After several years of dealing with the COVID-19 pandemic, experts warn that many areas of the country are now experiencing a “tripledemic” of COVID, influenza (flu) and respiratory syncytial virus (RSV), a common childhood illness that can also infect adults. Pregnant women and young children are particularly vulnerable to these viruses. Here’s what you need to know to keep yourself and your family safe.
“Many viruses prefer cold weather because they have a gel coating that breaks down in warm weather. Because of this, most viruses have a ‘season,’” explained Kristina Deeter, M.D, MBA, a pediatric intensivist with Pediatrix® Critical Care and Hospitalist Care of Nevada. “In winter, most of us come indoors and have closer contact with each other, allowing viruses to be rapidly transmitted from person to person.”
This year, the spread of the flu, RSV and other seasonal respiratory illnesses started earlier than usual and is expected to last through the spring. The flu virus typically peaks between December and February. According to experts, the flu infection rate in the United States this year is the highest in 13 years.
“We’re seeing many more cases of flu than we have in the past,” explained Brian G. Gilpin, M.D., MPH, specialty medical officer for the Pediatrix OB Hospitalist Program. “We’re seeing pregnant women in the hospital with the flu, along with very young children and the elderly. This is similar to the H1N1 flu epidemic we saw in 2009, but we aren’t even at the peak yet. This is just the beginning, and it started a little bit sooner than we expected this year.”
The symptoms of the flu can include:
Some people also may experience vomiting or diarrhea, though these symptoms are more common in children.
If you have flu symptoms, call your health care provider immediately. There are prescription antiviral drugs that can treat the symptoms and prevent serious complications. Treatment with an influenza antiviral drug should begin as soon as possible, ideally within 48 hours after symptoms begin.
If you are pregnant and have any of these signs, the Centers for Disease Control and Prevention (CDC) recommends that you call 9-1-1 right away:
Because you may also experience other symptoms, be sure to call your doctor for anything unusual or severe.
Unfortunately, the flu is more likely to cause severe illness in pregnant women than in women of reproductive age who are not pregnant, according to the CDC.
“Just being pregnant puts you in a higher risk category for the flu because of changes to your immune system, lungs and heart during pregnancy,” said Dr. Gilpin. “It makes you more susceptible to complications from the flu than the general population. Complications can include respiratory issues and pneumonia, which may require respiratory support in a hospital or ICU.”
The flu can be particularly difficult for women whose pregnancies are complicated by medical issues like high blood pressure or diabetes, Dr. Gilpin said. In addition, research shows that having the flu while pregnant is linked to higher rates of preterm birth and intrauterine death.
Getting a flu vaccine is the best way to protect pregnant and non-pregnant people from the flu and its potentially serious complications. A new vaccine is developed each year, and the amount of protection provided by the vaccine can vary from year to year. But in general, according to the CDC, vaccination can reduce the risk of flu in pregnant women by up to 50% and reduce a pregnant woman’s risk of hospitalization with flu by 40%. And, if you get a flu shot while pregnant, you’ll help protect your baby from the flu for the first several months after birth, when they are too young to get vaccinated themselves.
The flu vaccine has an excellent safety record. Over the last few decades, millions of pregnant women have safely received the flu vaccination. In fact, the American College of Obstetricians and Gynecologists (ACOG) says it’s safe for pregnant women to get vaccinated against the flu during any trimester of their pregnancies. In addition, it’s safe to get a flu vaccine along with a COVID-19 vaccine or booster and while breastfeeding. Find a vaccine near you.
“It’s absolutely safe to get the flu shot during pregnancy,” Dr. Gilpin explained. “The needle-based vaccines we give pregnant women do not contain live virus, so there is no danger. However, nasal spray-based vaccines contain live attenuated flu virus, which is not recommended for pregnant women.”
The most common side effects of flu vaccination experienced by pregnant women are the same as those experienced by others. They are generally mild and include fatigue, fever, headache, muscle aches, nausea and soreness, redness or swelling at the injection site. If side effects occur, they usually last only a day or two.
The flu is more dangerous for children than the common cold. Children die from the flu every year.
Flu seasons vary in severity, but children are at risk for getting sick with the flu every year. Children younger than 5 years old, particularly children under age 2, are at higher risk of developing serious flu-related complications. Children of any age with chronic health conditions such as asthma, neurologic conditions, obesity or weakened immune systems also are at higher risk.
Complications from flu among children can include:
The CDC urges parents to seek emergency attention if their child exhibits:
For infants less than 12 weeks old, warning signs include fever, fever or cough that improves but then returns or gets worse and worsening of chronic medical conditions.
Treatment of the flu in children can include prescription antiviral drugs in the form of pills, liquid, inhaled powder or IV solution.
Children should be vaccinated every flu season for the best protection. While not at heightened risk, children 5 years and older can spread the flu to their higher-risk family members, such as infants, adults 65 years and older or people with chronic health conditions. Because of this, it’s recommended that everyone 6 months and older get vaccinated against the flu yearly to help protect those most at risk.
In children, annual flu vaccination has been shown to reduce:
Children 6 months through 8 years of age who have never gotten a flu vaccine or who have not received at least two doses of the flu vaccine in their lives may need two doses taken at least four weeks apart. Your child’s pediatrician will know which vaccines are right for your child. Find a vaccine near you.
Ideally, everyone 6 months and older should be vaccinated by the end of October. Since it takes about two weeks after vaccination for the body to develop antibodies against the flu virus, it’s recommended that you and your children get vaccinated before the flu season begins. However, getting vaccinated later can still provide protection into January or even later.
RSV is one of the many viruses that cause respiratory illness. Typically, RSV causes a cold, which may be followed by bronchiolitis (lower respiratory infection) or pneumonia (lung infection). Symptoms generally last five to seven days. It’s most active in the late fall through early spring, according to the American Academy of Pediatrics (AAP). Almost all children get RSV at least once before age 2. For most healthy children, the symptoms of RSV are similar to a cold, but some children get very sick from the virus.
“RSV is one of the most common viruses that brings babies into the hospital,” explained Dr. Deeter. “It can block the nasal passages, cause oxygen levels to decrease and affect appetite. RSV infections make up more than 30% of respiratory illness in infants, with more than 50,000 babies being admitted nationally every year and up to 500 infant deaths each year,” Dr. Deeter said.
RSV spreads from one person to another like the common cold. It enters the body through the nose or eyes or from:
Thanks to mask-wearing and social distancing during the COVID-19 pandemic, there were fewer cases of RSV in 2020. However, once safety measures were relaxed, the number of RSV cases began to rise in spring 2021, according to the AAP.
According to the AAP and CDC, some children have a higher risk for severe RSV infection. This includes:
Additional risk factors for severe RSV infections include:
Only 1% to 2% of children younger than 6 months of age with RSV may need to stay in the hospital, according to the AAP. If admitted, babies may need oxygen to help them breathe or an IV line for fluids. Most of these children can go home in two or three days. Rarely, a child may need to be treated in a pediatric intensive care unit (PICU).
Symptoms can appear two to eight days after contact with RSV. In infants, the symptoms include:
If you think your child has RSV, watch his or her rib cage as they inhale. If you see it “caving in” and forming an upside-down “V” shape under the neck, they are struggling to breathe. The AAP has created a video to help parents identify RSV-related breathing issues.
Your child’s pediatrician may conduct a nasal swab test to determine if your child has RSV or another virus. A chest X-ray or oxygen saturation test also may be completed to check for lung congestion. However, because most children recover without difficulty and there is no treatment for RSV, these tests may not be necessary.
Children and adults can get RSV multiple times, even during a single season. However, repeat infections are typically less severe than the first.
While there is no cure for RSV, scientists are researching vaccines to prevent RSV and working to develop new medications to treat it. Unfortunately, medications like steroids and antibiotics don’t help. The good news is that almost all children recover from an RSV infection on their own. Symptoms are usually the most severe from day 3 to day 5.
“We currently do not have an effective treatment for RSV other than saline suctioning of the nose to keep it open and using respiratory devices to help the baby breathe,” Dr. Deeter explained.
To help your child feel more comfortable, the AAP also recommends using:
“Synagis (palivizumab) is a monoclonal antibody injection available for very premature babies and young children with certain heart and lung conditions,” added Dr. Deeter. “A shot can be given to children in these groups every month during the respiratory season. It has effectively prevented hospitalizations for our most vulnerable populations.”
Your pediatrician will let you know if your baby qualifies for this treatment.
Call your child’s health care provider immediately if he or she has any:
In addition, some children with RSV may be at increased risk of developing a bacterial infection, such as an ear infection.
The simplest thing you can do to protect yourself and your children from RSV is to wash your hands. Throughout the year and the day, use soap and water and scrub for at least 20 seconds. Remind your children to practice good hand hygiene all year as well.
Other ways to help prevent RSV, according to the AAP and CDC, include:
“Taking steps to keep mom and the rest of the family healthy and limiting contact with others can go a long way in preventing RSV in infants,” said Dr. Gilpin. “You don’t want a bunch of strangers coming around and kissing the baby right now. By preventing RSV in your family, you’re protecting your newborn, too.”