Infectious Disease

The US sees a late spike in RSV amid the decline in COVID-19

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Meissner does not report any relevant financial information.

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Respiratory syncytial virus cases have risen in recent weeks – months later than the traditional seasonal high of the common respiratory virus – according to the CDC, which can lead to serious infections in infants and older adults.

We spoke to H. Cody Meissner, MD, Head of the Department of Pediatric Infectious Diseases and Professor of Pediatrics at Tufts University School of Medicine on the late surge and what it could mean for clinicians.

Cody Meissner quote

Healio: What is driving the current top in RSV?

Meissner: The COVID-19 pandemic has changed much of what was considered normal behavior for both humans and viruses. The epidemiology of RSV, as well as other respiratory viruses such as influenza viruses, has changed dramatically in the past 12 to 18 months.

The explanation for the change in respiratory virus epidemiology is not clear because so much has changed. Perhaps the change can be explained by masking, decreased interaction with family members, greater attention to hand hygiene, reluctance of parents to seek medical help for fear of SARS-CoV-2 exposure, or reduction in childcare. Possibly a poorly understood interaction between two respiratory viruses that use the same upper airway entry portal – SARS-CoV-2 and RSV – makes infection less likely to occur. Whatever the reason, there has been a significant reduction in bronchiolitis cases around the world.

In most areas of the United States, RSV activity begins to increase in late fall, peaks in winter months, and decreases in spring. This year, activity has been remarkably slow in typical months, increasing in May, while COVID-19 evidence has waned following widespread adoption of the vaccine. Since the normal pattern of seasonal RSV disease cannot be fully explained, the explanation for a late peak in RSV activity has yet to be established.

Healio: What clinical implications could a later increase in RSV have?

Meissner: The pediatric admissions impact on pediatric hospitals is unlikely to be as profound as it normally is in the winter months, when 50,000 to 100,000 infants in the first year of life are admitted for a brief hospital stay. The overall low number of hospital admissions for bronchiolitis suggests a small likelihood of an increase in admissions during the summer months. In addition, the latest CDC data suggests that the late peak of RSV approvals may already be in decline.

Healio: Where is RSV on the list of infections in humans that need a vaccine?

Meissner: The high burden of RSV disease, particularly in children in their first year of life and adults over 65 years of age – especially those with comorbidities – shows the urgent need for safe and effective RSV vaccines for use in different age groups. Another very promising approach to control RSV infection in infants is a single injection of a monoclonal antibody with a long half-life given during or before the start of the RSV season.

References:

CDC. RSV national trends. https://www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html. Accessed May 18, 2021.

CDC. RSV trends and monitoring. https://www.cdc.gov/rsv/research/us-surveillance.html. Accessed May 18, 2021.

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