Respiratory Illness Surge: Differentiating and Treating RSV, COVID, and Flu in Children

Concern about a respiratory ‘triple-demic.’

Electron micrograph image of respiratory syncytial virus (RSV)/Image source: CDC

Take a walk through many of the country’s pediatric emergency departments (EDs) and inpatient units right now and you will be greeted with the sounds of pinging monitors, suction, and coughing as “respiratory season” settles in.

This will be the first fall and winter that many young children have been back at schools and day cares, largely unmasked, in nearly three years. While respiratory syncytial virus (RSV) and influenza are yearly problems in pediatrics, an unseasonably early and severe surge in RSV is causing an unprecedented number of hospital admissions that is already straining many health systems.

Public health officials are already warning of a “triple-demic” this year as the current RSV surge coalesces with expected rises in influenza and COVID cases. This, of course, does not include the dozens of other respiratory viruses that affect children each winter, including the atypically severe cases of rhinoviruses/enteroviruses and parainfluenza that have already been reported this year.

RSV, influenza, COVID have subtly different symptoms.

While RSV, COVID, and influenza are all viral infections that cause acute respiratory symptoms, they can present with subtly different symptoms. […]

Message from a Concerned School Nurse

Robin Cogan

In case you have not seen the new Centers for Disease Control and Prevention (CDC) guidelines for schools, published on August 11, 2022, here they are: Operational Guidance for K-12 Schools and Early Care and Education Programs to Support Safe In-Person Learning.

Key changes in CDC guidance for schools.

The CDC has chosen the path of least resistance as schools are about to reopen or are in their first few weeks of the new school year. Although the word “prevention” is included in the CDC’s name, this central goal seems to have been removed from these guidelines, including crucial pieces of the mitigation strategies that in the past prevented the school-level spread of the virus:

Poliovirus: Still a Threat

First U.S. polio case in nearly a decade.

Henderson respirator 20th century. Credit: Wellcome Library, London, via Wikipedia Creative Commons.

Last month, an unvaccinated 20-year-old in Rockland County, New York, was diagnosed with paralytic polio. He had not traveled in the previous month; he was infected by an (unknown) individual who had travelled and acquired the infection abroad.

According to the CDC, poliovirus was also found in wastewater from Rockland and a neighboring county—coincidentally sampled in May, June, and July as part of SARS-CoV-2 surveillance—and some of the positive samples were genetically linked to virus from the patient. This reflects ongoing community transmission and ongoing risk to unvaccinated residents. Because most poliovirus infections are […]

The Monkeypox Vaccine: What Nurses Need to Know

Colorized transmission electron micrograph of monkeypox particles (red) found within an infected cell, cultured in the laboratory. Credit: NIAID. (Wikimedia Commons)

In the current monkeypox outbreak, the pandemic-strained U.S. public health system is once again faced with a major threat. This time, a vaccine is already available, but only in limited quantities. Here’s what nurses need to know. It will remain important to keep up with new developments as they occur.

The Jynneos vaccine

Jynneos is a live but nonreplicating vaccine for the prevention of both monkeypox and smallpox. It is made from vaccinia virus, a less virulent relative of these two viruses. The vaccine is given subcutaneously in two separate doses administered at least 28 days apart, and a person is considered fully vaccinated two weeks after the second dose.

The most common vaccine side effects are pain, redness, induration, swelling, or itching at the vaccination site. (People with HIV infection or atopic dermatitis do not seem to experience additional or more severe side […]

Monkeypox Update: As Knowledge Increases, More to Be Learned

Colorized transmission electron micrograph of monkeypox particles (red) found within an infected cell (blue), cultured in the laboratory. Credit: NIAID. (Wikimedia Commons)

It seems impossible that we have to confront the rapid spread of a new virus when we’re still dealing with the effects of COVID-19. But for monkeypox, we didn’t have to respond “from scratch.” After decades of research and clinical work on smallpox, a related but considerably more lethal virus, testing protocols and vaccines were already available for use in monkeypox.

Nearly 20,000 cases of monkeypox have been reported around the world since May, with more than 5,000 infections reported in the U.S. There are probably many more undiagnosed and unreported cases.

Variations in presentation.

In New York City, where more than 1,000 cases of monkeypox have been reported, clinicians are seeing variations from “classic” presentations of monkeypox. The NYC Department of Health and Mental Hygiene reports that many people with monkeypox are not experiencing prodromal symptoms […]

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