Respiratory syncytial virus, or RSV, cases in kids have been increasing at an alarming rate.
Maybe your kids are showing flu-like symptoms and shortness of breath or wheezing. Cases are up 111% from November 2024, according to doctors at Johns Hopkins All Children’s Hospital in St. Petersburg.
And the increase is coming at a time when flu cases are normally decreasing.
Dr. Carlos Abanses, director of pediatric emergency at St. Joseph's Children's Hospital in Tampa, recently discussed the trend on WUSF’s “Florida Matters Live & Local.”
The interview below has been lightly edited for clarity and length.
WUSF: Why are we seeing an increase in RSV numbers so late in the year?
ABANSES: So, every year we have spikes in RSV, and it just kind of depends on when, and it kind of comes around just seasonally. And it just happens to be that different strains will hit at different times.
We used to have better time periods where you could almost predict a month that it would hit. But after COVID, for whatever reason, it’s kind of changed a little bit of all the systems of when the different viruses hit.
It just happens to be hitting a little bit later this year. It usually tends to hit, like November, December. It’s hitting a little bit more now this year.
Are cases of the flu just as high right now?
Cases of flu are definitely increasing, and it’s predicted to be a much stronger flu year. Because what we have this year is a different subclade. It’s called subclade K of the H3N2 virus.
So, the H3N2 virus has been around for a long time. It’s not something that just popped up, kind of more like COVID. It’s been around for a long time. Actually, the 1968 Hong Kong flu was part of that H3N2.
But what happens is you almost break off and create a little separate subset of it. So that’s why they call it subclade K. And so, we have this newer strain that most of our bodies haven’t seen.
When our bodies haven’t seen it, we are more prone to get sicker. We’re expecting there’s going to be more widespread infections with this because our bodies have less immunity to it, because we haven’t seen it, like a lot of the other flu strains where we would have partial immunity.
Are kids especially vulnerable, or can adults still get RSV?
Oh, anybody can get RSV, and it’s highly contagious. The younger and smaller you are, the more problems you have, because RSV gets into the lungs and just kind of kills off some of the normal cells, and creates a little debris in the lungs.
And [with] little debris, the smaller your airway passages are, the harder it is to breathe around that debris. So, if you’re bigger, you’re going to have a bad cold and cough like an adult parent of a child.
But a 1-month-old who has really tiny airways can have a lot more problems with it. It definitely affects the very young and the very old, who have weaker immune systems as well. They’re the ones that are most susceptible to having complications.
What would you suggest as some of the treatments for the younger set for RSV?
There’s no real treatment that works for it. It’s a virus, so we don’t have any medicines that kill it. So, one is prevention — trying to really wash your hands when you go out, try not to be around other people who are sick, keeping your child away from people who have been sick, and then just really good hygiene, washing stuff down.
If you’re going to be flying, you may want to be wearing a mask, clean off the little table, those things.
ALSO READ: Not flu or RSV: What parents should know about the winter stomach bug
But the biggest thing is watching for symptoms of increasing difficulty breathing. With RSV, kids that start having problems, you’re going to see that in their side ribs. You’ll start seeing the skin suck in between their side ribs, which tells me they’re having a difficult time breathing. That’s really when we need to see them in the ER.
The cough and congestion are going to be normal, and there’s unfortunately no medicine that really works. There have been really good studies on cough medicines that show they don’t have any benefit for kids, and they can actually cause more side effects with the heart and lungs.
Plus, you have this little debris in your lungs, and the goal of the body is to get that debris out, so they actually have to keep coughing.
Now with RSV, we know that children are always going to get sicker on either Day 3, 4 or 5 and then they gradually start getting better. But the cough, even after the virus dies in seven to 10 days, you still have that debris in your lungs. The cough will often continue for 14 to 21 days, which is really frustrating for parents because they don’t understand why the cough is just not going away.
Lots of flu cases this season. What can parents do? Because sometimes kids get fevers, and parents get really worried about fevers.
The biggest fear is always the fever. Influenza is going to cause fevers, and it’s going to cause fevers typically in young kids of 103 to 105. And that’s a typical temperature.
So, it’s very scary for parents when they see a temperature of 104-105 because people have so often been taught that high fevers cause seizures or that high fevers cause brain damage, but they don’t.
The fever is the body’s defense to kill off the virus. I actually try to tell parents not so much to treat the fever, but to treat how their child looks and feels.
For example, if a child has a 102 fever but is running around playing, it’s better to have the fever because it helps kill off the virus. If the fever is 101, but [the child looks] miserable and feel miserable, then I tell them, “Hey, give them a little Motrin or Tylenol so they feel better while their body fights it off.”
The thought behind fevers causing seizures is that we do have some genetic conditions that cause febrile seizures. But the amazing thing about febrile seizures is that they only happen on the first day. If you didn’t have a seizure on the first day, it’s not going to happen as a febrile seizure.
If the fever was causing febrile seizures, and the child still has fevers for seven to 10 days, you would expect the fevers to cause seizures every day, but they don’t. It only happens on the first day, which shows you it’s not really the fever causing it; it’s usually a genetic predisposition.
If my child has RSV symptoms, is there a window to get the vaccine?
The time to get the vaccine is beforehand, and that’s the key — trying to get it beforehand. But looking forward, especially for really young children, we now have a good vaccine that’s going to help prevent these symptoms.
Because especially in little babies, if they get it, it really puts them at high risk. So, getting them vaccinated is something that can be lifesaving for a lot of these children.
We talked about waiting out RSV, but for the flu, any recommendations on how to move that along quicker?
The biggest thing for the flu is — especially kids who are high risk, under age 2, with seizure disorders, asthma, heart conditions, any kind of cancers — if we catch it in the first 48 hours, we can start them on Tamiflu.
Tamiflu is a medication. We have no medication that kills a virus, so we have medications that decrease growth. The idea behind Tamiflu is to start it within the first 48 hours to decrease how much of the virus grows in their body. Theoretically, they may not get as sick because there’s less of it growing.
The other advantage is that the flu normally lasts on average seven to 10 days. If a child is going to have it for nine days, with Tamiflu they might only have it for eight days, or seven days.
Now, with vaccination rates for RSV or the flu, has that changed at a time when Americans are more skeptical about getting a vaccine?
Vaccination rates have dropped significantly. And that’s one of the reasons we’re seeing this increase in the flu and why we’re expecting a stronger flu season.
We’ve seen vaccination rates continue to dwindle after COVID. That leaves opportunities for these viruses to grow and create other subclades, because we’ve decreased herd immunity. That allows the viruses to gain a foothold and continue to spread.
Are there different recommendations for the elderly for RSV or the flu?
I do pediatrics, so I know more about the pediatric side. I do know for the elderly there is a vaccine to help, because as we get older, our immune system changes and we have more trouble with breathing. [Note: The CDC recommends a dose Arexvy, Abrysvo or mResvia) for ages 75 and older or ages 50 to 74 with increased risk.]
Trying to prevent elderly people from getting it — especially if they have grandkids and are going to be around grandkids — it’s a great idea to get vaccinated.
