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02 Oct, Sunday
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Montreal Families

Respiratory virus surging in Montreal

Stock up on the Kleenex, because sniffling, sneezing, and coughing are back in full force. While fall 2021 has seen a decrease in the number of COVID-19 cases, and brought about a gradual relaxation of restrictions, another respiratory virus that was virtually absent since the start of the pandemic has come back with a vengeance. And it’s hitting babies and toddlers hard.

What is respiratory syncytial virus (RSV)?

Respiratory syncytial virus (RSV) usually circulates between late fall and early spring, but this year an increase in cases was observed as early as August, with Dr. Horacio Arruda, Director of Public Health in Quebec, saying in late September that the virus was becoming a problem in the province.

Highly contagious, RSV is spread the same way as the common cold: through droplets containing the virus when someone coughs or sneezes, and can also live on surfaces such as toys, doorknobs, and hands, making it easy to transfer by someone who is infected. While similar to coronavirus in how it is transmitted, it contrasts in who is most affected, with children being more vulnerable to complications than adults.

While RSV infections are the common cause of lower respiratory tract infections among young children — with almost all children getting the virus at least once before they turn 2 — it can cause severe symptoms in some cases and is the leading cause of hospitalizations in children under the age of 1.  

The Public Health Agency of Canada notes that increased risk for RSV hospitalization has been associated with infants born premature, and those with chronic lung disease, congenital heart disease, and other chronic conditions including cystic fibrosis and immunodeficiency. According to the ReSViNET Foundation, an international non-profit committed to reducing the global burden of RSV infection, approximately 33.8 million episodes of RSV-associated acute lower respiratory infections occur in children worldwide every year.

For most, symptoms of RSV infection are indistinguishable from the common cold and may include a stuffy or runny nose, sore throat, mild headache, cough, decreased appetite, irritability, or fever. Older children and adults can contract RSV every few years but do not usually get very sick.

A rise in cases

Noting the “near-total disappearance of RSV and influenza cases” since the beginning of the pandemic, a report in the Canadian Medical Association Journal warned of the resurgence of RSV in Canada as children returned to schools and daycares in late summer, and pandemic-related physical distancing measures relaxed. Comparisons of RSV tests showed a drastic difference in the number of positive RSV cases, with 18 860 cases pre-pandemic versus 239 during the height of the crisis.

Another factor that may be contributing to the increase is infants’ reduced immunity to RSV because pregnant individuals were less likely to have been exposed to RSV during the pandemic, resulting in a lack of maternal antibodies being transferred to their babies. This raises the possibility that infants are less well protected than usual and could become sicker if infected.

As a result of loosening health restrictions and this lowered immunity, RSV is spreading rapidly among children, presenting a burden to parents and emergency rooms.

When to seek help

While RSV is usually mild and does not require treatment besides resting at home, in young children, their small airways may cause more severe symptoms. Infants in their first year of life and those with underlying health conditions are more likely to experience severe infections such as bronchiolitis or pneumonia and require hospitalization.

Symptoms that require medical treatment include increased breathing rate, retractions (where the chest pulls in with each breath, especially around the collarbone and around the ribs), wheezing or whistling while breathing, lethargy, or a persistent cough. If a child shows any of these signs and has difficulty breathing, take your child to the emergency department.

Treatment for RSV is focused on helping children with their breathing (for example, with suctioning and oxygen supplementation), fluids through a nasogastric tube or by IV, and respiratory support. While there are no active vaccines for RSV, some high-risk populations may receive monthly doses of the monoclonal antibody Palivizumab during RSV season.

What parents can do

To reduce your child’s chances of contracting a respiratory virus, Dr. Horacio Arruda, Quebec’s public health director, says the sanitary methods we’ve been using to prevent the spread of COVID-19, like practicing good hand washing to prevent the spread of germs and wearing masks, may help. “That’s why we’re asking, especially in situations where there is contact with babies and small children, for people to wear masks,” he said.

The Canadian Paediatric Society (CPS) also advises parents to keep babies under 6 months old away from people with colds, breastfeed so that babies receive antibodies, wash their children’s hands often, make sure they are not around smoke, and have their child receive all recommended immunizations. “Vaccines won’t prevent your child from getting RSV or other viruses that cause colds, but they will protect your child from some of the complications a cold can cause,” CPS states on their website.

As we approach the usual time of year when cases of colds, flu strains, and respiratory viruses are circulating, practicing good sanitary measures as well as getting our flu vaccines will help protect ourselves and at-risk children from RSV and other viruses.

Related reading:

Pediatric ER departments overwhelmed

Children’s emergency rooms remain open

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