Iowa sees sharp increase in respiratory illness in children

After largely avoiding spikes of cases for the last two years, pediatric clinics and hospital floors are seeing a sharp rise in RSV — respiratory syncytial virus — among children.

The latest numbers from Iowa’s Respiratory Virus Surveillance Report showed 938 cases of the virus, a sharp increase from 155 cases in the first week of October.

In Cedar Rapids alone, the uptick in positivity rates and hospitalizations of children has given doctors new cause for concern with a virus that’s been around for several decades, with tendencies to spike in the winter.

“We’ve had very high numbers, as have pretty much all pediatric units in the state,” said Dr. William Ching, pediatric hospitalist at UnityPoint Health-St. Luke’s Hospital in Cedar Rapids. “We’re seeing higher severity, particularly among toddlers. I think it’s going to be a long season.”

When he started to notice the increase of cases in September — earlier than usual — the positivity rate for RSV was under 10 percent. By early November, it spiked to 43 percent.

Usually, spikes in RSV start to show up around December and January. But just as concerning to Ching is the fact that he’s seeing more children over age 2 getting bad cases of the virus, which disproportionately affects young children. This year, he’s admitted about twice as many patients over age 2 compared with previous years.

Pediatricians are seeing the increase on the clinical side, too. As parents contend with COVID-19 and the flu, RSV is just another concern piled on top as the holiday season arrives.

“We’re having a lot more kiddos come in with viral-type symptoms,” said Dr. Amy Schumacher, pediatrician at Mercy Pediatric Clinic in Cedar Rapids. “It’s definitely making our clinics busier.”

Recognize the symptoms

As a respiratory virus, RSV symptoms overlap with many general cold and flu symptoms — fever, congestion, runny nose, decreased appetite, coughing, sneezing and wheezing.

But unlike those other symptoms, there are a few critical symptoms indicating respiratory distress that parents should watch for in babies and young children: flaring of the nostrils, audible grunting during breathing and head bobbing. Other warning signs, such as a child’s belly going up and down while breathing, indicate the child is struggling to breathe as the body uses accessory muscles in the diaphragm.

Dehydration is a risk with RSV, and children who aren’t feeling well generally won’t eat as much or can’t keep food down. For babies, a rule of thumb indicating dehydration is less than three wet diapers in a 24-hour period — or less than one about every eight hours.

When to seek medical attention

In addition to symptoms of respiratory address listed above, fevers that are not getting better or lasting more than five days are an important reason for a child to see a primary care provider.

“In order to be admitted, one has to have significant respiratory distress. We evaluate kids in terms of how fast they’re breathing and whether they’re showing retractions, oxygen saturation, using belly muscles,” said Ching.

Instead of using pulse oximeters to measure breathing, he recommends paying attention to breathing patterns and skin color changes as a more reliable indicator — children whose skin takes on a gray or blue tone should be evaluated immediately.

For children with milder symptoms, supportive measures at home will be helpful. Nasal saline suction can clear noses, acetaminophen or ibuprofen can ease pain and a cool mist humidifier can reduce discomfort. Most typical symptoms peak within three to five days, though a cough can last up to six weeks in children and longer in adults.

“Once they get sick, there’s nothing we can do to change the course of trajectory of the illness,” said Schumacher.

Ching said the hospitalization rate for RSV and the flu is much higher than it is for COVID-19 in young children.

How to reduce your family’s risk

As families gather for the holidays, Schumacher recommends a simple rule that can go a long way: have relatives refrain from kissing babies.

“It’s such an easy way to spread a virus that can be really dangerous for a baby and mild in adults,” she said. “It’s one easy step to avoid having their child admitted in the hospital for RSV.”

Additionally, keep babies away from adults with mild cold symptoms, like a runny nose, as much as possible.

Another easy step is ensuring every member of the family gets their flu shot as soon as possible with a doctor or pharmacy.

Other preventive measures are straight from the COVID-19 play book: keep your distance from sick people, wash your hands frequently and consider wearing a mask. Avoid touching your eyes, nose and mouth, and cover your cough.

Parents with children in day care should prepare for a higher risk.

“If they’re in day care, they will almost certainly get it just because of how prevalent it is in the community and how hard it is to keep kids apart,” said Ching.

It’s hard to say for sure why RSV is coming back with a vengeance this year, Ching said.

For the last two winters, pandemic mitigation measures worked against RSV in addition to combating COVID-19. People were masking more and avoiding large gatherings during the holidays before a large portion of the population had access to a COVID-19 vaccine.

University of Iowa conducting vaccine trials

Soon, an RSV vaccine could be available. The University of Iowa is currently participating in a Pfizer vaccine trial with 140 participants.

Pfizer and GlaxoSmithKline have signaled strong enough efficacy rates in vaccine trials to ask for approval from the U.S. Food and Drug Administration, according to Dr. Pat Winokur, executive dean in the Carver College of Medicine at the University of Iowa.

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