RSV peak spurs push for vaccine development

Robert Dowse, MD, a pediatrician in Cedar City, Utah, has spent this winter sprinting from exam room to exam room to see an usually large number of sniffling, sneezing and wheezing young patients.

"It's been pretty heavy," said Dr. Dowse, late last month. "We've doubled our numbers on a daily basis in the past three weeks, and we've been working hard and fast."

Local news reports in several U.S. communities have noted unusually large numbers of children sick with respiratory syncytial virus. Dr. Dowse is just one of many physicians strained by this year's activity. Flu hit early and hard in December, but RSV came quickly on its heels in January, filling doctors' offices, emergency departments and pediatric intensive care units with sick children.

"It certainly feels higher than ever before," said Don Bader, MD, medical director of the emergency department at Mercy Medical Center in Durango, Colo. "This has just hammered us. We're working harder, and the local pediatricians have had some clinic days where they've just been bursting at the seams."

Experts say the virus is following its normal two- to four-year cycle.

"Every year at this time RSV causes a substantial amount of disease," said Larry J. Anderson, MD, chief of the respiratory and enteric viruses branch at the Centers for Disease Control and Prevention. "The severity of a given RSV outbreak, however, varies from community to community."

But while the big picture might look normal, more focused views have doctors in the hard-hit locales wondering why them and why now. Some feel that there is truly more virus about than ever before. Others feel that more parents are bringing children in because of an increased awareness of respiratory illness due to recent attention paid to regular influenza outbreaks as well as the more exotic avian flu and severe acute respiratory syndrome.

"Parents are a little more antsy, a little more aware of what's out there, and they are more likely to bring the kids in for mild cases," said Neil Sheppard, MD, a family physician in Council Bluffs, Iowa, who has been dealing with numerous RSV cases -- including four hospitalizations.

Many physicians are feeling overburdened and begging for new tools to tackle the virus. RSV was discovered decades ago. But most physicians are limited to rapid testing, supportive care and expensive prophylactic antibodies only for their patients at highest risk of complications. This season's rush has renewed the urgent call for a vaccine.

"It would be wonderful to get an immunization for RSV," said Roger Unruh, DO, a pediatrician in Wichita, Kan. "That would be a big, big improvement."

Scientists have struggled for decades with this task because of the unique challenges involved in creating a vaccine for the youngest and most vulnerable infants. Numerous candidates have been tried but have failed, primarily because they create more illness than they prevent.

"We are still far away from a good vaccine," said Roberto Garofalo, MD, professor of pediatrics, microbiology and immunology at the University of Texas Medical Branch at Galveston. "It would have to be a live attenuated vaccine, and they produce some kind of local symptomatic disease, which in an older child is acceptable but in children of 2 months of age is not."

So for the time being, what is most critical is basic infection control.

"We need public education and awareness that when your child is ill, keep them home from daycare," Dr. Bader said. "And we need more hand washing."