Tripledemic is For Real: What Parents Should Know

Pediatricians are familiar with the usual fall uptick in viral infections. But this year is a little different, says Rachel Lewis, MD, assistant professor of pediatrics at Columbia University Vagelos College of Physicians and Surgeons.

Cases of COVID, influenza, and RSV (respiratory syncytial virus) are surging, along with a slew of other infectious diseases common in autumn that went under the radar during the first two years of the pandemic.

"After school opens in the fall, we usually see a rise in all kinds of contagious illnesses," Lewis says. "When you put kids back into school together, any viruses they picked up in the summer spread around. And then the weather changes, and they all get the wintertime viruses. So it's normal to see lots of flu, the common cold, and stomach flu in the fall and winter."

Lewis says the normal uptick is happening, but many viruses are surging earlier and some cases are more severe.

Parents should consult their pediatrician if children have any of the following symptoms: prolonged fever (longer than 3-5 days), trouble breathing, lethargy, or dehydration from vomiting/diarrhea or poor fluid intake.

"Back in September, we had two kids hospitalized with rhino/enterovirus-the common cold. We're used to seeing more severe illnesses in our more vulnerable patients with issues like chronic lung disease patients or prematurity. But to have an otherwise healthy 2-year-old requiring oxygen for the common cold is very unusual."

Both children who were hospitalized were young enough that they may never have had the common cold, which may explain why the cases turned more serious (both children have recovered).

"Because of the COVID pandemic, these kids may have never been exposed to the viruses most kids see multiple times by the time they're 3 or 4. Now that they're finally getting sick, their immune responses can be really exaggerated."

Flu-it never went away

In New York, flu season usually takes off in mid-November, rapidly rises in December, peaking in January and February.

This year, flu arrived early. By the middle of October, New York state reported influenza was already widespread across the state. And positive influenza laboratory results now number what's typically seen later in November in December.

"Get [the flu shot] now, get it anywhere. I tell parents, you shouldn't be hesitant about getting the vaccine at the pharmacy down the way... if that's most convenient."

Lewis wasn't surprised, based on what she's seen in her patients, when flu cases started ticking up in September. "The flu never went away this summer. We normally see zero cases in the summer; this year we had a couple summer camps with flu outbreaks, which I'd never seen before."

Though many people like to wait until later in the year to get a flu shot, Lewis advises getting the shot as soon as possible: "It's time. Flu is here. And the shot gives you six to eight months of protection, starting two weeks after you get the shot."

Everyone 6 months old and older should get a seasonal flu shot every year, and the shots are widely available at pharmacies, health clinics, and doctor's offices. In New York state, pharmacies may vaccinate children as young as 2 years of age.

"Get it now, get it anywhere. I tell parents, you shouldn't be hesitant about getting the vaccine at the pharmacy down the way or the urgent care across the street, if that's most convenient," Lewis says. "We all have the same vaccines."

RSV

RSV is a common virus that most often affects young children and elderly adults; Most kids have had RSV by age 2.

The respiratory virus usually causes mild, cold-like symptoms and, like influenza, typically peaks in late fall and winter. But the virus can affect children under 6 months more severely: 1% to 2% may need hospitalization, with some hospitalized patients requiring mechanical ventilation.

"The good news is that most babies improve on their own, and even those who require hospitalization usually recover fully."

"We started seeing RSV cases early this year, and now it's rising," Lewis says. "The good news is that most babies improve on their own, and even those who require hospitalization usually recover fully."

No routine vaccine exists for RSV (vaccine candidates are still undergoing testing and probably won't be available for children for at least a few years), so the best way to protect kids is to keep them home when they're sick, teach them to wash their hands correctly, and cover their coughs and sneezes.

Hand, foot, and mouth

Hand, foot, and mouth disease is usually a popular day care virus, spread by person-to-person contact. Young children are the most susceptible, but by the time kids go to kindergarten, most kids have had it, developed immunity, and don't get it again.

"But a lot of kids haven't gone to day care and playdates in the past two years, and now they're getting it for the first time," Lewis says.

Hand, foot, and mouth causes fever and sores on hands, feet, and inside the mouth. The sores hurt to the touch, and kids may refuse to drink because it hurts too much, which can lead to dehydration.

It usually clears up in a week or two, but people remain contagious until open sores heal, and kids need to stay out of school until then. In Lewis' practice, cases are not more severe than usual, but the practice is seeing it more than usual in older kids. And every now and then, a parent gets it.

"Most adults have some latent immunity, but we've seen a few parents get pretty sick," Lewis says. "It's not deadly, it's just really miserable."

Enterovirus and polio

The media began reporting about an increase in cases of enterovirus D68 (EVD68) in early October though the total number of cases is still relatively low.

Like other respiratory viruses, most children with EVD68 develop fever, runny nose, and cough. The virus also can cause muscle weakness (acute flaccid myelitis, or AFM), but only very rarely.

"There's no need to panic about enterovirus," Lewis says, because cases of acute flaccid myelitis are very low. So far in New York state, the CDC reports only two confirmed cases of AFM in 2022.

Parents should become concerned if their child is weaker than normal-has trouble standing or walking or has sudden weakness of an arm or a leg. "But most of these kids are going to have a regular cold," Lewis adds.

Polio is similar: Few known cases have been documented, so this is not a new epidemic. Unlike EVD68, polio is easily avoidable with vaccination.

"If you have any doubt about whether or not your child's polio vaccinations are up to date, this is the time to check with your doctor," Lewis says.

General advice for parents

Asking your young child to wear a mask in school these days to avoid infections is probably unrealistic, Lewis says. She advises teaching kids to wash their hands properly-singing "Happy Birthday" twice can help to make sure hands get 20 seconds of soapy scrubbing.

When kids get sick, parents should consult their pediatrician if children have any of the following symptoms: prolonged fever (longer than 3-5 days), trouble breathing, lethargy, or dehydration from vomiting/diarrhea or poor fluid intake.

And keep children home from school.

"I know kids have missed a lot of school in the past two years, but this is not the time to send them to class when they're under the weather. If they have a fever, they really should stay home, even if it's not COVID," Lewis says.

"It's going to be easier for your child to get sick and pass illnesses this year than you might be used to from three years ago," she adds.