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Old December 31st, 2009, 06:35 AM
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Default RSV virus on the upswing in Kentucky, targeting young children

Source: http://www.courier-journal.com/artic...young+children

RSV virus on the upswing in Kentucky, targeting young children

By Laura Ungar • lungar@courier-journal.com • December 30, 2009

While the nation has been worrying about swine flu, another potentially dangerous virus has begun preying on Kentucky's youngest children.

Called respiratory syncytial virus, or RSV, it's hitting Kentucky harder than other states and earlier than in past years — and keeping area hospitals busy.

According to the National Respiratory and Enteric Virus Surveillance System, about 35 percent of RSV tests in Kentucky came back positive during the most recent tracking period this month, compared with about 25 percent nationally and about 12 percent in Indiana.

At Kosair Children's Hospital, 43 percent of RSV tests were positive in December — part of reason officials declared the emergency department “beyond red” several times on four recent days, meaning children had to be held in the emergency department because no beds were available in the hospital.

RSV causes many of the same symptoms as flu: coughing, sneezing, runny nose, fever and sometimes wheezing and other breathing difficulties. While most children get mild cases and recover at home, federal statistics show that 75,000 to 125,000 U.S. children younger than 1 are hospitalized each year with RSV.

Stacy Stewart knows how dangerous RSV can be, having watched her daughter — who is now 2½ years old — struggle to breathe as a newborn, her tiny chest sinking with each breath.

The virus turned into pneumonia and put her in the hospital for a week.

“I was terrified,” Stewart, of Henderson, Ky., said of her worries about her daughter, Camryn Jones. “I really don't think people realize how serious it is until it hits them.”

Experts say the number of infections vary by region and year, and they don't know why some regions are hit harder than others. But the number of people at risk for complications from RSV may provide clues.

Babies born prematurely, or those with chronic lung disease, are especially prone to complications such a pneumonia, ear infections and bronchiolitis, inflammation of the small airways in the lungs. And Kentucky has one of the nation's highest preterm birth rates — 15.2 percent.

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Camryn, for example, was born three months premature and has cerebral palsy.

“With severe disease, there's always the potential it could be fatal,” said Dr. William Hacker, state public health commissioner.

RSV cases rising swiftly this season

RSV season typically runs parallel to flu season — roughly November through April.

While it usually peaks in January or February, “we're seeing it a bit earlier this year,” said Cis Gruebbel, Kosair's vice president of patient care and chief nursing officer.

Gruebbel said Kosair typically only tests babies 1 year old or younger, and the numbers of positive tests have grown steadily, from eight positives out of 71 tests (11 percent) in October to 48 out of 170 (28 percent) in November to 165 out of 386 in December (43 percent).

Overall, she said, 710 children of all ages were diagnosed in December with a non-H1N1 respiratory illness, including RSV.

Officials at the University of Kentucky's Kentucky Children's Hospital in Lexington said they began to get cases in October and saw them rise through December, with 12 the first four days of Christmas week and five Monday. And in Baptist East's emergency department in Louisville, doctors said, 24 children were tested in December, with 11 testing positive — four on Monday night alone.

While adults usually do better with RSV, elderly people, pregnant women and those with immune problems can get very sick.

In the past three months, University Hospital treated about seven adults for the virus in their emergency department, and two others in the labor and delivery area.

Nationally, studies show that RSV has been increasing in recent years; experts now estimate that nearly everyone is infected with the virus by age 3.

The first exposure is usually the worst, they say, with 25 percent to 40 percent of first-timers showing symptoms of pneumonia or bronchiolitis.

As a pediatrician and new mother, Dr. Julia Richerson, medical director at Family Health Centers in Louisville, said she knows the fear the illness can strike in parents.

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Her daughter, Nora Lovie Siegel, just turned 1.

“I do worry about her,” she said, “and I was very worried last year.”
Most cases of RSV aren't especially severe

Richerson said the vast majority of RSV patients seen at Family Health Centers have mild cases and do not have to be admitted to the hospital.

Mild cases are generally over in a couple of weeks, and doctors advise the same type of home care as for colds or flu — giving acetaminophen or ibuprofen if necessary, ensuring they get enough fluids and watching for signs of dehydration or breathing troubles.

“If someone has severe difficulty breathing, they should be seen by a health-care provider,” Hacker said. “If parents can't reach their regular doctor, don't wait. Go to the emergency room.”

For patients with more severe illness, treatment often includes therapy with a bronchodilator such as albuterol to help open the airways. In the hospital, children are closely monitored and may be given intravenous fluids if they become dehydrated and won't drink. Antiviral medicines usually aren't used.

But doctors said the best course of action is to prevent the illness in the first place. A preventive medicine called palivizumab, or Synagis, can be injected monthly during RSV season, but it is only for children at extreme risk of complications such as preemies and babies with congenital heart disease.

For most people, however, RSV can be prevented by the same steps used to ward off other germs — measures Marttinei Borders of Louisville knows well as she cares for her 21-month-old son, Samuel.

“We're constantly washing hands, watching who he's with, sanitizing things,” Borders said. “There's not much more you can do.”

Reporter Laura Ungar can be reached at (502) 582-7190
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