RSV causes respiratory tract infections in patients of all ages. It is the major cause of lower respiratory tract infection during infancy and childhood. In temperate climates like Massachusetts there is an annual epidemic during the winter months. In tropical climates, infection is most common during the rainy season. In the United States, 60% of infants are infected during their first RSV season, and nearly all children will have been infected with the virus by 2-3 years of age. Natural infection with RSV does not induce protective immunity, and thus people can be infected multiple times. Sometimes an infant can become symptomatically infected more than once even within a single RSV season.
It is very, very easy to contract RSV. It is spread by physical contact (such as shaking hands with an infected person) or thru the air (usually from sneezing or coughing). RSV can also live for several hours on surfaces, such as doorknobs, telephones, faucet handles, counters or used tissues, towels, etc. RSV infections are very common in areas where people are crowded together. In homes where there are multiple children, such as us, RSV can spread very rapidly from child to child. And older siblings can even bring the virus home from school or a friend's house.
For most people, RSV produces only mild symptoms, often indistinguishable from common colds and minor illnesses. The Centers for Disease Control consider RSV to be the "most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age." Infants born at less than 36 weeks gestational age are at a significantly elevated risk for severe RSV disease. According to the Centers For Disease Control and Prevention (CDC), each year, up to 125,000 children are hospitalized with serious RSV disease and some of these children may die from RSV complications. RSV is the leading cause of hospitalization for children under 1 year of age. And severe RSV infections may increase the risk of wheezing and asthma-like illness through childhood.
The practical implications of RSV are scary. At best, recuperation takes place at home with 2-hour breathing treatments through a nebulizer. Multiply those breathing treatments times three, and add other difficulties of having sick babies, not to mention the daily schedule that life with triplets brings, and you have a recipe for a long three weeks. But the worst part is that it would take years to repair the damage RSV does to premature lungs, including vulnerability to respiratory infection, likelihood of asthma, and continued reliance on nebulizers and steroids to clear bronchial passageways.
To illustrate, here's how RSV affects lungs (courtesy of the Synagis website). To see the pictures better, double-click on them.
Severe RSV disease is more likely to develop in babies with the following risk factors:
1. Premature birth. In infants born prematurely (ie, more than 4 weeks early), RSV can become a serious respiratory tract infection that requires hospitalization, especially early in life.
2. Being born with lung disease. Babies younger than 2 years old born with chronic lung disease who have needed medical care for it within 6 months before RSV season are at high risk.
3. Being born with heart disease. Babies younger than 2 years old born with serious heart disease may be at high risk.
4. Low birth weight. Low birth weight (less than 5½ pounds) greatly increases the risk of death from RSV.
5. Older brothers and sisters. Babies in contact with school-aged siblings can get RSV, particularly during the cold and flu season.
6. Going to daycare. Babies who go to daycare are at higher risk for getting RSV.3 (Daycare is defined by the Centers for Disease Control and Prevention [CDC] as any setting outside the home where a child regularly spends ≥4 hours/week with ≥2 unrelated children.)
7. Family history of asthma. There is a higher risk for severe RSV in children with a family history of asthma.
8. Tobacco smoke and other air pollutants. You should never allow anyone to smoke around your baby. Tobacco smoke and other air pollutants can irritate your baby’s lungs and make it harder to fight RSV.
9. Multiple births. Multiple births (for example, twins) increase the risk for RSV because of low birth weight and an increased number of young siblings in the household.
Of these factors, we have several--premature birth, a baby with a mild heart condition, family history of asthma, and multiple births, at least. That makes our triplets high-risk. Even though they appear healthy, our boys' lungs are still immature, and so we have to be extra careful.
There are simple steps that we can take. Thus we ask that:
1. Visitors and family members and caregivers wash their hands with warm water and soap before touching the babies.
2. Visitors must be free of cold symptoms for five days and should delay visits if they have been in contact with someone who is sick. It is a must to avoid being around the babies if you have a cold or fever. Even if the babies don't catch anything, we could, which means that either one of us would have to care for the triplets or that the sick parent would have to constantly change clothes and wear masks.
3. Avoid exposing the babies to other children with cold symptoms.
4. Please try to get a flu shot before they run out.
In essence, we're "quarantining" the babies and ourselves as much as possible this RSV season. Unfortunately, that means that we have to miss out on a lot of fun events, and risk angering people who may not understand the seriousness of RSV. We really want to make it through the triplets' first winter without ending up in the hospital. Their lungs have come a long way. But believe it or not, they are still very fragile, at least until they are 2. Then we can all breathe a little easier!
