Deborah Howell (Host): Respiratory syncytial virus, or RSV, is a very common illness, especially for babies under the age of two, that attacks the lining of the airways and lungs. With us today is Dr. Nick Hysmith, Medical Director of Infection Prevention at Le Bonheur Children's Hospital, to share more information about preventing and treating RSV, and to let us know what might be best for you and your child during the RSV season.

Welcome to you, Dr. Hysmith.

Nick Hysmith, MD, MBA, MS: Good morning, thanks for having me.

Host: So glad you're here. Let's jump right in. What is RSV?

Nick Hysmith, MD, MBA, MS: Yes, RSV is respiratory syncytial virus. It's a very common viral infection that really affects all of us. Older individuals don't really, you know, have a ton of symptoms, most likely a head cold, a runny nose, but where we do see issues is in our younger kids, so kids less than two and really kids less than one year of age see the most effects from RSV.

That's because their airways are so small. And RSV attacks the lining of those airways and it can really lead to difficulty breathing and it's actually the most common cause of admission in this age group during the fall and winter months.

Host: Oh, wow. Okay. And is this RSV season different from others? And if so, how?

Nick Hysmith, MD, MBA, MS: So it's a little different. Since COVID, we've had a shift in our RSV season in that we didn't really have a good way of knowing when we were going to start to see it. So a couple of years ago, it was in the summer, which really threw us all for a loop. This year, it looks to be another fall and winter season, which is what we saw prior to COVID. It is a few weeks earlier this year, so not terribly different, just a little bit early.

Host: Okay. And who exactly is susceptible to RSV?

Nick Hysmith, MD, MBA, MS: So really kids under two. So we see the most admissions and the most respiratory illness in kids that are younger than two. We really see those hospitalizations go up in kids that are under one, and kids that have underlying medical conditions, such as chronic lung disease or any kind of congenital heart disease. We see those kids be admitted with severe symptoms more frequently.

Host: And what's the RSV vaccine that just came out? How does it work? And who should take it?

Nick Hysmith, MD, MBA, MS: Right. So this is a really exciting time for RSV. We have several vaccines that have come out in the last several weeks, so we're really excited about Beyfortus is one of the vaccines that just came out and that's going to be for kids less than eight months of age who are entering their first RSV season and we are really hopeful that that is going to really prevent admissions this year and then really seeing that effect next year as we really get the entire population vaccinated and that's going to be for all kids. So in the past, we've had a vaccination called Synagis or palivizumab that's just been for very high risk kids, but this new vaccine is for everyone and we're really excited about it.

Host: That is great news. So how is Le Bonheur treating RSV patients who come through the doors?

Nick Hysmith, MD, MBA, MS: Yeah, so most of our kids present in our emergency department, first, which is very similar to how it is, you know, across the country. And then they're evaluated for RSV with a quick test. That test also tests for COVID and then a little bit later it'll add flu onto that. Once we know kids have RSV, then we do a risk assessment sort of based on their age.

If they're less than two years of age, then the likelihood is that they'll be admitted to our hospital for a few days, because we know that RSV is a little bit worse on the third day of illness. So we like to watch those kids that are less than two, just a little bit longer. So the provider comes in, evaluates breathing, makes sure the oxygen levels are what they should be.

And then based on that information, they can get admitted to our hospital or if the kid looks fine and it's a little bit later in the illness, some of those kids are discharged home. It's a viral illness that we've dealt with for years, for decades, so we have a really good way of treating it, but the new vaccines are really going to hopefully prevent this from even being an issue.

Host: Great. Can you tell us a little bit about the Enanta study?

Nick Hysmith, MD, MBA, MS: So this is an exciting study that we have enrolling patients here at Le Bonheur. And it's looking at kids who come in and are diagnosed with RSV. So it's essentially a treatment for RSV, whereas the vaccines are a prevention tool for RSV. So hopefully in the coming years, the vaccines will prevent the hospitalizations and the acquisition or the getting of the RSV and once kids have RSV, we'll look to drugs like we're testing in the Enanta study that will actually help treat RSV in these smaller kids. So we are enrolling here at Le BonHeur, and very excited about that study.

Host: That's great news. Is there any way RSV can be prevented?

Nick Hysmith, MD, MBA, MS: The biggest way are the vaccines. So, since COVID, we've talked a lot about vaccines, more than we had in the past, which is a little bit unfortunate because we probably should have been talking about them more in the forefront for a really long time, but really the vaccines prevent the illnesses.

That's what we've known about flu and all of our vaccine preventable illnesses that we see in young kids. So that is by far in a way, the best way to prevent RSV. I think, we are in this situation where kids have started back to school, everyone's in daycare, so if your kid is sick or has respiratory symptoms, try to keep them out of daycare. Just a lot of hand washing and cough etiquette and things that we've all become so familiar with over the last several years is probably secondarily the best way to prevent RSV.

Host: And what should I do if I think my child has RSV, and how can I tell if it's RSV or another respiratory virus?

Nick Hysmith, MD, MBA, MS: Great question. So, you know older kids, kids that are three, four, five, school age kids, this is going to be just a run of the mill cold for the most part. So they're going to have a runny nose, some congestion, usually a lot of congestion is what we see with RSV. When you get into those smaller kids, those two and under, then you're going to start to see a little bit more of the lung involvement. So you're going to see some difficulty breathing. You might see the skin kind of tugging in around the ribs when these young kids take deep breaths, that's going to be the big sign that you probably need to take your child to their primary care physician, and let them be evaluated. Almost all primary care physicians have quick tests in their office to test for RSV.

So once they're able to do that, they can tell you if it's RSV or not. And if it is, we kind of know what the progression is from there based on the day of illness and that sort of thing. Really the only other viruses we care about, in that setting, are flu and COVID we're not really seeing any flu at all right now, so we're not so worried about that.

And then we have those quick tests for COVID in the PCP's offices as well. So I think if you see increased work of breathing in a kid less than two, have them evaluated by their primary care provider.

Host: And that's where everything starts with primary care.

Nick Hysmith, MD, MBA, MS: Right. Yes, definitely.

Host: They can let you know when they need to make hospital admission and et cetera, et cetera. So prevention is the key.

. Well, Dr. Hysmith, thank you so much for talking to us today about RSV and helping us to understand more about RSV and how to treat it. This is the Peds Pod by Le Bonheur Children's Hospital. Please visit lebonheur.org for all your pediatric needs. I'm Deborah Howell. Thanks for listening and have yourself a great day.