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Respiratory syncytial virus activity is on the rise in the Southeast, and with numbers ticking up over recent weeks the Centers for Disease Control and Prevention is warning that numbers are likely to rise nationally over the next several months.

Historically, such regional increases have predicted the beginning of RSV season nationally, with increased activity spreading north and west over the following two to three months. RSV can cause severe disease in infants, young children and older adults, the CDC said.

In anticipation of this trend, the CDC is encouraging clinicians to prepare to implement new RSV prevention options. Monoclonal antibody products, including a new, long-acting product called nirsevimab (Beyfortus, Sanofi and AstraZeneca), are available to protect infants and some young children at higher risk for severe RSV disease. 

For all infants younger than 8 months, and infants and children ages 8–19 months who are at increased risk of severe RSV, clinicians should start to offer nirsevimab when it becomes available, which is expected to be by early October, according to the agency.

Additionally, two new vaccines are available to protect older adults from severe RSV disease. For adults ages 60 years and older, clinicians should offer a single dose of an RSV vaccine, either RSVPreF3 (Arexvy, GSK) or RSVpreF (Abrysvo, from Pfizer), based on shared clinical decision-making between the provider and the patient. Clinicians should also talk to their patients about other vaccines available this fall to help prevent respiratory infections.

The CDC added that clinicians should consider testing symptomatic patients with high-risk conditions for COVID-19, influenza and RSV to inform treatment decisions. Healthcare personnel, childcare providers and staff at long-term care facilities should stay home and not go to work when they have fever or symptoms of respiratory infection; this is to reduce the spread of all respiratory infections, including RSV.

WHAT’S THE IMPACT?

RSV is an RNA virus, and transmission occurs primarily via respiratory droplets when a person coughs or sneezes, or through direct contact with a contaminated surface. Infants, young children and older adults, especially those with chronic medical conditions, are at increased risk of severe disease from RSV infection.

The CDC estimates that, every year, RSV causes about 58,000-80,000 hospitalizations and 100-300 deaths in children younger than 5, as well as 60,000-160,000 hospitalizations and 6,000-10,000 deaths among adults 65 and older.

In the U.S., the annual RSV season has historically started in the fall and peaked in winter. However, this pattern was disrupted during the COVID-19 pandemic, likely due to public health measures to reduce the spread of COVID-19 that also reduced the spread of RSV, the CDC said.

THE LARGER TREND

The CDC said in January that the rise of respiratory diseases during the 2022-23 winter season was likely the direct result of the COVID-19 pandemic. In the past two years, respiratory viral disease activity has been highly impacted by COVID-19, resulting in the circulation of other viruses, according to Dr. Jose Romero, director of the CDC National Center for Immunization and Respiratory Diseases.

“We suspect that many children are being exposed to some respiratory viruses now for the first time, having avoided these viruses during the height of the pandemic,” Romero said during a December 2022 CDC news conference.

RSV is a common respiratory illness with no specific treatment beyond supportive care. Most children are able to recover at home, but the disease can lead to bronchiolitis or pneumonia in babies and toddlers.
 

Twitter: @JELagasse
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