Feeling Under the Weather? It's COVID, RSV, and Flu Season

The winter cold and flu season took off with a roar. COVID, RSV, and flu — and now Strep A — are in the news daily. This combination is causing the number of respiratory infections to skyrocket. What are these bugs, and is there anything new that parents need to know?

Key takeaways:
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    COVID-19, influenza, respiratory syncytial virus, and group A streptococcus are circulating earlier than normal this year.
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    Vaccines for COVID-19 and influenza reduce the risk of serious illness requiring hospitalization.
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    Parents should be vigilant for signs that children are dehydrated or unable to eat.
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    Scarlet fever is caused by Group A Strep and, therefore, requires urgent medical care.

This year the seasonal viruses peaked earlier than expected, and in some cases, at rates higher than usual. While rates are trending down in most of the US, the holidays may have caused another surge in early to mid-January.

  • Respiratory syncytial virus (RSV). is a common childhood cold virus that can be particularly nasty for very young babies with small airways or those with chronic lung conditions.
  • Influenza (flu). It causes seasonal upper and lower respiratory illness and is a particular concern for the elderly and infants.
  • COVID-19. It is a coronavirus that causes upper respiratory illness and has a similar risk profile as the flu, affecting the very young (under six months of age) and the elderly as well as those with chronic health conditions, which makes any respiratory infection more concerning.
  • Strep A (Group A streptococcus). It is a bacteria that commonly causes sore throat and sinusitis as well as scarlet fever and, rarely, invasive Group A Strep (iGAS) infection.

Why is everyone sick?

While the group above are all common seasonal illnesses, lack of exposure during the two years of pandemic winters due to reduced social mixing may have caused many people to miss out on developing immunity. For instance, RSV is a common childhood illness that most people have immunity to by the age of two.

However, RSV is also a common cause of pediatric hospitalizations. With reduced social mixing, several birth cohorts of kids are getting RSV for the first time all at once, and even though serious illness is unlikely, if more kids are getting sick, then hospitals may see an increased number of admissions. Even teenagers can catch RSV and develop a nasty cold.

What should parents do?

While these viruses are not new, parents should be on the lookout for warning signs like not being able to hydrate, difficulty breathing, high fever, and a sandpaper rash — a symptom of scarlet fever.

Suffering from a secondary bacterial infection, in addition to a viral illness, can cause complications. In addition, with multiple viruses and bacterial mixing, it is possible that a coinfection could be causing a more severe illness.

The immune system benefits from sleep, hydration, and nutrition. These are simple strategies that parents can use to fortify their children against normal viral and bacterial exposures.

Reducing the risk of these illnesses

While there is no routine pediatric vaccine for Strep A or RSV — although one for RSV is in development — we do have vaccines for COVID-19 and influenza. The influenza vaccine is a good match for this year’s strain. It may reduce hospitalization risk by 35 to 40 percent, according to experts at the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP).

Other routine pediatric immunizations can reduce the risk of serious illness from measles, mumps, and rubella (MMR vaccine). In addition, vaccines are available for varicella (chickenpox), pneumococcal pneumonia (PCV), Haemophilus influenza, meningitis B (Hib), diphtheria, and rotavirus. And finally, the old standard tetanus, polio, and pertussis (DTaP-IPV) vaccines are also available. Pediatricians can recommend which shots your child should get immediately if you need to catch up on missed vaccines.

Pregnant women and the flu shot

The CDC notes that flu vaccination among pregnant women is lower this year than before the pandemic. Meanwhile, hospitalization rates are higher due to the increased circulation of the flu virus.

Pregnancy can increase the risk of complications from influenza infection. Pregnant women account for 50% of all flu-related admissions among women of childbearing age. The CDC has conducted multiple studies to review safety data for the flu shot among pregnant women and found no evidence of increased risk of miscarriage or congenital disabilities.

The medical community is urging child-bearing-age women to get a flu shot because it reduces the risk of hospitalization with influenza. Furthermore, it induces the production of antibodies that can protect the baby after birth.

Which drugs help treat these illnesses?

The Health and Human Services Agency (HHS) announced on December 21, 2022, that it would authorize states to use their stockpile of the anti-viral Tamiflu (oseltamivir) to meet the demand for influenza. Unfortunately, Tamiflu has not been shown to be effective for COVID-19.

Although Tamiflu is available, it is important to consider the relative risks and benefits of taking any drug. For example, a meta-analysis concluded that Tamiflu might reduce the duration of illness, but side effects include nausea, vomiting, headaches, and psychiatric syndromes, particularly in children and adolescents.

The authors concluded that “the trade-off between benefits and harms should be borne in mind when making decisions to use oseltamivir for treatment, prophylaxis, or stockpiling.” The CDC recommends prompt treatment (within two days) for people who are at higher risk for serious complications due to influenza.


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