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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.

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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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Flu shots are now free for everyone in Quebec due to overwhelmed hospital ERs

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While the campaign for flu shots has already been underway in Quebec for several weeks, the provincial government announced on Friday that immunization will now be free of charge for any Quebecer over the age of six months.

Previously, only people who met certain criteria (babies, seniors, the chronically ill, etc) were able to get the influenza immunization free of charge, and the vaccination sites set up for COVID-19 were only handling free flu shots. Meanwhile, the general population in Quebec was previously only able to get vaccinated at pharmacies, for a fee.

The decision was made due to the critical state of hospital ERs in the province, particularly at children’s hospitals in Montreal, where kids are being brought in by parents in larger numbers than usual due to rising rates of flu, COVID-19 and RSV infections.

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“With the trio of viruses currently circulating, the influenza vaccine is now available free of charge to all Quebecers who wish to take advantage of it. It’s one more tool to limit the pressure on our network.”

—Quebec Health Minister Christian Dubé

To schedule an appointment for a flu shot and/or a COVID-19 shot, please visit the Clic Santé website.

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Deadly Bird Flu Outbreak Is The Worst In U.S. History

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An ongoing outbreak of a deadly strain of bird flu has now killed more birds than any past flare-up in U.S. history.

The virus, known as highly pathogenic avian influenza, has led to the deaths of 50.54 million domestic birds in the country this year, according to Agriculture Department data reported by Reuters on Thursday. That figure represents birds like chickens, ducks and turkeys from commercial poultry farms, backyard flocks and facilities such as petting zoos.

The count surpasses the previous record of 50.5 million dead birds from a 2015 outbreak, according to Reuters.

Separately, USDA data shows at least 3,700 confirmed cases among wild birds.

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Turkeys in a barn on a poultry farm.
Turkeys in a barn on a poultry farm.

Turkeys in a barn on a poultry farm.

On farms, some birds die from the flu directly, while in other cases, farmers kill their entire flocks to prevent the virus from spreading after one bird tests positive. Such farmers have occasionally drawn condemnation from animal welfare advocates for using a culling method known as “ventilation shutdown plus,” which involves sealing off the airways to a barn and pumping in heat to kill the animals.

The virus has raged through Europe and North America since 2021. A variety of wild birds have been affected worldwide, including bald eagles, vultures and seabirds. This month, Peru reported its first apparent outbreak of highly pathogenic avian influenza after 200 dead pelicans were found on a beach.

Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.
Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.

Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.

The migration of infected wild birds has been a major cause of the spread. Health and wildlife officials urge anyone who keeps domestic birds to prevent contact with their wild counterparts.

While health experts do not generally consider highly pathogenic avian influenza to be a major risk to mammals, a black bear cub in Alaska was euthanized earlier this month after contracting the virus. Wildlife veterinarian Dr. Kimberlee Beckmen told the Juneau Empire newspaper that the young cub had a weak immune system.

Over the summer, avian flu also spread among seals in Maine, which the National Oceanic and Atmospheric Administration believed contributed to an unusually high number of seal deaths.

The Centers for Disease Control and Prevention states that the risk “to the general public” from the bird flu outbreak is low. However, the agency recommends precautions like wearing personal protective equipment and thoroughly washing hands for people who have prolonged contact with birds that may be infected.

In April, a Colorado prisoner working at a commercial farm became the first person in the U.S. to test positive for the new strain, though he was largely asymptomatic.

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Successful tests in animal models pave way for strategy for universal flu vaccine

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An experimental mRNA-based vaccine against all 20 known subtypes of influenza virus provided broad protection from otherwise lethal flu strains in initial tests, according to a study.

This could serve one day as a general preventative measure against future flu pandemics, the researchers from University of Pennsylvania, US, said.

According to the study, tests in animal models showed that the vaccine dramatically reduced signs of illness and protected from death, even when the animals were exposed to flu strains different from those used in making the vaccine.

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The “multivalent” vaccine, which the researchers described in a paper published in the journal Science, used the same messenger ribonucleic acid (mRNA) technology employed in the Pfizer and Moderna SARS-CoV-2 vaccines, the study said.

This mRNA technology that enabled those Covid-19 vaccines was pioneered at Penn, the study said.

“The idea here is to have a vaccine that will give people a baseline level of immune memory to diverse flu strains, so that there will be far less disease and death when the next flu pandemic occurs,” said study senior author Scott Hensley.

Influenza viruses periodically cause pandemics with enormous death tolls. The best known of these was the 1918-19 “Spanish flu” pandemic, which killed at least tens of millions of people worldwide.

Flu viruses can circulate in birds, pigs, and other animals, and pandemics can start when one of these strains jumps to humans and acquires mutations that adapt it better for spreading among humans.

Current flu vaccines are merely “seasonal” vaccines that protect against recently circulating strains, but would not be expected to protect against new, pandemic strains. The strategy employed by the Penn researchers is to vaccinate using immunogens – a type of antigen that stimulates immune responses – from all known influenza subtypes in order to elicit broad protection, the study said.

The vaccine is not expected to provide “sterilizing” immunity that completely prevents viral infections. Instead, the new study showed that the vaccine elicited a memory immune response that can be quickly recalled and adapted to new pandemic viral strains, significantly reducing severe illness and death from infections.

“It would be comparable to first-generation SARS-CoV-2 mRNA vaccines, which were targeted to the original Wuhan strain of the coronavirus.

“Against later variants such as Omicron, these original vaccines did not fully block viral infections, but they continue to provide durable protection against severe disease and death,” said Hensley.

The experimental vaccine, when injected and taken up by the cells of recipients, started producing copies of a key flu virus protein, the hemagglutinin protein, for all twenty influenza hemagglutinin subtypes—H1 through H18 for influenza A viruses, and two more for influenza B viruses.

“For a conventional vaccine, immunizing against all these subtypes would be a major challenge, but with mRNA technology it’s relatively easy,” Hensley said.

In mice, the mRNA vaccine elicited high levels of antibodies, which stayed elevated for at least four months, and reacted strongly to all 20 flu subtypes. Moreover, the vaccine seemed relatively unaffected by prior influenza virus exposures, which can skew immune responses to conventional influenza vaccines.

The researchers observed that the antibody response in the mice was strong and broad, whether or not the animals had been exposed to flu virus before.

Hensley and his colleagues currently are designing human clinical trials, he said. The researchers envision that, if those trials are successful, the vaccine may be useful for eliciting long-term immune memory against all influenza subtypes in people of all age groups, including young children.

“We think this vaccine could significantly reduce the chances of ever getting a severe flu infection,” Hensley said.

In principle, he added, the same multivalent mRNA strategy can be used for other viruses with pandemic potential, including coronaviruses.

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