A wave of babies extremely sick with RSV, or respiratory syncytial virus, is once again filling pediatric beds in Atlanta. While not yet as severe as last fall when hospitals reported being overwhelmed with sick children, it could put the state on track for another wintertime outbreak.
The uptick has arrived at the start of a busy season for respiratory viruses, when flu and COVID-19 cases begin a rise seen in each of the past three fall and holiday seasons.
While the viruses are not all swelling at the same time, doctors are saying now is the time to take advantage of newly approved vaccines and preventative treatments for all three, which can stave off a triple punch of respiratory viruses.
“People remember last year, the ‘tripledemic’ when RSV, flu and COVID all came together,” Dr. James Fortenberry, chief medical officer for Children’s Healthcare of Atlanta said Thursday. “The good news is they are not all happening together. And that gives us opportunities moving forward for adults and kids to get vaccinated against the flu and against the COVID-19 virus.”
This year, for the first time, the FDA approved three new shots to prevent severe RSV infection for both children and adults, a common respiratory virus that can turn serious and even fatal for some. A new monoclonal antibody treatment is available and recommended for all babies under 8 months old who are born during or entering their first RSV season and some high-risk infants up to 19 months of age.
There is also a new RSV vaccine for pregnant women, which gives their newborns protection from the virus, and a vaccine for older adults. Most infants whose mothers received an RSV vaccine do not need to also get an RSV antibody, according to the Centers for Disease Control and Prevention.
The CDC monitors RSV hospitalizations through a voluntary reporting program that includes 58 counties in 12 states. In Georgia, eight metro Atlanta counties report the number of people hospitalized with lab-confirmed cases of RSV.
For the week ending Sept. 30, Georgia’s hospitalization rate was the highest among the dozen states that report data to the CDC. Georgia reported 55 of every 100,000 children under six months old were hospitalized with RSV. That’s down from a rate of 87 per 100,000 in the previous week, though both those figures could be adjusted because there’s a lag in reporting. This time last year, the state’s hospitalization rate for children under 6 months old was 94 out of 100,000.
The risk of hospitalization is highest among infants. The most recent data show children between the ages of 1 and 4 had a lower hospitalization rate of around 18 out of 100,000 in Georgia. That’s still the highest among the participating states, where the overall rate is about 4 per 100,000.
Fortenberry said the rise in RSV cases, followed by an increase in cases of rhinovirus, the cause of many colds, is leading to a “significant rise” in the number of patients who need care across the health system. Urgent care centers and emergency rooms are especially hard hit. He said at Children’s Healthcare of Atlanta, a small number of children with RSV are in the intensive care unit.
While CHOA doesn’t share the specific number hospitalized, Fortenberry said the numbers have been on the rise since August, just like last year. So far, he said the hospital system is able to manage the heavy patient volumes.
RSV is a common virus that usually causes mild, cold-like symptoms. Most recover in a week or two but it can be especially dangerous for preterm infants as well as older adults.
Among U.S. kids under age 5, RSV typically leads to 58,000 hospitalizations and up to 500 deaths in a year. For adults 65 and older, RSV causes 177,000 hospitalizations and 14,000 deaths yearly.
Small children are at particular risk from the virus because it can cause pneumonia and bronchiolitis — that’s when tiny airways swell and fill with mucus and make breathing hard.
Credit: cus
Credit: cus
At a meeting Wednesday between CDC leaders and pediatricians, the American Academy of Pediatrics reported that pediatricians were encouraged to talk to families about RSV immunization for children. Dr. Mandy Cohen, director of the Centers for Disease Control and Prevention, acknowledged logistical and financial barriers that come with the RSV antibody treatment that costs $495 per dose for those with private insurance and $395 in the federal Vaccines for Children Program, according to an account of the meeting by the Academy.
Private insurance companies are expected to eventually cover the cost of RSV shots for children, but for now the payment systems have not been fully ironed out. Parents may have to pay up front and hope to be reimbursed later. Cohen said at the meeting the CDC is encouraging insurance companies to move quickly to cover it because it can prevent the leading cause of infant hospitalization.
For now, Cohen said Medicaid, the Children’s Health Insurance Program and the Vaccines for Children program are covering the RSV shot for children.
The Academy also reported their member pediatricians and the CDC discussed problems with the rollout of the COVID vaccines for children, which have seen distribution delays and insurance challenges. A major issue: pediatricians say they are still waiting for private insurance companies to update billing codes needed to cover the vaccines. For those who must pay out of pocket, the cost can amount to $200 a shot.
Several local pediatricians have told The Atlanta Journal-Constitution they are still waiting for billing codes to be updated and waiting to learn just how much some insurance companies will reimburse for the vaccine.
Dr. Reshma Chugani, a pediatrician with the Atlanta Children’s Clinical Center, said she has never experienced problems like this with a new vaccine. She worries they are missing opportunities to vaccinate children heading into a busy travel season. She is hoping it gets resolved quickly.
“Insurance companies are giant conglomerate corporations and I get that, but they are in the health care business. They are not in the business of selling socks,” Chugani said in an interview. “This is people’s lives. This is really going to affect children, their health, their parents.”
More about RSV
What is it? Respiratory syncytial virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but the threat of serious illness is greatest for infants, older adults and other vulnerable people, who can get serious airway and lung infections.
It’s not just a cold: The symptoms may look like a cold and include a runny nose, cough, and fever. But if an infant’s runny nose and cough turn into more serious breathing trouble, the problem could be RSV, which is potentially life-threatening. In children who were born prematurely and in those with other medical conditions such as lung or heart conditions, an RSV infection can be more severe.
When to call the doctor: Seek medical care if your child has any of the following symptoms of RSV: Difficulty breathing or fast breathing with visible straining of the chest muscles; gray or blue-tinged color around the lips or fingernails; wheezing; lethargy or extreme tiredness; refusal to drink liquids or breastfeed; decreased number of wet diapers
SOURCE: Children’s Healthcare of Atlanta, The Associated Press
