Post Gazette: RSV, influenza trend upward nationally as we enter the holiday season

A third of those polled during a national survey believed vaccines to be unnecessary for those who are not at high risk

Last year’s “tripledemic,” that collision of COVID-19, influenza and RSV, peaked the week of Dec. 3 with 235,850 cases reported across the country.

The holiday season timing of that spike was perhaps no surprise with celebrants in enclosed spaces like airplanes and dining rooms talking, hugging, laughing — and spreading respiratory droplets.

As another holiday season starts, a host of currently available tools — some new, others tried and true — offer opportunities to control droplet dissemination and to protect both loved ones and strangers during the holidays and beyond.

“With COVID, as an example, this novel virus spread from one area in China around the entirety of the globe, very quickly. And the way it did that is because of how integrated and rapid our travel systems are,” said Dr. Megan Conroy, a pulmonologist and critical care specialist at the Ohio State University Wexner Medical Center.

“As we take advantage of those travel systems over the holidays, we are more likely to encounter people and to bring germs with us in those travels. So it can be a high-risk time, both for exposure of yourself or exposing other people.”

The general advice remains the same, with the medical community at large in step with recommendations from the U.S. Centers for Disease Control and Prevention that people should get vaccinated. The 2023-24 season sees updated vaccines for COVID-19 and influenza, while brand-new options offering protection against respiratory syncytial virus were approved for babies, adults over the age of 60 and pregnant women just this year.

“What we know is, when you’re vaccinated, your chance of contracting infection is lessened, as is your risk of becoming severely ill or hospitalized or even dying,” said Dr. Gena M. Walker, associate chief medical officer at St. Clair Health. “So from a love-thy-neighbor perspective and herd immunity thinking, even healthy folks should partake in vaccinations when they’re able to.”

Whether or not people will do so was asked and answered in a new national survey from OSU’s Wexner Medical Center, which found 33% of respondents thinking their vaccination decisions for respiratory illnesses don’t impact others. A third of those polled during the Oct. 20-23 survey believed vaccines to be unnecessary for those who are not at high risk. Results were culled from a sample of 1,007 respondents.

The results were not “particularly surprising, in light of what we’ve seen and heard from the public over the last couple of years with regard to the ways that they approach vaccination,” said Dr. Megan Conroy, also a clinical assistant professor in OSU’s College of Medicine.

A strength of the survey, she noted, was that it focused more generally on respiratory virus seasons. “As COVID has become endemic, it’s fair to think about it in line with seasonal influenza. At this point, it’s fair to think about it in line with respiratory syncytial virus.”

The seasons for respiratory viruses — not unlike the temperature fluctuations of the meteorological seasons — don’t exactly line up perfectly year after year. Knowing precisely when, say, influenza will kick into high gear annually is difficult to know, but nationally cases of both the flu and RSV are beginning to trend upward. Rates of COVID, nationally and in Western Pennsylvania, remain relatively low.

That is not to say that COVID is benign. Dr. Andrew Nowalk, clinical director of the Division of Infectious Diseases at UPMC Children’s Hospital of Pittsburgh, expressed concern about death rates remaining far higher than those from the flu.

“It’s still worse than most flu seasons we’ve had in the last 20 years. So we really need to continue to protect our older folks against it,” he said.

Nationally, provisional data from the CDC shows 1,199 deaths related to COVID for the week of Oct. 14. In Pennsylvania, COVID accounted for 2.5% of all deaths for the week ending Nov. 4, per the CDC, a percentage that has held over the past three months.

CDC influenza mapping shows a concentration of high activity in the southeastern U.S. for the week of Nov. 4. That means it’s on its way to the Pittsburgh area, likely in about four to six weeks, said Dr. Nowalk. “It’s coming,” he said.

The wait for RSV, however, is over.

“RSV is here,” Dr. Nowalk said. “RSV has been less severe than last year. We’re still seeing a lot of it, but not nearly the skew toward a lot of older kids in addition to the babies.”

In addition to older adults, particularly those with underlying conditions such as suppressed immune systems, infants are particularly susceptible to severe cases of RSV.

“We’re seeing lots of them being admitted to the hospital. And lots of them are really sick, requiring oxygen. Some of them going to the ICU, some of them requiring ventilators. This is a bad virus in infants. It makes them really sick,” he said, adding that parents with severely ill children should not be deterred by wait times at Children’s Hospital’s Emergency Department, which were longer than usual during last year’s RSV surge.

“We have triage nurses out front,” he stressed. “Really ill children get cared for immediately.”

An addition to the arsenal as of this summer is Beyfortus (co-developed by Sanofi and AstraZeneca), which provides immunization against RSV for our tiniest citizens and is recommended for babies less than 8 months during the season.

In addition to how severe the illness can be for infants, and knowing that “early RSV in infants predisposes them to bad asthma later in life,” Dr. Nowalk noted the excitement around the new drug, generically known as nirsevimab. “But the supplies have not kept up with that excitement.”

Recognizing the dearth, and the demand, the CDC and FDA announced in a Thursday statement that 77,000 additional doses would be shipped “immediately” to hospitals and physicians.

“If you have a chance to give it to your infant, 100% give it. RSV puts so many infants in the hospital,” Dr. Nowalk said.

This year saw another potential game-changer for RSV season, in the form of two vaccines for adults 60 and older: Arexvy, from GSK, and Abrysvo, from Pfizer. Abrysvo is additionally recommended by the CDC to be administered to pregnant women, at 32 to 36 weeks gestation, providing protection to babies in utero.

Though these options are “really effective ways to prevent RSV infection,” said Dr. Conroy, “because they’re very new, not a lot of people know about them.”

That public education challenge also intersects with potential public malaise, after an intense past several years focused on COVID.

“As we approach the holiday season, there is a particular risk to folks for a couple of reasons,” said Dr. Walker.

“We have some test fatigue. Combine that with the reluctance for some people to undergo COVID booster vaccination or even flu vaccination, and we probably have to be very cautious as we move toward colder winter months and the holiday season where we have large gatherings together.”

All three experts stressed a common-sense approach, which includes staying home if you don’t feel well and taking simple precautions such as wearing a mask or asking others to if they are in contact with someone at high risk for severe illness.

“Wearing a face mask is a very reasonable, cheap, pretty low-risk intervention that someone can take on to help reduce the risk of contracting lower respiratory diseases, or spreading those through their travels,” Dr. Conroy said.

Leave the cloth masks to history, though. “Surgical masks are good, KN95 or N95 masks are better,” she said, also nodding to another solid standby: washing hands.

While “the easiest way to protect yourself is still vaccine,” Dr. Nowalk said, keep in mind that the vaccines generally take about two weeks to provide full protection, making supplemental measures even more key during the Thanksgiving holiday for those yet to receive them.

“If you’re not vaccinated for [the] COVID booster, influenza or RSV, if you’re eligible, by now, you will not have full protection through vaccination by Thanksgiving at this point,” Dr. Conroy said.

Of course, just like flu season, additional holidays are on the way.

“People can consider the benefits to getting vaccination, soon, as a way to help prevent risk of spreading or contracting disease if they’re exposed in their travels, or visiting family around holidays, following Thanksgiving,” Dr. Conroy said.


First Published November 19, 2023, 5:30am