Respiratory syncytial virus cases at Cook Children’s Medical Center in Fort Worth reached an early seasonal peak last week as cold and flu spread among children.
Between Oct. 29 and Nov. 4, 240 patients admitted at Cook Children’s Medical Center tested positive for RSV. That’s a 29% positivity rate out of the 834 children tested — a spike from the previous week.
During the week of Oct. 22 and Oct. 28, tests for the virus came back 25% positive of the 764 patients who were tested.
“We’re seeing our winter spikes earlier, and I have absolutely no idea why,” said Dr. Karen Schultz, medical director of pulmonary services at Cook Children’s.
The pediatric hospital is seeing an increased number of RSV patients in its emergency room, which has resulted in longer wait times.
The health care system also is facing shortages in the newly FDA-approved medication used to prevent the virus — limiting who can receive it.
What is RSV?
RSV is a respiratory virus that typically causes mild, cold-like symptoms such as cough, runny nose and fever. Most children will be infected by the virus by the time they are 2 years old — most recover in a week or two.
The virus sends anywhere from 58,000 to 80,000 children under 5 years old to the hospital each year, according to the Centers for Disease Control and Prevention. If untreated, RSV can become bronchiolitis and pneumonia.
People can prevent the spread of the virus by washing their hands frequently, covering their sneezes and coughs, and staying home when sick. This is especially important as the holiday season closes in, said Schultz.
“Holidays are time for family, and everybody wants to see the new baby, but sometimes you have to be selfish with your infants,” she said.
What medication is used to prevent RSV?
The first preventative treatment for RSV in infants was approved by the Food and Drug Administration in June 1998. The medication, also known as palivizumab, is available only for children born prematurely, at or before 35 weeks, and who are 6 months old or younger at the beginning of RSV season, which occurs in the fall and winter months.
The treatment has to be injected monthly throughout the season, said Schultz.
In July, the FDA approved a new shot to prevent severe respiratory disease caused by RSV in infants and children. The medication, called nirsevimab, is available to children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season. The treatment has to be injected only once to provide five months of protection.
Clinical trials showed that nirsevimab reduces the risk of hospitalization for the virus by 75%.
But, the demand for the medication quickly outpaced the supply.
On Oct. 23, the CDC announced limited availability of nirsevimab. It recommended any available doses be supplied for patients who are prone to severe RSV. The group includes:
- Premature infants
- Infants 6 months and younger
- Children younger than 2 years old with congenital heart disease or chronic lung disease
- Children with weakened immune systems
- Children with neuromuscular disorders
Cook Children’s currently has a limited dose of the new medication.
What to do if your child tests positive for RSV
If your child only has mild symptoms, it is advised you do not bring them to the emergency department.
For mild symptoms, health officials recommend frequent nasal suctioning at home, hydration and check-ups with your children’s pediatrician.
If your child begins to have severe difficulty breathing, faster breathing than normal, turns blue or has become drowsy, call 911 immediately.
Other concerning signs include flared nostrils, wheezing or rattling in their chest, excessive sleepiness, lack of appetite and trouble feeding.
“If you can’t get in to see your child’s primary care physician, then urgent care is the next best place to go,” Kara Starnes, medical director of Cook Children’s Urgent Care Services, said in a statement.
Navigating the shortage
Cook Children’s locations across Tarrant County will continue to prioritize infants at the highest risk to receive nirsevimab. At the health system’s flagship location, infants admitted to the neonatal, cardiology and pulmonology units will receive the injection.
Other eligible patients will receive nirsevimab as it arrives at Cook Children’s locations.
“All areas of Cook Children’s are working diligently to provide this product and to keep our families up to date with the most current information on supply and recommendations,” Dr. Alice Phillips, pediatrician at Cook Children’s Pediatric Cityview, said in a statement. “Cook Children’s Health Care System remains actively engaged to provide this important preventative medication to our most vulnerable infants.”
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