CHICAGO–Kristen Padavic said no one told her about respiratory syncytial virus, or RSV, when she delivered twin daughters prematurely eight years ago.
The 39-year-old architect’s girls were fine upon hospital discharge, and when they were six months old their pediatrician said it was safe to take them to daycare.
Within two days the girls contracted RSV, a respiratory infection that causes cold and flu-like symptoms.
Most healthy children infected with RSV suffer runny noses, coughing and sore throats before getting better. But in children born prematurely or seniors with compromised immune systems, symptoms can escalate to breathing difficulties, pneumonia and even death.
Can Kill Young Children, Seniors
RSV is the most common cause of pneumonia and bronchiolitis, an inflammation of the lung’s small airways, among children under the age of one, according to the Centers for Disease Control and Prevention. The CDC also notes:
•Almost all children will have had an RSV infection by their second birthday.
•RSV leads to 57,527 hospitalizations annually among kids under 5 and kills more than 200 U.S. children a year.
•Among adults over 65, RSV leads to 177,000 hospitalizations and 14,000 deaths annually.
“I’d never heard of it before having my children,” said Padavic, who lives in Austin, Texas, with her architect husband, Michael, and their eight-year-old daughters.
Until recently, her twins contracted RSV repeatedly, necessitating emergency room visits three to four times a year.
Daycare schools “have every disgusting germ all year round,” she said. “Our pediatrician didn’t tell us that our twins’ lungs were underdeveloped and that they were susceptible to this.”
Andrew Pavia, MD, a spokesman for the Infectious Diseases Society of America, said pediatricians have known about RSV and children for decades.
“But it’s flown under the radar for people who care for adults,” said Pavia, chief of pediatric infectious diseases at the University of Utah. “It’s the Rodney Dangerfield of the viral world. It gets no respect.”
Children’s Hospitals and Nursing Homes
A vaccine for children would be a tremendous help, he added.
“Every winter, hospitals across the country are overwhelmed with children hospitalized with RSV,” he said. “Having a vaccine would mean we wouldn’t have to build more beds in children’s hospitals.”
Thomas Yoshikawa, MD, of the VA Greater Los Angeles Healthcare System said geriatricians in recent years have learned many older patients thought to have had the flu really had RSV.
“The problem is that most people don’t consider RSV as a cause of respiratory infections in older people, especially in nursing home residents,” he said.
Until recently, diagnosis was through serology tests that took weeks to get results.
“Now we can take nasal secretions and test in the office for the RSV antigen,” he said.
Yoshikawa said most health care providers are knowledgeable about flu infections but less familiar with RSV.
“We all tend to consider the diseases we know most about,” he said, urging public health officials to better spread the word about the virus.
“When the CDC puts out a health notice, most physicians pay attention,” Yoshikawa said.
Geriatricians, Pediatricians See Threat
Otherwise healthy older adults usually suffer mild RSV symptoms, said Marie A. Bernard, MD, deputy director of the National Institute on Aging. But adults with weakened immune systems — particularly those in nursing homes — often experience more severe symptoms.
Bernard said RSV is now recognized in geriatric circles as a threat.
“We’re in an evolving landscape,” Bernard said. “Soon we may be able to say what to do to prevent RSV.”
Pediatrician H. Cody Meissner of the American Academy of Pediatrics [http://tinyurl.com/gmj3rca] said RSV is the most common cause of hospitalization during a child’s first year of life.
“At the other end of the age spectrum, RSV is an important cause of hospitalization and even death in elderly people,” added Meissner, a professor at Tufts University School of Medicine in Boston.
He said that until a few years ago, CMS, the federal agency that administers Medicare, didn’t even list a treatment for RSV.
Meissner said an experimental RSV vaccine is being tested for pregnant women, who can then pass on immunity to their children.
“A maternal vaccine would be fantastic because it will protect everyone, not just the ill or at risk,” he said.
Mothers who smoke while pregnant are more likely to have children with more severe RSV disease and second-hand smoke puts babies at high risk, Meissner said.
Just like the flu, RSV outbreaks are more common during the winter, said Benjamin Schwartz, MD, deputy chief of the acute communicable disease control program at the Los Angeles County Department of Public Health.
“Similar to other respiratory diseases, it can be prevented by hand washing and sick people staying away and avoiding contact with others,” Schwartz said.
Limited Preventive Options
There currently aren’t any antiviral drugs targeting RSV.
“There is a medication used for prevention that is recognized by the American Academy of Pediatrics for particular groups of children: those born prematurely or with congenital heart disease,” Schwartz said.
He said the FDA-approved injectable drug palivizumab, known as Synagis, is only recommended for infants born before 29 weeks. Individual doses cost between $1,500 and $3,000 and a full regimen can run up to $15,000, making it unaffordable for many families.
He urged public health officials and doctors to focus on RSV education and to help ensure that children eligible for preventive medicine can get those drugs.
“Parents of children, physicians and hospital staff where children are born prematurely need to be informed about RSV and make sure their families know,” he said.
From New America Media.