Wisconsin DHS Health Alert #51: Increased Circulation of Multiple Respiratory Viruses Among Children and Adults in Wisconsin
Bureau of Communicable Diseases
November 16, 2022
Key Points
- Department of Health Services (DHS) surveillance data indicate a significant increase respiratory syncytial virus (RSV) and influenza activity in Wisconsin. Simultaneous increases of both viruses are unusual for this time of year.
- Significant increases in hospitalizations for these respiratory illnesses, especially among children, have been noted in multiple locations across Wisconsin.
- To inform clinical management and infection prevention decisions, clinicians should prioritize testing patients with respiratory illness for both COVID-19 and other respiratory viruses using a multiplex respiratory virus panel.
- People who have symptoms should stay home to prevent the potential spread of illness, especially in schools, childcare programs, long-term care facilities, hospitals, and other settings where close contact is likely.
Background
DHS surveillance data indicate a significant increase of non-COVID respiratory illnesses. Positive tests for respiratory syncytial virus (RSV), and influenza have significantly increased in recent weeks. These viruses in addition to the SARS-2 virus are a major cause of severe lower respiratory infection in young children and older adults. The populations most at risk for these illnesses are young children, children in day care settings, older adults in long-term care, and people with weakened immune systems.
In Wisconsin, the activity of these viruses has increased over the past few weeks to levels higher than would typically be expected for this time of year, based on data reported to the Wisconsin State Laboratory of Hygiene and the National Enteric and Respiratory Virus Surveillance System. Data from syndromic surveillance of hospital emergency departments also indicate a significant increase in influenza-like illness among children less than five years old. Combined with an increase in COVID-19 cases, this is the first year that three severe respiratory viruses are circulating simultaneously with significant increases in cases being reported.
Recommendations for Healthcare Providers
Prevention
CDC and DHS recommend that healthcare providers offer prompt vaccination against influenza and COVID-19 to all eligible people aged 6 months and older who are not up to date. Vaccination can prevent hospitalization and death associated with influenza and SARS-CoV-2 viruses.
To prevent RSV-associated hospitalizations, eligible high-risk children should receive palivizumab (Synagis®) treatment in accordance with AAP guidelines. In brief, children eligible for palivizumab include infants prematurely born at less than 29 weeks gestation, children younger than 2 years of age with chronic lung disease or hemodynamically significant congenital heart disease, and children with suppressed immune systems or neuromuscular disorders.
Everyday actions can also prevent the spread of these viruses.
- Washing your hands often with soap and water, cover coughs and sneezes.
- People who have symptoms should stay home to prevent the potential spread of illness, especially in schools, childcare programs, long-term care facilities, and other settings where close contact is likely.
- Clinicians should continue to prioritize testing all patients with respiratory illness for COVID-19. Additional testing for other respiratory viruses with a multiplex respiratory virus panel using RT-PCR, is indicated for patients who test negative for COVID-19.
Testing
It is vital to continue to test for COVID-19 in patients with COVID-like illness, and to follow current recommendations for influenza testing now that influenza is circulating in the United States. In addition, multiplex respiratory viral PCR testing should be considered in settings where such testing is available, and should be prioritized for patients hospitalized for apparent viral respiratory illness.
Treatment
Influenza
CDC and DHS recommend influenza antiviral treatment as early as possible for any patient with confirmed or suspected influenza who is:
- Hospitalized
- An outpatient at higher risk for influenza complications; or
- An outpatient with severe, complicated, or progressive illness
Clinical benefit is greatest when antiviral treatment is administered as early as possible after illness onset (ideally within 48 hours), although antiviral treatment initiated later than 48 hours after illness onset can still be beneficial for some patients (e.g., outpatients at increased risk for complications and hospitalized patients). Clinicians should not wait for laboratory confirmation to decide when to start influenza antiviral treatment in patients with suspected influenza.
Oral oseltamivir (generic formulation or Tamiflu®) is the recommended antiviral for outpatients with severe, complicated, or progressive illness and for hospitalized influenza patients. Oral baloxavir marboxil (Xofluza®) is approved by the U.S. Food and Drug Administration (FDA) for treating acute uncomplicated influenza in people 5 years and older who are otherwise healthy or in people 12 years and older who are at high risk of developing influenza-related complications.
SARS-CoV-2
COVID-19 antiviral agents reduce risk for hospitalization and death when administered soon after diagnosis. The antiviral medications nirmatrelvir and ritonavir (Paxlovid) or remdesivir (Veklury) are the preferred treatment options for COVID-19 in patients with mild to moderate illness who are at increased risk for severe illness, including older adults, unvaccinated persons, and those with certain medical conditions The antiviral medication molnupiravir (Lagevrio) and monoclonal antibody bebtelovimab are alternative treatment options when Paxlovid and Veklury are contraindicated or not available.
Resources
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist for Communicable Diseases
Wisconsin Department of Health Services
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