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What Pregnant Women and Parents Need to Know About the ‘Tripledemic’ and RSV

NightLight · January 5, 2023

By Jodi McCaffrey, Pediatrix

After several years of dealing with the COVID-19 pandemic, experts warn that many areas of the country are now experiencing a “tripledemic” of COVID, influenza (flu) and respiratory syncytial virus (RSV), a common childhood illness that can also infect adults. Pregnant women and young children are particularly vulnerable to these viruses. Here’s what you need to know to keep yourself and your family safe.

“Many viruses prefer cold weather because they have a gel coating that breaks down in warm weather. Because of this, most viruses have a ‘season,’” explained Kristina Deeter, M.D, MBA, a pediatric intensivist with Pediatrix® Critical Care and Hospitalist Care of Nevada. “In winter, most of us come indoors and have closer contact with each other, allowing viruses to be rapidly transmitted from person to person.”

This year, the spread of the flu, RSV and other seasonal respiratory illnesses started earlier than usual and is expected to last through the spring. The flu virus typically peaks between December and February. According to experts, the flu infection rate in the United States this year is the highest in 13 years.

“We’re seeing many more cases of flu than we have in the past,” explained Brian G. Gilpin, M.D., MPH, specialty medical officer for the Pediatrix OB Hospitalist Program. “We’re seeing pregnant women in the hospital with the flu, along with very young children and the elderly. This is similar to the H1N1 flu epidemic we saw in 2009, but we aren’t even at the peak yet. This is just the beginning, and it started a little bit sooner than we expected this year.”

The symptoms of the flu can include:

  • Body aches
  • Chills
  • Cough
  • Fatigue
  • Fever
  • Headache
  • Runny or stuffy nose
  • Sore throat

Some people also may experience vomiting or diarrhea, though these symptoms are more common in children.

If you have flu symptoms, call your health care provider immediately. There are prescription antiviral drugs that can treat the symptoms and prevent serious complications. Treatment with an influenza antiviral drug should begin as soon as possible, ideally within 48 hours after symptoms begin.

When to Seek Emergency Medical Care

If you are pregnant and have any of these signs, the Centers for Disease Control and Prevention (CDC) recommends that you call 9-1-1 right away:

  • Trouble breathing or shortness of breath
  • Ongoing pain or pressure in the chest or abdomen
  • Ongoing dizziness, confusion or listlessness
  • Seizures
  • Decreased urine output
  • Severe muscle pain
  • Severe weakness or unsteadiness
  • Fever or cough that improves but then returns or gets worse
  • High fever that stays over 104 F despite Tylenol®
  • Little or no movement from your baby

Because you may also experience other symptoms, be sure to call your doctor for anything unusual or severe.

Flu Facts for Pregnant Women

Unfortunately, the flu is more likely to cause severe illness in pregnant women than in women of reproductive age who are not pregnant, according to the CDC.

“Just being pregnant puts you in a higher risk category for the flu because of changes to your immune system, lungs and heart during pregnancy,” said Dr. Gilpin. “It makes you more susceptible to complications from the flu than the general population. Complications can include respiratory issues and pneumonia, which may require respiratory support in a hospital or ICU.”

The flu can be particularly difficult for women whose pregnancies are complicated by medical issues like high blood pressure or diabetes, Dr. Gilpin said. In addition, research shows that having the flu while pregnant is linked to higher rates of preterm birth and intrauterine death.

Fighting Back Against the Flu

Getting a flu vaccine is the best way to protect pregnant and non-pregnant people from the flu and its potentially serious complications. A new vaccine is developed each year, and the amount of protection provided by the vaccine can vary from year to year. But in general, according to the CDC, vaccination can reduce the risk of flu in pregnant women by up to 50% and reduce a pregnant woman’s risk of hospitalization with flu by 40%. And, if you get a flu shot while pregnant, you’ll help protect your baby from the flu for the first several months after birth, when they are too young to get vaccinated themselves.

The flu vaccine has an excellent safety record. Over the last few decades, millions of pregnant women have safely received the flu vaccination. In fact, the American College of Obstetricians and Gynecologists (ACOG) says it’s safe for pregnant women to get vaccinated against the flu during any trimester of their pregnancies. In addition, it’s safe to get a flu vaccine along with a COVID-19 vaccine or booster and while breastfeeding. Find a vaccine near you.

“It’s absolutely safe to get the flu shot during pregnancy,” Dr. Gilpin explained. “The needle-based vaccines we give pregnant women do not contain live virus, so there is no danger. However, nasal spray-based vaccines contain live attenuated flu virus, which is not recommended for pregnant women.”

The most common side effects of flu vaccination experienced by pregnant women are the same as those experienced by others. They are generally mild and include fatigue, fever, headache, muscle aches, nausea and soreness, redness or swelling at the injection site. If side effects occur, they usually last only a day or two.

Flu Tips for Parents

The flu is more dangerous for children than the common cold. Children die from the flu every year.

Flu seasons vary in severity, but children are at risk for getting sick with the flu every year. Children younger than 5 years old, particularly children under age 2, are at higher risk of developing serious flu-related complications. Children of any age with chronic health conditions such as asthma, neurologic conditions, obesity or weakened immune systems also are at higher risk.

Complications from flu among children can include:

  • Pneumonia, an illness that affects the lungs
  • Dehydration
  • Worsening of long-term medical problems like heart disease or asthma
  • Issues with how the brain functions
  • Sinus problems
  • Ear infections

The CDC urges parents to seek emergency attention if their child exhibits:

  • Fast breathing or trouble breathing
  • Bluish lips or face
  • Ribs pulling in with each breath
  • Chest pain
  • Severe muscle pain (child refuses to walk)
  • Dehydration (no urine for eight hours, dry mouth, no tears when crying)
  • Not alert or interacting when awake
  • Seizures
  • Fever above 104 F

For infants less than 12 weeks old, warning signs include fever, fever or cough that improves but then returns or gets worse and worsening of chronic medical conditions.

Treatment of the flu in children can include prescription antiviral drugs in the form of pills, liquid, inhaled powder or IV solution.

An Ounce of Prevention

Children should be vaccinated every flu season for the best protection. While not at heightened risk, children 5 years and older can spread the flu to their higher-risk family members, such as infants, adults 65 years and older or people with chronic health conditions. Because of this, it’s recommended that everyone 6 months and older get vaccinated against the flu yearly to help protect those most at risk.

In children, annual flu vaccination has been shown to reduce:

  • Illness
  • Doctor’s visits for flu
  • Missed school days
  • Flu-related hospitalizations
  • Flu-related deaths

Children 6 months through 8 years of age who have never gotten a flu vaccine or who have not received at least two doses of the flu vaccine in their lives may need two doses taken at least four weeks apart. Your child’s pediatrician will know which vaccines are right for your child. Find a vaccine near you.

Ideally, everyone 6 months and older should be vaccinated by the end of October. Since it takes about two weeks after vaccination for the body to develop antibodies against the flu virus, it’s recommended that you and your children get vaccinated before the flu season begins. However, getting vaccinated later can still provide protection into January or even later.

The ABCs of RSV

RSV is one of the many viruses that cause respiratory illness. Typically, RSV causes a cold, which may be followed by bronchiolitis (lower respiratory infection) or pneumonia (lung infection). Symptoms generally last five to seven days. It’s most active in the late fall through early spring, according to the American Academy of Pediatrics (AAP). Almost all children get RSV at least once before age 2. For most healthy children, the symptoms of RSV are similar to a cold, but some children get very sick from the virus.

“RSV is one of the most common viruses that brings babies into the hospital,” explained Dr. Deeter. “It can block the nasal passages, cause oxygen levels to decrease and affect appetite. RSV infections make up more than 30% of respiratory illness in infants, with more than 50,000 babies being admitted nationally every year and up to 500 infant deaths each year,” Dr. Deeter said.

RSV spreads from one person to another like the common cold. It enters the body through the nose or eyes or from:

  • Direct contact with saliva, mucus or nasal discharge
  • Unclean hands (Experts say RSV can survive 30 minutes or more on unwashed hands.)
  • Unclean objects (such as toys or keyboards) or surfaces, such as door knobs or countertops (RSV can survive up to 6 hours on surfaces)

Thanks to mask-wearing and social distancing during the COVID-19 pandemic, there were fewer cases of RSV in 2020. However, once safety measures were relaxed, the number of RSV cases began to rise in spring 2021, according to the AAP.

Who’s at Risk for RSV

According to the AAP and CDC, some children have a higher risk for severe RSV infection. This includes:

  • Infants 12 weeks old or younger at the start of the RSV season
  • Premature or low birth weight infants (especially those born before 29 weeks gestation)
  • Children under 2 with chronic lung disease of prematurity
  • Children under 2 with certain types of heart defects
  • Children with weak immune systems due to illness or treatments
  • Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Additional risk factors for severe RSV infections include:

  • Having siblings
  • A mother who smoked during pregnancy
  • Exposure to secondhand smoke in the home
  • History of allergies or eczema
  • Not being breastfed
  • Being around children in a childcare setting
  • Living in a crowded home

Only 1% to 2% of children younger than 6 months of age with RSV may need to stay in the hospital, according to the AAP. If admitted, babies may need oxygen to help them breathe or an IV line for fluids. Most of these children can go home in two or three days. Rarely, a child may need to be treated in a pediatric intensive care unit (PICU).

Recognizing the Symptoms of RSV

Symptoms can appear two to eight days after contact with RSV. In infants, the symptoms include:

  • Belly breathing, tugging between the ribs or the lower neck
  • Congestion
  • Cough (dry or wet)
  • Fast breathing
  • Fever (temperature of 100.4 F or higher)
  • Flaring of the nostrils and head bobbing while breathing
  • Fussiness
  • Poor feeding
  • Rhythmic grunting during breathing
  • Runny nose
  • Sneezing
  • Wheezing

If you think your child has RSV, watch his or her rib cage as they inhale. If you see it “caving in” and forming an upside-down “V” shape under the neck, they are struggling to breathe. The AAP has created a video to help parents identify RSV-related breathing issues.

How RSV Is Diagnosed

Your child’s pediatrician may conduct a nasal swab test to determine if your child has RSV or another virus. A chest X-ray or oxygen saturation test also may be completed to check for lung congestion. However, because most children recover without difficulty and there is no treatment for RSV, these tests may not be necessary.

Children and adults can get RSV multiple times, even during a single season. However, repeat infections are typically less severe than the first.

Treating RSV

While there is no cure for RSV, scientists are researching vaccines to prevent RSV and working to develop new medications to treat it. Unfortunately, medications like steroids and antibiotics don’t help. The good news is that almost all children recover from an RSV infection on their own. Symptoms are usually the most severe from day 3 to day 5.

 

“We currently do not have an effective treatment for RSV other than saline suctioning of the nose to keep it open and using respiratory devices to help the baby breathe,” Dr. Deeter explained.

To help your child feel more comfortable, the AAP also recommends using:

  • A cool-mist humidifier to break up mucus and make it easier to breathe
  • Fluids and frequent feedings to keep your child hydrated
  • Acetaminophen or ibuprofen (if older than 6 months) to treat a low-grade fever (avoid aspirin and cough and cold medication)

“Synagis (palivizumab) is a monoclonal antibody injection available for very premature babies and young children with certain heart and lung conditions,” added Dr. Deeter. “A shot can be given to children in these groups every month during the respiratory season. It has effectively prevented hospitalizations for our most vulnerable populations.”

Your pediatrician will let you know if your baby qualifies for this treatment.

Call your child’s health care provider immediately if he or she has any:

  • Symptoms of bronchiolitis (sneezing, a runny or blocked nose, a cough and a slightly high temperature)
  • Symptoms of dehydration (fewer than one wet diaper every eight hours)
  • Pauses or difficulty breathing
  • Gray or blue color to tongue, lips or skin
  • Significantly decreased activity and alertness

In addition, some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection.

How to Protect Your Children from RSV

The simplest thing you can do to protect yourself and your children from RSV is to wash your hands. Throughout the year and the day, use soap and water and scrub for at least 20 seconds. Remind your children to practice good hand hygiene all year as well.

Other ways to help prevent RSV, according to the AAP and CDC, include:

  • Keeping your hands off your face
  • Keeping immunizations up to date, including flu and COVID-19 vaccines
  • Limiting your child’s exposure to crowds, other children and anyone who is sick
  • Avoiding close contact, such as kissing or sharing cups and eating utensils, with people with cold-like symptoms
  • Keeping children home from school or daycare when they are sick
  • Teaching children to cover their coughs and sneezes
  • Regularly disinfecting objects and surfaces in your home
  • Avoiding exposing your child to smoke from tobacco or other substances
  • Feeding your baby breastmilk, which has antibodies that prevent and fight infections

“Taking steps to keep mom and the rest of the family healthy and limiting contact with others can go a long way in preventing RSV in infants,” said Dr. Gilpin. “You don’t want a bunch of strangers coming around and kissing the baby right now. By preventing RSV in your family, you’re protecting your newborn, too.”