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Respiratory syncytial virus can be a baby killer

Although most children recover from a respiratory syncytial virus infection, it can be severe and even cause death
Although most children recover from a respiratory syncytial virus infection, it can be severe and even cause death
Robin Wulffson, MD

The flu season, which typically peaks during the winter months, is now in full swing. However, another virus is also flexing its muscles during this period. Respiratory syncytial virus (RSV) is a virus that causes infections of the lungs and respiratory tract. It is extremely common—most children have been infected with the virus by age two. Although most children recover, the infection can be severe and even cause death. Kari Judson and her husband endured every parent’s nightmare when their son, Alexander, succumbed to RSV and his identical twin brother became severely ill with the disease.

Kari told me that Alexander and Dominic Judson were born on January 4, 2008 at 36 weeks and 2 days gestational age. Because their birth weights were on the healthy side (4.7 pounds and 4.13 pounds), they were considered full term for twins. They thrived in their first few days and their lung function was normal. Since the twins were doing well and healthy, they were sent home, even before their mother was released. The first 11 months of their lives were illness-free; then, Alexander became lethargic and was slightly feverish. He was brought to the emergency department; shortly thereafter, he crashed three times from bronchial spasms. He was diagnosed with a severe case of RSV and airlifted to Egleston Children's Hospital in Atlanta, Georgia. His brain function was normal throughout the flight; however, upon landing, his brain function ceased and he was placed on life support. Unfortunately, Kari and her husband, Lyle had to face a parent’s worst nightmare, and decided to remove him from life support and donate his organs.

Adding to the Judson’s anguish, as Alexander was being airlifted, Dominic was also battling RSV. His infection grew in severity; thus, he required intense treatment and hospitalization for 11 days. Following discharge, Dominic began receiving monthly Synagis (palivizumab) injections, and was approved for five doses of Synagis throughout the RSV season. Synagis is a RSV F protein inhibitor monoclonal antibody; it is indicated for the prevention of serious lower respiratory tract disease caused by RSV in children at high risk of RSV disease.

To get the latest information on RSV, I consulted with Dr. William Hitchcock who is a Fellow of the American Academy of Pediatrics and certified by the American Board of Pediatrics. He has a particular interest in allergy, asthma, infectious diseases, and vaccines. He has been involved in clinical research in asthma and allergy and clinical trials involving antimicrobials and vaccines. Dr. Hitchcock noted that, in adults and older, healthy children, the symptoms of RSV are mild and typically similar to that of the common cold. Self-care measures are usually all that is required to relieve any discomfort. However, Infection with respiratory syncytial virus can be severe in some cases, especially in premature infants and those with underlying health conditions such as congenital heart disease. RSV can also become serious in older adults, adults with heart and lung diseases, or anyone with a compromised immune system (i.e., patients with HIV/AIDS or those on immunosuppressive medication).

Unlike influenza, there currently is no vaccine for RSV. Synagis treatment is currently only recommended for children at high risk. At present, the safety and efficacy has been established in children with bronchopulmonary dysplasia, infants with a history of premature birth (less than or equal to 35 weeks gestational age), and children with significant congenital heart disease. To date, the safety and efficacy of Synagis have not been established for treatment of RSV disease; thus, it is only used in cases where the benefits outweigh the risk, such as Dominic Judson’s situation.

Dr. Hitchcock cited the warning signs of a RSV infection that requires prompt medical attention:

  • Severe cough
  • Rapid breathing
  • Lethargy
  • Avoidance of eating or drinking, which can result in dehydration
  • High fever, which can also increase dehydration

If the above symptoms occur in your child, rush him or her to the emergency department that can administer a high level of care. In Los Angeles, Ronald Reagan UCLA Medical Center and Cedars-Sinai Medical Center are excellent choices. A parent must be a proactive advocate of his or her child. If you sense that your child is not receiving prompt attention, speak up.

When a tragedy occurs, soul-searching follows. The question is asked: “What could have been done to prevent it?” Throughout the course of his illness, Alexander Judson received prompt and excellent care. When he became ill, his parents rushed him to their local hospital where he received prompt attention. He was then airlifted to Egleston Children's Hospital, which is among the top pediatric facilities in the nation. Despite prompt and intensive intervention, Alexander succumbed to RSV. Kari Judson struck me as a strong, determined women. She is now proactive regarding RSV and has become involved in radio and television campaigns. After the passing of Alexander, Kari and Lyle gave birth to a healthy baby boy in 2010; Kari is currently pregnant with her fourth child. She notes that additional information regarding RSV can be found at rsvprotection.com.

RSV and influenza are currently at a peak in the nation. According to the Los Angeles County Department of Public Health, the 2012-13 influenza season in Los Angeles County was moderately severe. Influenza activity quickly rose at the end of 2012, rapidly increasing from 10% prevalence to almost 30% during January 2013. RSV surged earlier than influenza then dropped off as flu activity increased. Rhino/enterovirus lagged behind both, then peaked in the spring after RSV and influenza virus activity decreased. Coronavirus remained low throughout the season; however, parainfluenza activity had minor upward movement in the early fall and late spring when RSV and influenza were at their lowest.