What is Tripledemic? RSV, Covid and Flu — Oh my.

The United States is already seeing a spike in new Covid-19 cases and a slight increase in hospitalizations as winter approaches. To add to our concerns, children are affected by three types of viral respiratory infections, including Covid-19, leading to what is now called “triplemia”.

The other two viruses, RSV (respiratory syncytial virus) and influenza (flu) are leading to sharp increases in pediatric respiratory illness hospitalizations across the country, which Dr. Bruce Y. Lee for Forbes in October. This is getting worse every week.

The first child death due to complications from the flu was reported in North Carolina on November 2, 2022. According to the Centers for Disease Control, this was the first reported flu-related death in a child since February 2020. The flu is certainly not new virus, and in previous years, prior to 2020, the United States would typically see between 20,000 and 60,000 deaths per year from complications of the flu. Vaccines to protect against the flu are adjusted each season, based on the previous season’s flu strains, to minimize the risks of flu-related infections, complications, hospitalizations, and deaths. In most years, less than 50% of the population receives the flu vaccine, which is approved and recommended for all ages 6 months and older.

RSV, or respiratory syncytial virus, is also not new. Children usually develop anything from cold-like symptoms to a more severe cough or even difficulty breathing. Higher-risk infants are eligible to receive RSV prophylaxis called palivizumab. This is not a vaccine, but an antibody treatment offered in limited supply to specific groups of infants at higher risk of RSV-related hospitalization. As I mentioned about Forbes, the American Academy of Pediatrics expanded palivizumab eligibility this year as we see massive increases in RSV infections months earlier than in previous years. Despite the widespread use of palivizumab, hospital beds are filled with previously healthy, “low-risk” children suffering complications from RSV infections.

And then there’s Covid. With almost all mitigation measures lifted, especially in schools, children are getting more Covid infections. Most are mild, but some are not, and the kids land in the hospital once again. At the end of October 2022, there were 46 children under the age of 5 in the US hospitalized with Covid-19. There were fewer than 25 of these 5-17 year olds hospitalized in the same week. This is likely due to lower vaccination rates in younger children, especially with the younger BA.4 and BA.5 strains predominating. There has also been a large increase in infants under 6 months being hospitalized with Covid infections, as this group is not yet eligible for the Covid vaccination.

Big cities like Los Angeles are already seeing an early winter spike in Covid-19 infections, which will undoubtedly translate into an increase in hospitalizations and deaths in the coming months. With incredibly low uptake of the newest bivalent amp taken nationally, we may be in for another tough winter. Patients with Covid complications won’t be the only ones filling up beds – children’s beds are already filling up, first with RSV, now with flu, and probably soon more adults and children will be hospitalized again with Covid. Recommendations for coverage enter the public health debate. Once more. Resuming the mask this winter may help eliminate the projected increase in all three infections.

What is Tripledemic?

We have flu, RSV and Covid-19 infecting children as a three-virus attack, called triplemia. None of these viruses are new, as SARS-CoV-2 has been around for at least three years now, and RSV and influenza have been around for decades. Some have claimed that the nation’s children suffer from an “immune debt” as their bodies have not been exposed to these viruses because of mitigation measures, including early stay-at-home requirements, coverage, testing and physical distancing. However, there is no such thing as immune debt. The immune system is not weakened, weakened or immature due to lack of viral loads. Yes, many of the viruses that children are exposed to allow them to develop brief periods of antibody protection, but most of the viruses that children and adults get keep coming back, with no permanent protection due to infection.

Now that almost all mitigation measures have been lifted, children from newborns to young adults are exposed to these three, and many other, respiratory pathogens that routinely cause everything from colds to severe lung infections every year.

What is the difference between Covid, Flu and RSV?

These three respiratory infections can look quite similar. According to UC Davis infectious disease specialist Dr. Dean Blumberg, there are several differences to note in these three diseases:

Covid-19 infections:

  • fever or chills
  • respiratory symptoms (cough, sore throat, runny nose)
  • loss of taste and smell
  • fatigue
  • sore throat
  • muscle or body aches;
  • headache

Influenza (influenza) infections:

  • sudden fever or chills
  • respiratory symptoms (cough, sore throat, runny nose)
  • muscle aches and pains;
  • headaches

RSV infections:

  • catarrh
  • cough
  • fever
  • whistling
  • decrease in appetite

What can you do to reduce the risks of disease?

Without sounding like a broken record, the means to reduce the risks of disease remain the same as in previous years. Information about Covid vaccinations clearly reduces the risks of complications from Covid infections. This includes the newest bivalent Covid booster vaccine. Everyone over the age of 6 months should get an annual flu shot. This is especially critical for pregnant women, as flu protection can be passed on to their newborn during the first six months of the baby’s life, before they are eligible for vaccination. This transmitted protection also applies to Covid-19. Pregnant women vaccinated against Covid-19 transfer antibody protection to the fetus. This protection continues in the first months of the baby’s life. As for RSV protection, there is no vaccine to protect against RSV, although Pfizer recently published promising data on the RSV vaccine given to pregnant women, which will provide protection to vulnerable newborns.

Other means of protection continue to include wearing a mask indoors this winter. Masks have clearly been shown to reduce the risk of viral transmission, thereby reducing the risk of disease. For those who remain mask skeptics, thank your health care professionals who wear their masks while caring for sick people, don’t get sick themselves, and showed up to care for the sick during this outbreak, in the past, and during the ones to come. they are coming.

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