Children Aren’t Getting More Respiratory Viruses — It Just Seems That Way

The U.S. Centers for Disease Control and Prevention this month announced the outbreak of a polio-like mystery illness that has affected at least 70 children and may stem from a common respiratory virus.

Around the same time, the agency reported the first pediatric flu death of the season.

And this week, there is the tragic news that a ninth child has died at a health facility in New Jersey, where at least eight deaths have confirmed as being caused by adenoviruses.

This flurry of stories about kids getting gravely ill and even dying from common respiratory viruses is enough to put any parent on edge, particularly as their kids head off to day care or school and return home with runny noses and persistent coughs.

But infectious disease specialists say there isn’t cause for alarm.

So far, there is no evidence that the 2018-2019 respiratory virus season is shaping up to be particularly bad — or that respiratory illnesses have become more virulent or widespread in recent years.

Some bad news and good news: Respiratory viruses are incredibly common in the fall and winter, but that hasn’t necessarily changed since the CDC began tracking the flu and respiratory syncytial virus infection (RSV) in the 1980s, or rhinovirus, enterovirus, and human metapneumovirus (basically, another virus that can cause upper and lower respiratory infections) in 2007.

What has changed during that time is the widespread availability of relatively rapid diagnostic tests for children who show up at their doctor’s office or an emergency room.

“Ten years ago, no one would have been told, ‘You have rhinovirus,’” said Aaron Michael Milstone, an epidemiologist at Johns Hopkins Hospital and an associate professor of pediatrics with Johns Hopkins University School of Medicine. “You’d just be told, ‘You have a cold.’ … That’s a change ― that ability to put a name on something.”

So, had there been a deadly adenovirus outbreak a decade ago, experts may not have been able to pinpoint the exact cause, Milstone said. 

On top of that, the greatly expanded media landscape means that stories about relatively rare outcomes garner more national attention than they used to, as has been the case with the recent New Jersey deaths.

The reality is that adenoviruses tend to cause relatively mild issues, like colds, sore throats and pink eye ― not death. Individuals with weakened immune systems are at greater risk of developing more serious complications — and indeed, each of the children infected at the Wanaque Center for Nursing and Rehabilitation in New Jersey had a compromised immune system beforehand. 

Respiratory viruses tend to peak in the late fall and winter in part because people tend to spend more time indoors in groups, where they can easily spread germs. That’s certainly true in schools, where kids tend to pass viruses back and forth. 

Indeed, the CDC says colds are the top reason why kids miss school each year. 

So, while parents shouldn’t fret too much over the possibility of severe complications stemming from respiratory viruses, they might also do well to accept them as a fact of life for a certain stretch of the year. 

“For a run of the mill, otherwise healthy young child who is fully vaccinated, but goes to school or day care or preschool, it is not unusual to get as many as eight or even 10 respiratory viruses in a season,” said Gail Shust, a pediatric infectious disease specialist at Hassenfeld Children’s Hospital at NYU Langone. “That in and of itself — I mean, it’s a bummer, obviously — but it should not alarm a parent.” Given that it can take infections 10 or more days to clear the system, your kid might be sniffling and coughing all winter long.

The 2017-2018 flu season was a particularly severe one across all age groups, resulting in more than 180 pediatric deaths — the highest number the CDC has recorded during a regular flu season. It’s not clear why, but the dominant strain that circulated last year tends to hit people particularly hard.

At this point in the flu season, it’s not possible to say whether this season will be particularly bad — or whether this year’s vaccination will be a good fit.

But public health experts resoundingly agree that parents can help protect their children by getting them a flu shot. Last year, 80 percent of the children who died had not been vaccinated.

“Get your child vaccinated. In terms of the flu, if you haven’t done it already, now is a good time to do it, because we haven’t reached the peak of the season yet and it takes a few weeks until the immune system builds up a response to the vaccine,” Shust said.

Acute flaccid myelitis, or AFM — the polio-like illness that causes sudden onset limb weakness and even paralysis — is a bit different, because it appears to be relatively new. There have been 72 confirmed cases thus far in 2018, with an additional 119 possible cases being investigated. The disease appears to intensify every other year, with 120 confirmed cases in 2014 (when CDC began tracking it) and 149 in 2016.

Experts fear this year’s outbreak may outpace previous clusters and are hastening to find a cause. Many suspect enteroviruses, which cause up to 15 million infections a year, are at the root of the illness. The CDC, however, continues to cast a wide net, sparking backlash from the agency’s own medical advisers, who told CNN the CDC has been slow to respond and has been reluctant to focus on enteroviruses. 

But again, experts emphasize that cases of AFM are incredibly rare.

“I believe this is a notable, uncommon complication of something,” Milstone said. “And unfortunately we haven’t figured out what it is just yet.”

Overall, the important thing is to practice good prevention: Get the flu shot, remind your kids to cover their mouths when they need to cough or sneeze, and wash those little hands.

“Unfortunately, I think illnesses make for good media stories,” said Milstone. “But I’m a big nonalarmist, and I like to say that common things happen commonly. Be as safe as you can with your kids and practice good hygiene.”