Stock up on the Kleenex, because sniffling, sneezing, and coughing are back in full force. After a sharp decrease in the number of respiratory virus cases during the early part of the pandemic, seasonal viruses are back with a vengeance; and they’re hitting babies and toddlers hard. Respiratory syncytial virus (RSV) — a seasonal virus that can be very serious for infants and young children in particular — is surging in parts of the country. In Montreal, 15 per cent of people tested are positive with the virus while the national average is approximately 3.5 per cent. And the emergency rooms of children’s hospitals in Montreal are well over capacity.
What is respiratory syncytial virus?
Respiratory syncytial virus usually circulates between late fall and early spring, but in 2021 and 2022 an increase in cases was observed as early as August.
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. Babies under 12 months are 16 times more likely to be hospitalized for RSV than the flu.
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. On October 26, 2022, Sainte-Justine Hospital and The Montreal Children’s Hospital were reporting Emergency Room occupancy at 150 and 225 per cent respectively.
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 — inflammation of small airways in the lungs, 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 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, The Canadian Paediatric Society (CPS) 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, avoid taking young babies into crowded areas or having contact with sick people. Also, clean and sanitize surfaces and toys regularly, make sure kids are not exposed to smoke, and ensure they have 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 its 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 and COVID boosters will help protect ourselves and at-risk children from RSV and other viruses.
The Montreal Children’s Hospital (MCH) reminds parents that there are alternatives to the emergency department when their child is sick, but the case is not urgent. The MCH recommends calling the Info-Santé 811 telephone line to speak to a nurse, contacting their family doctor for a consultation or a walk-in clinic through the Québec Medical Appointment Scheduler portal. In addition, those Montreal kids up to the age of 17 who do not have a family doctor, can contact the Guichet d’accès à la première ligne (GAP) by calling 514-890-6111.
