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Surge of respiratory viruses in children spurs CDC advisory

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With multiple respiratory viruses placing a strain on health care systems, especially children’s hospitals, the Centers for Disease Control and Prevention (CDC) has issued an advisory that summarizes prevention and treatment measures.

The CDC is tracking levels of respiratory syncytial virus (RSV), influenza viruses, SARS-CoV-2 and rhinovirus/enterovirus. Respiratory viruses other than SARS-CoV-2 are hitting the nation early and hard, especially among children.


Most regions are seeing an increase in RSV, with some already near seasonal peak levels usually observed in December or January. While activity seems to be plateauing in some places, the timing, intensity and severity of the current season remain uncertain.


Cumulative hospitalization rates for children are notably higher than at the same period in previous seasons since 2010-’11. Highest levels of activity are in the southeast and south-central U.S. The CDC estimates continued high-level circulation this fall and winter.


While COVID-19-associated hospitalizations in all age groups have decreased since August, activity is expected to increase in the fall and winter. COVID-19 community levels show rates in infants younger than 6 months remain higher than in other pediatric age groups and higher than in all adults except those 65 years and older. The virus continues to circulate in all states.

General recommendations for health care providers

  • Offer prompt vaccination against influenza and COVID-19 to all eligible people ages 6 months and older who are not up to date.
  • Of influenza A(H3N2) viruses analyzed in the U.S. since May, most are genetically and antigenically closely related to the updated A(H3N2) vaccine component, suggesting the vaccines should be protective against the predominant viruses to date.
  • SARS-CoV-2 bivalent mRNA booster doses approved for patients 5 years of age and older offer protection against both the ancestral SARS-CoV-2 virus and the predominant omicron BA.4 and BA.5 subvariants. Emerging evidence suggests that COVID-19 vaccination provides some protection against multisystem inflammatory syndrome in children and against post-COVID-19 conditions, and that vaccination among people with post-COVID-19 conditions might help reduce symptoms.
  • To prevent RSV-associated hospitalizations, eligible high-risk children should receive palivizumab treatment in accordance with AAP guidelines. Eligible children include infants born at less than 29 weeks’ gestation, children younger than age 2 years with chronic lung disease or hemodynamically significant congenital heart disease, and children with suppressed immune systems or neuromuscular disorders.
  • While vaccination is the primary means for preventing influenza and COVID-19,  antiviral medications are important adjuncts to treat illness in patients with severe illness and those at increased risk for complications.

Considerations for health care providers

  • Recommend and offer vaccinations against influenza and COVID-19 to all eligible people ages 6 months or older.
  • Use diagnostic testing to guide treatment and clinical management.
  • Treat patients with suspected or confirmed influenza who meet clinical criteria with influenza antivirals.
  • Treat outpatients and hospitalized patients with confirmed SARS-CoV-2 infection who are at increased risk for severe illness and meet age- and weight-eligibility requirements.
  • Access resources for patient education. The advisory includes multiple links and references for all of the respiratory viruses addressed.
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