Protecting kids from RSV, a reemerging respiratory illness

Presented by Alaska Native Tribal Health Consortium

For decades, the respiratory disease and common cold virus known as RSV has had an outsized impact in Alaska compared to the rest of the United States. That’s what made tracking the disease in 2020 and 2021 so fascinating for Dr. Rosalyn Singleton, a pediatrician and research physician with the Alaska Native Tribal Health Consortium and guest researcher at the U.S. Centers for Disease Control and Prevention.

When pandemic restrictions first went into effect in March 2020, people stayed home, schools closed, and social distancing became commonplace. As a result, RSV cases dropped virtually to zero. For just over a year, Alaska had next to none.

“I’ve been practicing medicine for 36 years and I had never seen anything like this, a whole season with no RSV,” said Singleton.

But in spring 2021, as pandemic restrictions eased around the country, it didn’t take long for RSV to make a resurgence in Alaska. Cases began cropping up last summer.

Now, doctors and other health experts say, people need to be vigilant about the illness, which can be particularly serious in young children and infants. Learn about heightened risk factors in rural Alaska, how to protect your family, and the differences in how RSV is spread compared to other respiratory diseases.

Impact on Western Alaska

RSV (which stands for respiratory syncytial virus) generally has a season of November through April in Alaska. In infants and young children, it can start with a runny nose, and progress into the lungs, causing wheezing and airway issues requiring hospitalization.

This winter, hospitals in regional hub communities transferred children needing higher level of care to Alaska Native Medical Center, said Dr. Anna Ogena, medical director for inpatient pediatrics.

“Our unit was filled with mainly RSV,” Ogena said. It peaked from December through February, with cases declining in March.

“I think we are seeing more RSV this season because people have been so focused on COVID-19, we have forgotten about other viruses,” said Francis Connor, nurse practitioner and clinical coordinator for the walk-in clinic at ANTHC.

“Additionally, people are no longer socially distancing and wearing masks like we were two years ago. The lower incidence of flu and RSV from the past two years is not what we are seeing this year,” Connor said.

Most children have had RSV by age two, and most adults get the illness periodically. But infants younger than three months typically get the worst symptoms because they are at the highest risk of needing oxygen or ventilator support if they get sick.

“For most adults, RSV … manifests as a nasty cold, but it’s really a concern for younger children because their bodies just can’t clear the secretions,” said Connor. “With younger children (under two years old), the biggest question is, ‘Is their respiratory system going to stand up to it?’”

Even though RSV is no longer at its peak, Singleton said it is still circulating at higher rates in Western Alaska.

Preventative measures are even more critical in Western and Northern Alaska, where RSV case rates are typically much higher and have a disproportionate impact on Alaska Natives.

The virus is considered an “important cause of hospitalization for infants in the United States,” the Alaska Department of Health and Social Services said in a November bulletin. Premature infants and infants with chronic lung disease or congenital heart disease have higher hospitalization rates.

“Rural Alaska Native children have had five-fold higher RSV hospitalization rates compared to other U.S. children,” the state said.

Learning from the past to move forward

When Singleton first came to Alaska in the late 1980s, significant RSV outbreaks occurred for several years in a row during the winter season. The outbreaks were so bad that Alaska hospitals ran out of bed space for babies and had to transfer some infants to Seattle.

“That highlights how critical RSV was,” Singleton said, “and that helped us to become more prepared.” Alaska hospitals started sharing information and equipment to help manage outbreaks and improved communication about bed space during high respiratory disease seasons.

Researchers have learned a lot about the disease since then and have identified several risk factors. At the top of the list are overcrowding (in homes, daycares, and similar settings), lack of running water, and indoor pollution from sources such as wood stoves.

Those factors are more applicable in rural areas of Western and Northern Alaska than in Anchorage, Singleton said.

“Alaska has overcrowding rates that are approximately double the national average, and some regions of Alaska are extremely overcrowded,” according to Alaska Housing Finance Corp.’s 2018 statewide housing assessment report.

The report says that overcrowding affects up to 50 percent of households in some rural areas.

While overcrowding can make slowing the spread of an illness more challenging, a lack of running water adds a barrier to hygiene practices like frequent handwashing. Roughly 31 Alaska Native communities — 1,700 homes — still have no running water or in-home sanitation, according to ANTHC.

Hospitals in hub communities such as Nome, Bethel, Kotzebue and Dillingham can treat babies with RSV. Still, severely sick infants needing more advanced care typically need to be transported to larger facilities in Anchorage.

“They only have so many resources in the village to treat complexities which may be linked to RSV, influenza, or other respiratory infections,” said Connor.

Preventive measures and response

Luckily, there are plenty of tools that the general population has learned from two years of a pandemic that are just as applicable to preventing RSV as COVID-19. These include good handwashing habits and isolation from others who are sick or might be sick.

But RSV isn’t spread in the same way COVID-19 is, Singleton said; RSV is spread more by touching surfaces the virus has landed on after a sneeze or cough. That’s why handwashing is critical.

Here are other preventive measures people can take to protect themselves, babies, and other children in their communities:

● Keep sick kids home from school, daycare, other group settings, and other children

● Try not to take babies to large functions or places that might expose them to people who are sick

● Avoid tobacco smoke exposure, which can make airways more susceptible to illness

● Reduce indoor air pollution -- for instance, burn only clean, dry wood in wood stoves

● Get your COVID-19 vaccine and flu vaccine to protect from other illnesses

Even though most cases of RSV are mild, it’s essential to know when to seek medical help, said Ogena at ANMC.

Worsening symptoms that should prompt urgent medical care include:

● Rapid breathing

● Evidence of increased work to breathing (such as retractions, grunting, or flaring nostrils)

● Apnea or pauses between breaths

● Cyanosis

● Poor feeding

“If an infant is breathing hard and fast, call your primary provider or pediatrician to get a same-day appointment or go to the urgent care or ER,” Ogena said. “When it’s not just a mild cough, cold or wheezing that can be managed at home, that’s when to seek attention.”

This story was sponsored by the Alaska Native Tribal Health Consortium, a statewide nonprofit Tribal health organization designed to meet the unique health needs of more than 175,000 Alaska Native and American Indian people living in Alaska.

This story was produced by the sponsored content department of the Anchorage Daily News in collaboration with ANTHC. The ADN newsroom was not involved in its production.