An unusual summertime respiratory syncytial virus (RSV) outbreak began in May and continues as we head into fall.

Published: October 4, 2021 | Updated: March 1, 2022

The respiratory syncytial virus (RSV) outbreak of 2021 brought unprecedented summertime levels of the infection to states like Kentucky, raising some concerns about the traditional cold-weather season for RSV.

At Norton Children’s, health care providers are seeing some children infected with both RSV and COVID-19, said Kristina A. Bryant, M.D., physician with Norton Children’s Infectious Diseases, affiliated with the UofL School of Medicine, hospital epidemiologist at Norton Children’s Hospital.

RSV diagnoses peaked at about 300 a week at Norton Children’s Hospital and Norton Children’s Medical Group pediatricians’ offices in August.

“RSV cases are starting to trend down as we head into fall, but RSV has not disappeared. Some experts fear that we could be in for a prolonged RSV season as we head into the months in which we traditionally see RSV,” Dr. Bryant said.

Children born during or just before the start of the pandemic likely didn’t get exposed to RSV while isolating from the coronavirus that causes COVID-19. That’s reflected in the low rates of RSV before May 2021. Now, more children are out and about, so more of them are picking up RSV, causing an outbreak.

Children who are infected with one more virus at a time sometimes develop more severe symptoms that children infected with a single virus.

A panel of experts convened by the Academy of Medical Sciences in the United Kingdom warned that RSV and flu in the coming winter could be about twice the magnitude of a normal year and could overlap with a surge in COVID-19.

Reduced immunity following a mild RSV and flu season a year ago could contribute to an increase in RSV this fall and flu this winter, according to the Academy.

Even before flu starts making the rounds in the Louisville area, according to Dr. Bryant, Norton Children’s Hospital has seen instances of kids infected with both RSV and the coronavirus that causes COVID-19.

Fever, cough, runny nose and wheezing are all common symptoms of flu, RSV and COVID-19.

RSV in children: How serious is it?

RSV usually causes mild cold symptoms in adults, but can be quite serious in babies and toddlers. Infants, young children and older adults with chronic medical conditions are the most at risk of severe disease due to RSV.

RSV is the most common cause of bronchiolitis and pneumonia in children under age 1 in the U.S. The condition leads to an average of 58,000 hospitalizations, with 100 to 500 deaths among children younger than 5 in the U.S., according to the Journal of the American Medical Association. RSV can cause pneumonia, with respiratory distress and respiratory failure — requiring hospitalization in intensive care. Children born prematurely and those who experience immunity issues due to conditions such as lung diseases, congenital heart conditions or cancer are more at risk.

“There is not currently a vaccination for RSV,” Dr. Bryant said. “However, very specific criteria exist to administer a monthly shot that can help protect premature babies and other children at high risk for RSV.”

What families can do

“The same advice we give to parents during the winter months to prevent respiratory infections like RSV holds true now,” said Scott Bickel, M.D., pediatric pulmonologist with Norton Children’s Pulmonology, affiliated with the UofL School of Medicine. “This includes many of the habits you may have adopted to combat COVID-19 spread.”

Families can take these steps to protect children from RSV:

• Clean and disinfect surfaces at home, especially if someone is sick.
• Wash hands often, especially if you are sick.
• Don’t allow anyone to smoke around a baby.
• Keep your child away from anyone, including household members such as siblings or relatives, who is sick with cold-like symptoms.
• Stay home and keep your child away from crowds.
• If your child is at high risk, try to limit the amount of time spent at day care when RSV rates are high.
• Avoid having family and friends kiss a new baby, and insist on hand-washing before touching or holding the baby.