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RSV impacting children and healthcare systems

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Health Advisory UPDATE: Increased Respiratory Virus Activity Impacting Children and Regional Healthcare Systems

Health advisory

November 22, 2022

NOTE: this is an update to a Health Advisory posted on November 11, 2022. This advisory includes additional information and recommendations to help address the increased respiratory virus activity in our local community and the burden that it is placing on our healthcare providers and systems.

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  • Be aware of early and continued increases of respiratory virus activity this season, particularly among pediatric patients.
    • This includes a surge in respiratory syncytial virus (RSV) infections, early increases in influenza activity, and anticipated increases in COVID-19 circulation this season.
    • Elevated regional respiratory virus activity has placed significant strain on healthcare systems which includes outpatient clinics, emergency departments, and hospitals.

  • Prepare for stress on healthcare systems from increased hospitalizations related to respiratory infections, exacerbated by the limited number of pediatric beds and shortages in healthcare staff.

  • Recommend and offer prompt vaccination against influenza and COVID-19 for all patients 6 months and older who are not up-to-date.
    • Influenza and COVID-19 vaccinations can be given at the same visit if the patient is due for both vaccines.
    • Vaccination in advance of travel or gatherings can help decrease transmission and severe disease in these settings.
    • Pregnant women and infants are at increased risk for severe outcomes related to respiratory viral infections; receipt of influenza vaccination and staying up-to-date with recommended COVID-19 vaccinations during pregnancy is vital to protect both the pregnant individual and the newborn.

  • Use diagnostic testing to guide treatment and clinical management due to multiple co-circulating viruses, and administer medications as early as possible after symptom onset.
    • Strongly consider palivizumab treatment for eligible children at high-risk for severe RSV infections in accordance with AAP guidelines to prevent hospitalizations. Eligible children include:
      • Infants prematurely born at less than 29 weeks gestation.
      • Children younger than 2 years of age with chronic lung disease or hemodynamically significant congenital heart disease.
      • Children with suppressed immune systems or neuromuscular disorders.
    • Treat high risk patients with suspected or confirmed influenza who meet clinical criteria with influenza antivirals.
    • Treat high-risk outpatient and hospitalized patients with confirmed COVID-19 who meet requirements and clinical criteria with COVID-19 antiviral medications.

  • In order to decrease the stress on local healthcare systems, the following are recommended:
    • Discuss anticipatory guidance for prevention and treatment steps with patients ahead of time: determine symptoms warranting clinical evaluation, when to get testing, and how to obtain available antiviral treatments.
    • Encourage families to utilize primary care clinic triage lines to determine next steps for medical evaluation (see WSMA info, below).
    • Extended outpatient clinic, telemedicine, and nurse triage hours where possible.
    • Continue universal masking in all healthcare facilities in accordance with the Washington Secretary of Health Order.
    • In addition to vaccination, diagnostic testing, and targeted treatment as outlined above, advise patients on how they can reduce the risk of respiratory virus transmission particularly as individuals pursue holiday plans and travel:
      • Wear a well-fitting, high quality mask in indoor public settings.
      • Protect vulnerable children and adults at gatherings by being up-to-date with recommend influenza and COVID-19 vaccinations.
      • Protect newborns and other vulnerable patients at risk for severe complications by keeping ill people away and ensuring caregivers and contacts are vaccinated against influenza and COVID-19.
      • Avoid contact with others if an individual is ill regardless of symptom severity and COVID-19 testing status.
      • Stay home from work or school if ill.
      • Improve indoor air ventilation and filtration.
    • See information from the Washington State Medical Association with guidance on prevention steps and when to seek care for an ill child.

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) in early November to provide updated information about increased respiratory virus activity nationally, particularly among pediatric patients. In King County, RSV levels are extremely high, influenza levels are increasing rapidly, and COVID-19 activity has palateaued and is showing early signs of increasing. This elevated respiratory disease incidence caused by multiple viruses is straining healthcare systems so it is crucial to optimize respiratory virus prevention and treatment measures. Many respiratory viruses with similar clinical presentations circulate year-round in the U.S. and at higher levels in fall and winter. In the previous two years, respiratory disease activity was dominated by SARS-CoV-2, and seasonal circulation of other respiratory viruses was atypical. Meanwhile, SARS-CoV-2 also continues circulating in all U.S. states and is anticipated to increase in the coming months. In King County, we are also seeing continued surges in RSV infections and early increases in influenza. It is likely these trends will continue in the coming weeks.

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