Rapid Rise of RSV Cases Affecting Infants, Adolescents, and Immunocompromised Catches Healthcare Providers Off-guard
Respiratory syncytial virus, commonly known as RSV, is a respiratory virus that causes cold-like symptoms – but the number of cases this year has led to overflowing emergency and hospital rooms as healthcare providers warn of a surge in cases.
Most adolescents contract RSV one or more times by the age of two (usually recovering on their own within a week or two) until they eventually gain immunity from the disease.
But RSV infections can lead to more severe conditions, especially among infants under 12 months, such as bronchiolitis (lung inflammation) or pneumonia. Immunosuppressed individuals are also at heightened risk. In a typical year, between 200 – 300 children and around 14,000 adults with RSV succumb fatally to the disease, but the numbers may be higher this year.
Researchers Look for Clues behind the Jump in RSV Cases
Health researchers are trying to track the scope of these new cases, but unfortunately, RSV infections are not actively tracked by the CDC, and doctors rarely test for them.
Instead, we have to rely on indirect measurements, such as the number of occupied pediatric hospital beds (now reaching 75% nationally) or the number of RSV cases in the ICU, which has leaped up to 50% or more in some regions.
Is the resurgence of RSV related to the Covid pandemic? Possibly. RSV numbers were suppressed during the pandemic due to social distancing and increased sanitation, especially handwashing and mask-wearing.
Now that we’ve entered a period of “Covid fatigue,” quite a few people have taken up bad habits again, such as skipping handwashing, which could contribute to the spread of RSV. Also contributing to the problem is “Covid youth” who didn’t become immune to RSV at an early age and are only now becoming infected.
GSK and Pfizer have New RSV Vaccines Undergoing in Human Trials
After a false start several decades ago (in which an RSV vaccine tragically failed to work after it was introduced), several drug makers have returned to the fray to develop next-generation RSV vaccines that target a spike on the virus that tries to bind with a receptor in human cells (not unlike a Covid vaccine.)
However, the RSV spike is tricky.
The RSV spike, known as the F protein, will fold into a new shape (postF) after it fuses with a human cell, creating a disguise for the body’s immune system. The trick for vaccine designers was to create a vaccine that mimics the pre-infection spike shape (known as preF), which required adding chemical bonds to the vaccines to hold their shape. This approach allows the body’s immune system to identify and fight off RSV viruses before they infect cells and change into their postF disguise.
Both GSK and Pfizer have conducted clinical trials of new RSV vaccines.
The GSK version, designed for adults, is further along and could be approved in the next few months. The tests indicate it offers 84% efficacy against serious diseases among adults aged 60+.
Pfizer’s initial RSV vaccine offering is designed for infants, but it probably won’t be approved until next year in time for school season to start in the fall (with an adult version coming later).
In the meantime, there is a limited supply of monoclonal antibodies (Beyfortus) developed by AstraZeneca and Sanofi that can help those most at risk of becoming infected with RSV.
Could RSV “Merge” with Other Viruses, such as Influenza, to Create a New Threat?
Public health officials are concerned about the potential of a “tri-demic” as we head into winter, where cases of RSV, influenza, and Covid-19 peak at the same time.
RSV cases, which normally peak in mid-winter, rose rapidly in August. Flu cases, especially in the Southern states, have also spiked earlier than expected as well. Covid-19 remains a wildcard, but if another variant arises and infections surge again, the US healthcare system could become quickly overwhelmed with sick patients.
As a gentle reminder, today is a great day for you, your family, and your colleagues at work to get a flu vaccine and a bivalent Covid vaccine if you have not done so already.
Unfortunately, there are more potential dangers on the horizon.
Researchers from the MRC-University of Glasgow in Scotland believe they have identified a new hybrid virus that combines RSV and influenza A into a new dangerous pathogen.
This combined virus has a palm tree-like structure, with the RSV element making the “trunk” and the influenza A virus elements forming the “fronds.”
Worryingly, the researchers observed this hybrid virus was able to effectively bypass the body’s immune system protection against influenza – the hybrid used the RSV component as a “trojan horse” to infect cells with the flu virus.
Hopefully, this new hybrid virus is a rarity and not a harbinger of what’s to come. But researchers will need to monitor this development carefully.
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