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RSV Symptoms, Transmission and Treatment

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Before the Covid pandemic, most people caught respiratory syncytial virus before the age of 2. Now things have changed.

You may have seen respiratory syncytial virus, or R.S.V., in the news recently, as rates of the virus have ticked up across the United States. R.S.V. usually circulates from late December to mid-February. But this year, an early spike in cases is resulting in markedly higher numbers of infections and hospitalizations.

As rising R.S.V. rates coincide with the expected wintertime surge in Covid-19 as well as an early flu season, experts are worried about a “tripledemic” and the strain it could place on hospitals and emergency departments that are already stretched thin.

Here’s what to know about R.S.V., who is most at risk and what you can do to avoid getting sick.

R.S.V. is a common winter virus that typically causes mild cold-like illness in most people, but can occasionally be very dangerous for young children and older adults, said Emily Martin, an associate professor of epidemiology at the University of Michigan School of Public Health.

“The youngest infants have a high risk of coming into the hospital in what we call their first R.S.V. season,” Dr. Martin said. “If a child is born in the summer and they get exposed for the first time in the winter, they are at risk of having more serious disease. But many infants didn’t experience the first R.S.V. season on the regular schedule that they would have, particularly if they were born in or after 2020.”

In a normal prepandemic year, 1 to 2 percent of babies younger than 6 months with an R.S.V. infection may need to be hospitalized. And virtually all children have gotten an R.S.V. infection by the time they are 2 years old.

But many experts believe masking, social distancing, school closures and other precautions taken during the first year or two of the pandemic protected most children from exposure to the virus and other germs. “As a result, there are still many children who are less than 3 years old who’ve never been exposed to R.S.V.,” said Dr. James Antoon, an assistant professor of pediatrics and pediatric hospitalist at Monroe Carell Jr. Children’s Hospital at Vanderbilt University in Nashville, Tenn. “The virus is now playing catch-up in all these kids.”

They can. “Adults still get R.S.V. fairly regularly and they can get reinfected multiple times throughout adulthood,” Dr. Martin said. Because adults already have a lot of antibodies against the virus from previous exposures, their illness tends to be much milder. In fact, it can be almost indistinguishable from the common cold or even a mild case of the flu or Covid-19, she said.

Most adults with R.S.V. are able to shake off an infection in a week or two, but seniors and those who have weakened immune systems, as well as those with chronic lung or heart disease, can develop more severe cases. According to the Centers for Disease Control and Prevention, an estimated 177,000 older adults are hospitalized with R.S.V. each year and 14,000 of them die.

In adults and children, R.S.V. typically causes mild symptoms like a cough, runny nose and fever. These appear gradually, four to six days after getting exposed. In young babies, the only signs of an infection may be general lethargy, irritability and a decreased appetite, said Dr. Priya Soni, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s in Los Angeles. Parents should also be on the lookout for signs that their child is having difficulty breathing, Dr. Soni said. For example, if an infant or toddler is breathing faster than usual, if you notice more of their ribs or belly moving as they breathe or if their nostrils are flaring, those are all signs that you should take them to see a doctor.

Young children tend to struggle more, not just because their immune systems are still learning to recognize and fight off viruses, but also because their airways are so small, Dr. Soni said. An R.S.V. infection can dramatically increase mucus secretions in the airways, which older children and adults are able to cough or sneeze out. But infants and toddlers do not yet have strong enough muscles to cough up all the extra fluid, so parents or health care providers need to do the job for them by suctioning their airways.

If mucus collects in the small airways in the lungs, it can cause blockages and inflammation known as bronchiolitis, which is one of the most common complications that results in hospitalization. Another outcome of severe R.S.V. in young children is pneumonia. Several studies have also linked severe R.S.V. to an increased risk of recurrent wheezing and asthma later in life. “R.S.V. can be extremely disruptive to young lungs,” Dr. Martin said.

Those at highest risk for severe infections include premature infants, babies under 6 months of age, infants and toddlers with chronic lung disease or congenital heart disease, as well as children with weakened immune systems and those who have neuromuscular disorders that make it difficult to clear out mucus.

There are rapid antigen tests and P.C.R. tests to check for R.S.V., but they are typically reserved for young children or older adults, because there is no treatment for an infection if you do not need hospitalization, Dr. Soni said. If a patient is showing signs of a severe infection, a health care provider may also check their breathing with a stethoscope and order a white blood cell count or other tests, such as a chest X-ray or CT scan.

Unlike Covid, R.S.V. can spread when people touch contaminated surfaces. It also spreads through respiratory droplets, Dr. Martin said. So it’s a good idea to disinfect surfaces, particularly in settings like day care centers, where young children are constantly touching things, sneezing on things and sticking them in their mouths.

Premature infants and children with certain medical conditions can also take a monthly monoclonal antibody medication called Palivizumab during R.S.V. season to help keep them out of the hospital.

Although several vaccines in clinical trials have started to show promise for R.S.V., none are available yet. That’s why experts recommend more general measures to prevent infection, such as frequent hand-washing — and for those who are sick, staying home.

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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