Respiratory syncytial virus, or RSV, a virus that can be severe for some babies, is increasing at winter rates already in Chicago after a slowdown following measures to prevent the spread of COVID-19.

       Pediatricians are noting an earlier season for RSV, with hospitalizations increasing so much that hospitals expanded the window in which they provide treatment that can help prevent hospitalizations.

       In typical years, said Michael Cappello, vice chair of pediatrics at Advocate Children’s Hospital in Park Ridge, “If we started seeing an RSV case at the end of September, it’s like ‘Oh, it’s a little early.’ ” Now, he said, they are seeing increasing admissions for sick kids.

       Earlier this year, doctors were seeing fewer cases as social distancing, masking and staying home for COVID-19 helped many kids avoid germs.

       RSV can cause severe infections such as bronchiolitis, an inflammation in the lungs and pneumonia. According to the Centers for Disease Control and Prevention, severe illness most commonly occurs in very young infants. But children with underlying conditions including prematurity, chronic lung disease, congenital heart disease, suppressed immune system or neuromuscular disorder are also considered at high risk.

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       Cappello emphasized RSV is most dangerous for children under 1; older children do better because their airways are bigger.

       Multiple Chicago children’s hospitals are logging winter-level cases of RSV.

       “Since July and then August it really picked up,” said Allison Bartlett, a professor of pediatrics at the University of Chicago and medical director of the pediatric infection control program. In July, they had 28 admissions and in August, 60. The hospital had zero from July 2020 through the end of March 2021.

       Lurie’s numbers of RSV were sporadic in April, May and June, but began to increase substantially in late June and July. After discussing the rise in cases with doctors at other children’s hospitals such as the University of Chicago and Rush University Medical Center, Lurie’s requested and was granted Medicaid approval for August reimbursement — typically which would be considered out of season — for palivizumab, or Synagis, a monoclonal antibody treatment given via a shot every month for five months that can reduce hospitalizations should babies get RSV.

       Not every baby is eligible; there are limits on who qualifies, such as infants born before 29 weeks or who are immunocompromised. The shots also can present logistical challenges as families must come in monthly.

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       This is currently the only approved treatment for RSV. The pharmaceutical companies AstraZeneca and Sanofi are also creating candidates.

       Illinois doctors are continuing to submit monthly data to the state, to maintain the Medicaid reimbursement, which may ultimately continue longer than the typical five-month season.

       In August, the American Academy of Pediatrics released new guidance saying pediatricians could give the treatment earlier.

       “RSV activity is on the rise in certain regions of the United States, with corresponding increases in emergency department visits and hospitalizations of infants and children,” according to the statement.

       The AAP noted that it’s unclear how long this increase will last.

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       RSV typically causes mild symptoms. Sick kids usually have a runny nose and decrease in appetite first, then develop a cough one to three days later. Sneezing, fever and wheezing might also occur; young babies might have irritability or decreased activity.

       Most babies who get RSV do not need hospitalization; those who do may require oxygen, intubation or mechanical ventilation.

       abowen@chicagotribune.com

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