A Rutgers Health pediatric nurse practitioner and educator discusses prevention, symptom management and when to seek medical care
As respiratory virus season begins, pediatric experts are preparing for an expected rise in cases of Respiratory Syncytial Virus (RSV), which can cause cold-like symptoms in most people but serious illness in infants and older adults.
Meghan Faulkner, a certified pediatric acute care nurse practitioner and clinical instructor at Rutgers School of Nursing, discusses her approach to the season in her clinical practice and what families should know about prevention and care.
What are you seeing in your clinical practice and public health reporting as the RSV season gets underway?
For nearly the past 20 years, I have braced for impact as a pediatric provider as RSV season gets underway. The season typically runs from September through April, with most cases exhibiting in the winter months. For the 2024-2025 season, the Centers for Disease Control and Prevention estimated that the burden of disease was responsible for 3.6 million to 6.5 million outpatient visits, 190,000 to 350,000 hospitalizations and 10,000 to 23,000 deaths in the United States.
Historically, young infants, immunocompromised individuals and older adults have been the most affected. However, the availability of monoclonal antibodies such as Beyfortus, also called nirsevimab, has helped reduce the overall impact of RSV.
In my current practice, children are being admitted to the hospital for RSV bronchiolitis far less frequently than they were in prior years. Recent advances in noninvasive oxygen and ventilation modalities, such as high-flow nasal cannula, in the hospital setting also have made it easier to manage children admitted with bronchiolitis.
Which factors most often determine how severely a child - or an adult - is affected by RSV?
Several factors contribute to the severity and burden of illness for both children and adults. RSV is known to cause bronchiolitis, or airway inflammation secondary to mucous plugging. Due to their lack of immunity, inability to expectorate mucus, and more pliable, collapsible airways, neonates and young infants are at the highest risk for developing serious complications and requiring hospitalization from the disease. Infants with any history of prematurity, lung conditions or congenital heart disease are especially at high risk.
Older children and adults, those with preexisting lung conditions, such as asthma or cystic fibrosis, or those who are immunocompromised, also at risk for developing complications such as pneumonia or respiratory distress. In the general population, RSV typically presents as a common cold.
How can parents or caregivers distinguish between mild symptoms and those that require medical attention?
Illness from RSV usually lasts about 14 days, with peak symptoms occurring between days four and six. Mild symptoms of RSV include fever, runny nose with hallmark thick mucus, cough and decreased appetite.
Parents and caregivers should monitor their children and loved ones, providing supportive care with suctioning of mucus and antipyretics such as Tylenol and Motrin, and ensure they stay hydrated.
More severe symptoms of RSV include rapid breathing, difficulty breathing such as babies flaring their nostrils, ribs sucking in, bobbing their heads to breathe as well as lethargy, wheezing or color changes, in which the skin or lips turn blue.
Meghan Faulkner
Certified Pediatric Acute Care Nurse Practitioner and Clinical Instructor, Rutgers School of Nursing
More severe symptoms of RSV include rapid breathing, difficulty breathing such as babies flaring their nostrils, ribs sucking in, bobbing their heads to breathe as well as lethargy, wheezing or color changes, in which the skin or lips turn blue. If a parent or caregiver observes any of these symptoms in their child or loved one, they should seek medical attention immediately.
What prevention options are available this season, and how should families discuss them with their health care provider?
In July 2023, the monoclonal antibody, Beyfortus, was approved by the Food and Drug Administration for the prevention of severe illness against RSV. Individuals who qualify include pregnant women during weeks 32 to 36 to protect their baby from severe RSV disease, infants younger than 8 months of age if the mother did not receive the vaccine during pregnancy, young children ages 8 to 19 months who are at increased risk for severe disease, all adults ages 75 and older and adults ages 50 to 74 who are at increased risk of severe disease.
Prior to this, Synagis, or palivizumab, was a monoclonal antibody that was reserved for administration to only at-risk infants, including those with a history of prematurity or congenital heart disease. Synagis is being discontinued.
Clinical trials have proven that nirsevimab decreases the severity of illness for those who are most at risk during RSV season. I highly recommend families discuss eligibility, availability and benefits of administration with their health care providers during routine wellness visits and as RSV season approaches to prevent the serious complications RSV can cause.
With RSV, COVID-19 and flu infections expected to rise, what guidance do you share with families to help limit the spread of respiratory illnesses during the colder months?
Limiting the spread of respiratory illnesses like RSV, COVID and influenza is important, and both patients and caregivers play a role in prevention.
These viruses can all be spread rapidly through respiratory droplets and direct contact. Therefore, individuals who are sick should avoid contact with others until their fevers have subsided for over 24 hours without the use of Tylenol or Motrin. These rules should also be followed when allowing children or infants to return to school or daycare, where the viruses often run rampant.
Excellent hand hygiene and masking while respiratory symptoms persist are also extremely beneficial during these winter months. Additionally, obtaining annual COVID-19 and influenza vaccines can be crucial for preventing the spread and other serious complications associated with these viruses.
