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Spring may have arrived, but worries about respiratory illnesses persist, with respiratory syncytial virus (RSV) cases emerging later than anticipated and a new COVID-19 variant making its way across the nation.
The Centers for Disease Control and Prevention (CDC) recently noted that RSV has been showing up later than usual across many parts of the United States.
“This atypical timing suggests that elevated RSV activity might persist into April in several areas. Emergency room visits and hospital admissions for RSV are most frequent among infants and children under four years old,” the agency reported.
For the majority, RSV manifests as a mild, flu-like illness. However, it poses a significant risk to young children and the elderly, potentially leading to severe symptoms and hospitalization, sometimes necessitating ventilator support.
“Unlike some other viruses, individuals remain quite contagious throughout the duration of their RSV infection. So, if a child with RSV is coughing and attends daycare, all the other children are at risk of exposure. It’s certainly one of those illnesses we are concerned about,” explained Sarah Nosal, a physician and president of the American Academy of Family Physicians.
There are currently no treatments specifically indicated for RSV, though preventive treatments have been approved in recent years.
RSV vaccines are available to seniors and pregnant women, with administration to expectant mothers believed to confer some protection to their children before they are born. An RSZV monoclonal antibody is also available for infants and young children.
Nosal noted this past respiratory viral season was also unique in how the flu behaved.
“Flu sort of had two spikes this year in that we had an early flu A,” she said. “We had what we predicted, and then had a late flu B as well, where we had lots of patients. And I saw those patients in the last month or so who were still getting this tail end of influenza B.”
The strain that circulated later in the season was dubbed a “super flu” in the media. However, physicians emphasized that it was just another strain of the influenza virus, one that presented with somewhat more severe symptoms and appeared to evade immune protection more effectively.
As states deal with a late RSV season, more are also detecting cases of the so-called “cicada” variant of COVID-19, with 25 now reporting the strain. According to the CDC, COVID-19 activity remains low, but some aspects of this strain are of concern.
“This ‘cicada’ variant has had more mutations in the spike protein, which makes it a bit more different. It’s a more distant cousin, and therefore it’s able to evade some of the protection that we’ve had from prior infections and from prior vaccinations. So, it’s finding a place out there and being able to spread,” said William Schaffner, professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine.
“Fortunately, it’s not more severe,” he added. “It’s likely to be a variant that is included the next time the covid vaccine is updated.”
Nosal added that the extra mutations observed in the “cicada” variant, while likely giving it more of an ability to evade the immune system, also indicate it’s ultimately less able to cause infection.
“The actual mutations don’t match as well to like human cellular morphology. It doesn’t kind of match and infect ourselves as easily,” she said.
Schaffner lamented that this past season was affected by the mass layoffs at the CDC carried out by the Department of Government Efficiency.
A study published this year found that among the nearly 40 CDC databases that were no longer being updated, 87 percent were vaccine-related. Among the remaining stagnant databases, four out of five pertained to respiratory diseases.
While respiratory viruses from the winter continue to circulate, springtime allergies are also beginning to hit people, which could play a role in how individuals are affected by lingering viruses.
“There are research studies that show just being exposed to pollen and other allergens, even if you personally don’t get allergy symptoms, increases your inflammation in your mucosal membranes and makes you more vulnerable to viral illnesses,” said Nosal.
She noted that many people are prone to dismissing respiratory virus symptoms for allergies during this time of year and advised that they still test themselves if they’re feeling unwell.
Due to the late RSV season, many state and local health departments have extended their RSV seasons and the immunization window for children, at least until the end of April. Schaffner advised that parents consider these options despite it being past the typical respiratory viral season.
“RSV continues to be the leading cause of hospitalization in young infants, so being able to prevent that is very important,” Schaffner said. “And since the RSV season is extending, the recommendations have been to pediatricians and parents to still consider even though it’s kind of late in the season.”
Both Schaffner and Nosal said planning for each respiratory viral season is essential to better outcomes for people.
“For my chronically ill patients, I’m going to see them in three months. So I’m going to start seeing them again as we start to think about starting vaccination for the fall,” said Nosal.