergency visits for RSV compared to previous years.

“This winter season has been pretty severe already with cases of children being hospitalized due to RSV,” said Dr. Julia Retureta, a board-certified pediatrician with HCA Florida Lawnwood Hospital in Fort Pierce.

In her capacity as assistant medical director of Lawnwood’s pediatric emergency department, Dr. Retureta, treats children with RSV from all over the Treasure Coast.

“We are the only dedicated pediatric facility on the Treasure Coast, so we get a lot of transfers in from other hospitals,” she said. “We have an entire staff of pediatric physicians on the pediatric floor and in the pediatric intensive care unit.”

RSV is the major cause of respiratory illness in children. Nearly all children will get an RSV infection by the time they are 2. Most of the time RSV causes only a common cold but sometimes it infects the lungs and breathing passages, leading to serious breathing problems for infants and young children. The Centers for Disease Control and Prevention estimates that as many as 80,000 children under the age of 5 are hospitalized annually due to the highly contagious virus.

RSV spreads through air droplets, mostly during the winter months. In older children it generally just causes a cold with upper respiratory symptoms, but it is more dangerous for children under the age of 2 – especially those less than 6 months of age and those born prematurely.

Early symptoms are generally the same as a common cold, including runny nose, decrease in appetite and a cough, but these symptoms can progress into bronchiolitis. Parents should be concerned if their child experiences shortness of breath, fast breathing, wheezing, abdominal breathing or nasal flaring – all signs of decreased air exchange in the lungs, which can progress into pneumonia.

Some children have apneic spells – basically holding their breath, which can lead to respiratory failure. Infants less than 6 months old may only show signs of RSV with irritability, decreased activity and appetite, and apnea.

“Unfortunately, there is no vaccine for RSV but there is a monoclonal antibody reserved for ex-preemies less than 28 weeks and congenital heart disease babies,” Dr. Retureta explained. “It’s a monthly intramuscular injection given for six months during the RSV season to prevent them getting the virus. Parents of these high-risk infants should talk to their pediatrician about this preventative measure.”

Mild cases of RSV typically clear up on their own after a week or two. To help relieve symptoms and make your child more comfortable, your doctor may recommend over-the-counter medications such as ibuprofen or acetaminophen. Some medications are not recommended for babies, however, so consult your pediatrician before using any nonprescription medicine.

You should take your baby to the ER immediately if there are signs of dehydration (decrease in wet diapers), labored breathing, high fever, lethargy, skin turning blue (especially lips and fingernails), or unresponsiveness.

If you are unsure whether your baby has severe RSV, err on the side of caution and seek medical treatment. If the RSV infection is severe enough for the child to be hospitalized, treatments may include intravenous fluids, humidified oxygen and, in rare cases, mechanical ventilation or a breathing machine.

“RSV is not at new virus. It’s been around for a long time,” Dr. Retureta said. “[Fortunately] there are some commonsense preventative measures parents can adopt to ward off the virus.

“Since RSV spreads by air droplet transmission, avoid close contact with sick people, wash your hands frequently, clean and disinfect surfaces, and cover your mouth when coughing. This year, RSV is more prevalent than ever so parents should be diligent in recognizing the symptoms and seeking medical help if the symptoms worsen.”

Dr. Julia Retureta graduated from the University Central Del Caribe School of Medicine and completed her pediatrics residency at UM/Jackson Memorial Hospital. She works exclusively in the Pediatric Emergency Room at HCA Florida Lawnwood Hospital. Should you suspect that your child needs emergency care for RSV, call the Consult-a-Nurse at 844-706-8773, also known as 844-70-NURSE.

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By Amy Norton HealthDay Reporter


WEDNESDAY, Jan. 18, 2023 (HealthDay News) -- As colds, flu and COVID continue to circulate this winter, a new U.S. government study finds that young children infected with COVID plus a second virus tend to become sicker.

While severe COVID is rare among children, kids can and do fall ill enough to end up in the hospital.

During the pandemic's first two years, young U.S. children who were hospitalized with COVID tended to be more severely ill if they also tested positive for a second respiratory virus, according to the new study, by the U.S. Centers for Disease Control and Prevention.

Usually, those coinfections were with one of the many viruses that cause the common cold -- including rhinoviruses, enteroviruses and respiratory syncytial virus (RSV).

RSV, which can cause more serious lung infections in babies, practically vanished early in the pandemic due to social distancing, mask-wearing and other COVID-controlling measures. The virus then came roaring back in the spring and summer of 2021 -- well outside of its normal peak in wintertime -- as COVID restrictions eased.

The CDC study found that when children younger than 5 were hospitalized with COVID, they were twice as likely to become severely ill if they also tested positive for one of those other respiratory viruses.

"Severe" meant they were admitted to the intensive care unit or required machines to help them breathe.

Experts in pediatric infectious disease said the findings align with their experience during the first two years of the pandemic.

But things are somewhat different now, they said. For one, the flu has staged a comeback this season -- after all but disappearing at the pandemic's outset, and then laying low in 2021 as well.

So while COVID/flu coinfections were rare during the study period, that's no longer the case.

"It has definitely been an evolving picture," said Dr. Vandana Madhavan, clinical director of pediatric infectious diseases at Massachusetts General Hospital in Boston.

She said the hospital is still seeing kids with RSV, sometimes in combination with COVID, but the flu and other viruses -- as well as bacterial infections -- are taking center stage, too.

In general, it's breathing problems that prompt parents to rush their child to the ER, according to Madhavan, who is also a spokeswoman for the Infectious Diseases Society of America.

As far as testing for the culprit, she said, "we start with the heavy hitters -- COVID, the flu and RSV."

If a child is sick enough to be admitted to the hospital, more extensive testing may be done, Madhavan said. That's, in part, for infection control -- to keep children with, say, the flu away from other kids without it.

There may be cases where having a second infection along with COVID affects a child's treatment. Madhavan said. But often, it does not change things -- as symptom control and keeping kids hydrated and breathing well are the priorities.

The CDC study -- published Jan. 18 in Pediatrics -- is based on data from hospitals in 14 U.S. states. From March 2020 through February 2022, 4,372 children were hospitalized with COVID. More than 60% were also tested for other respiratory viruses, with 21% testing positive.

Kids with coinfections were more likely to need a CPAP or BiPAP machine to help them breathe (10% did, versus 6% of other children), and more often needed to be admitted to the ICU (38%, versus 27%).

When the researchers looked at the data by age, they found that multiple infections raised the risk of severe illness only among children younger than 5.

When youngsters have more than one infection, it's hard to know what's "driving" their symptoms, said Dr. William Muller, an infectious disease specialist at Lurie Children's Hospital of Chicago. He also noted that severely ill kids are probably more often tested for multiple bugs.

But to Muller, the bottom line is straightforward: "We need to vaccinate more," he said.

That means both COVID vaccination and the yearly flu shot, Muller said. Both can be given to children age 6 months or older, and both slash the risk of severe illness.

Both doctors stressed that the point is not to alarm parents: The vast majority of children with COVID or the flu do not land in the hospital. At the same time, there are ways to lower those odds.

And even in mid-January, both doctors said, it's not too late for children to get the flu shot. Flu season can extend into April or even May, and often peaks in February.

Some simple measures can also limit the spread of respiratory bugs, Madhavan noted -- like delaying that play date if your child has a runny nose or cough.

SOURCES: Vandana Madhavan, MD, MPH, clinical director, pediatric infectious diseases, Massachusetts General Hospital, Boston, and spokeswoman, Infectious Diseases Society of America, Arlington, Va.; William Muller, MD, PhD, attending physician, infectious diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, and professor, pediatrics, Northwestern University Feinberg School of Medicine, Chicago; Pediatrics, Jan. 18, 2023, online

Copyright © 2023 HealthDay. All rights reserved.

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As the mercury falls down, the respiratory problems also increase in people. Winter is the time when our immunity is at its lowest and we can easily fall sick. At the same time, the mucus also becomes stickier and thicker than normal. Because of which it can block the windpipe.

Winter problems? MediBuddy’s Head of Medical Operations Dr. Gauri Kulkarni He told that pollution, smog, allergy and dust mixed with winter can have serious consequences. These factors can lead to respiratory problems, common cold and cough, viral and bacterial infections, bronchitis, severe asthma or COPD (chronic obstructive pulmonary disease). That’s why it is necessary to do some work to stay healthy in winter.

get flu shot

One of the best ways to stay healthy during the winter is by getting vaccinated against the flu and common cold. This will help reduce the chances of getting infected with these diseases. If you have not taken your covid booster dose, then you must also take it. Pneumococcal vaccination is also recommended for seniors.

stay hydrated and warm

It is also important to stay hydrated during winters. This means that you have to drink enough water and stay away from alcohol. At the same time, keep the body warm and dry. Dress warm enough for this and protect yourself from getting wet.

wear a mask

When out of the house, cover your face with a mask. This remedy will help in protecting the lungs from strong wind. Also, check the smog forecast before you go out and try to stay indoors as much as possible if pollution is high outside.

get enough sun and rest

It is important to get enough sunlight and rest in winter. Because, their deficiency can weaken the immune system. Taking sunlight gives vitamin D3, which increases immunity. Along with this, you can stay away from diseases by taking iron and calcium rich diet.

Keep inhaler and medicines close

If you have a respiratory problem such as asthma, bronchitis or emphysema, always carry essential inhalers and medicines with you. Avoid doing heavy exercises outside the house and insist on indoor workouts.

If you are struggling with any health problem and want its solution or any kind of information related to the disease, then you can send your questions to us directly at [email protected] Our doctors and experts will try to answer them.

Disclaimer: This article is for general information only. It cannot be a substitute for any medicine or treatment in any way. Always consult your doctor for more details.

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Los Alamos

Ahhh … the elusive 8 hours. Isn’t that what many of us dream of when we aren’t tossing and turning and trying to sleep? The study of sleep is a relative newcomer to the health and wellbeing arena, but studies show that adequate sleep can lower our risk of certain cancers, dementia, heart attack, stroke, diabetes and even the common cold. You might also feel less motivated and of course lack energy when you don’t get enough sleep.

Research also shows that people who get better sleep suffer less from anxiety and are more creative. No longer the late night high achievers boast of getting only 4-5 hours of sleep. The times are changing and people are realizing the benefits of a good night’s sleep.

When you drift off to sleep, your heart rate slows down, your breathing slows down and your muscles relax – sounds a bit like the benefits of yoga doesn’t it? In addition, during good sleep, your body goes into healing mode. In essence it’s when the trash collector comes and picks up certain proteins and other cellular debris your brain/body no longer needs.

The CDC says that ⅓ of adults don’t get enough sleep (CDC Online Newsroom, 2016).

Ram Rao, a neuroscientist and yoga teacher writes of six primary reasons to improve sleep:

  • Sleep helps the brain sustain and preserve new information to memory;
  • Sleep deficits contribute to accidents, falls and traffic mishaps;
  • Sleep deprivation triggers emotional disturbances;
  • Sleep disorders can be a cause of hypertension and irregular heartbeat;
  • Sleep deprivation lowers immunity;
  • Sleep deprivation triggers weight gain.

The National Health Sciences Statistics Reports on Wellness related activities (No. 85, Nov. 4, 2018) indicates that 55 percent of participants who practiced yoga got better sleep.

There are a number of reasons why yoga can help with sleep:

  • Breathing. The breath is a big part of yoga and becoming more aware of your breath can help calm the mind and the body down. Deep breathing is beneficial for better sleep.
  • Mindfulness/Meditation: Yoga encourages participants to stay in the moment, pay attention to what is happening right now in the mind and the body. Meditation can increase melatonin in the body (Meditation and Its Regulatory Role on Sleep, Ravindra P. Nagendra, Nirmala Maruthai, and Bindu M. Kutty,Frontiers in Nuerology). Melatonin can help with sleep.
  • Movement: Regular exercise or movement has been shown to help with sleep in general. A regular yoga practice can also help with sleep although doing a vigorous practice before bed may not be the best idea.

As mentioned above, a vigorous yoga practice before bed might be stimulating rather than down regulating.

When thinking about what type of yoga to do before bed, consider any of these three styles:

  • Restorative yoga: The body is supported with the use of props such as blankets, blocks, and bolsters to ensure deep relaxation and diaphragmatic breathing.
  • Yoga nidra: Also known as yogic sleep, this form of yoga is done laying down and utilizes guided relaxation to withdraw from the senses and drop into a deep state of relaxation while still maintaining full consciousness.
  • Gentle yoga: Is a quiet practice using simple postures and breathing techniques to loosen the muscles and connective tissues.

Before bed pose for better sleep – Constructive Rest

  • Props: sturdy chair, pillow or folded towel for under your head, calming music (optional)
  • Place a chair on a carpeted area in your house or on your yoga mat.
  • Sit down close to the chair with your legs on either side of the chair.
  • Place your legs up on the seat of the chair so they are at a 90 degree angle with your knees and hips.
  • Place your head on the folded towel or pillow.
  • Close your eyes and breathe naturally.
  • Try to relax your thighs and hips.
  • Stay here for 10-15 minutes.
  • To come out, bend your knees into your chest and roll to one side. Stay here for 4-6 breaths to let the blood re-balance in the body.

Note: if getting up and down off the floor is difficult, try this on your bed or sofa propping your legs up with a number of pillows.

Before bed breath practice for better sleep – Left Nostril Breathing

  • Sit on a chair, in your bed or even lie down in your bed.
  • Practice a few rounds of full yogic breathing (breathing into your lower belly, up through your ribs toward your collarbones, release completely top to bottom)
  • Gently place your right thumb on your right nostril crease and slowly breathe in and out of your left nostril.
  • Do this for 2-5 minutes and then release your thumb and breathe through both nostrils.

Jacci Gruninger is a Certified Yoga Therapist, Thai Yoga Massage Therapist, Focusing Coach and Facilitated Stretch Practitioner. She regularly helps clients manage the ups and downs of life with yoga, meditation, breathwork, focusing, stretching and bodywork. Her Wellness Center is located at 190 Central Park Square #212. For her in person and online teaching schedule and information on her other services, visit her website at to find out more.

young man in bed with eyes opened suffering insomnia and sleep disorder thinking about his problemCourtesy image

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