Prior to the Thanksgiving holiday in the US, experts warned about the possibility of spreading viruses to higher-risk older people who might be seeing extended family.
Now that we are a few weeks out from the first of our two big holiday travel events of the season, we can look to see whether there was an uptick in RSV-related hospitalizations, as expected and feared.
Thanksgiving Day (November 23rd) is shown with the vertical dashed line. Because the interval between RSV infection and hospitalization can be up to a week, each data point for hospitalizations reflects infection from the week prior. So, we see that there had been a steady rise in RSV-related hospitalizations during November which then markedly increased in older adults (ages 75-84 and 85+) the week after Thanksgiving (12/03/23). This might reflect their in-person social networks suddenly expanding (i.e., interacting with more people than usual) during the holiday.
The problem is that these could just be continuations of ongoing seasonal trends. That’s why looking at school-aged children gives us an opportunity. School-aged children have the opposite social change during the holidays; their social networks suddenly shrink. No daily bus rides, busy classrooms, and cafeterias. (Airport travel might offset this, but on the whole, it doesn’t even out). If the in-person social networks of children contract during the holiday, we’d expect to see a decrease in RSV-related hospitalizations in school-ages kids the week after Thanksgiving.
I’d say that it pretty compelling. The graph of adults by itself isn’t really enough. But comparing it with the graph of school-aged kids is pretty compelling (albeit circumstantial) evidence that the holidays are big opportunities for viruses like RSV to spread.
What can we do about this? RSV vaccines and antibodies.
Christmas and New Years holidays are coming up. It is not too late to get vaccinated against RSV if you’re age 60 or older (or have conditions that qualify). So far, around 17% of US residents ages 60 and up have received an RSV vaccine. That low number may in part be due to the newness of the vaccine, as this is its first year on the market. Also, the CDC’s guidance on this chose the term “shared clinical decision-making” with respect to the RSV vaccine recommendation for this age group (largely because the clinical trials were small—as a result the CDC changed its planned verbiage from “should” to “may” during the development period). Anyone who is pregnant should also get the vaccine. For infants (whose mothers did not get a vaccine during pregnancy), an antibody called nirsevimab (Beyfortus) should be given to all infants <8 months of age, plus higher risk 8-19 month-olds. There’s been a shortage of Beyfortus, though the Biden administration has announced around 300,000 extra doses are coming to ease that. Given that well over 300,000 infants are born each month in the US, that’s a dent, but would not be enough if there were 100% uptake.
Given that the RSV vaccines and antibodies are brand new options this year, I think we can see this season as a “first go-round” and hope that in 2024-2025 both demand and supply will be increased. For now, though, I’d recommend people follow these guidelines. RSV is no joke, and there’s still time this week and even next week to get these protections on board. Looking for RSV vaccines?
For Beyfortus antibodies for infants, call your pediatrician.
Thanks to Benjy Renton for maintaining the Inside Medicine Covid, Flu, and RSV dashboard.
Questions? Comments? Leave them in the Comments section.
I’m 64 and immunocompromised
I would like to get the RSV vaccine
It’s frustrating there is no safe way to receive it
It’s only available at CVS and Walgreens
Standing in line with unmasked customers and waited on by unmasked staff, while some customers are buying rapid tests or picking up Paxlovid is not safe
There needs to be safer ways to get vaccinated
It’s crazy how no one is masking! I don’t go out much to any enclosed place with lots of individuals unless I have to, such as the grocery store, doctor visits, dentist or ortho visits. But when I do I will wear a N95 mask. Lots of friends have children who just preformed in winter break performances and so many are now sick with either covid-19, RSV or both. I also have several HS classmates who became sick with covid-19 after the Thanksgiving holiday from family gatherings. Right before Thanksgiving covid-19 finally got me. Ugh. Paxlovid saved me, but it took me about 2 1/2 weeks to finally feel 100%. I have an assumption of how I contracted covid-19, but it really could have been anywhere. My thoughts on contracting it was from an orthodontist visit when I had to get a new Invisalign retainer. There were people in the waiting room coughing, no one was wearing a mask, except me and when it was finally my turn to be seen, the back was full of kids mostly. Some of the staff had masks on, but none were wearing an N95. Working as a school nurse every single kid who comes to the health office district wide not feeling well always test positive for covid-19. So that’s how I figured I finally caught covid-19 during that ortho appointment when I did have to take off my mask for close to an hour to be fitted for a new one. Before finally catching covid-19, I hadn’t been sick for nearly 4 years. My symptoms were as follows: the night before I had body aches and chills. Took a rapid test and it turned positive immediately! I took some Tylenol and went to bed. When I woke up the next morning the body aches and chills were gone but I then had congestion and what felt like a bad cold. I had some coughing, but it wasn’t like I was coughing nonstop. I got a prescription of Paxlovid that day and road out the covid-19 ride. I am vaccinated and fully boosted, receiving the most current covid-19 booster when it came out this past September. I know that also helped me. During the 2 1/2 weeks, although I didn’t feel well, I wasn’t bed bound. I was up and about in my home. But rested the entire time and the only time I went out was to be seen at the urgent care and to pick up the prescription of Paxlovid where I wore an N95 mask. I waited in my car after checking in to see the doctor for the Paxlovid prescription and was able to go thru the CVS pharmacy drive thru to pick up the Paxlovid prescription. I tested positive for covid-19 on the rapid tests for 6 days straight and finally tested negative on the 7th day. I continued to test on the rapids every few days after to make sure it stayed negative. I was at Trader Joe’s the other day, wearing my N95 and all I could think of while I was shopping was about all the other shoppers and staff who were not wearing a mask and how they will more than likely get sick with covid-19, RSV, the flu or all of them,and how it will impact all the urgent cares and ED’s. Not good.
As for my Thanksgiving, it was different being sick. I also stayed away from my lab pup and 2 cats and masked when I fed them. Didn’t want them getting sick if that is even possible. Word at the vets offices are lots of sick pups. Luckily my animals did not get sick. Be safe and stay well friends! Merry Christmas and Happy Holidays!