Nov 02, 2023

Oregon kids return to school — and the festival of viruses begins

Children are back in school in many parts of Oregon this week, and respiratory virus season is around the corner.

Parents, prepare to marvel at the sheer number of viruses children can catch and the amount of snot that can droop from a tiny nose.

While there’s likely no avoiding the many unnamed colds that circulate, health care providers say Oregonians will have more options than ever to minimize the consequences of an infection with one of the now-familiar big three: COVID-19, RSV and influenza.

Below are intel and tips for the back-to-school and virus season.

COVID-19 hasn’t settled into any distinct seasonal pattern yet. While there’s been some national buzz about a late summer surge or mini-surge this month, when you put it in context against the last few years, it’s relatively small so far.

Weekly hospital admissions have ticked up in August, but the overall number in Oregon is still low. There were 156 new COVID-19 positive admissions the week of Aug. 19, similar to what the state has seen throughout the past year.

Jenni McCord, right, comforts her son as he receives a vaccination at a pediatric COVID-19 vaccine clinic held at Clackamas Town Center, Nov. 10, 2021 in Happy Valley, Ore. The clinic was offered by the Clackamas County’s Department of Public Health and offered Pfizer-BioNTech vaccines for children ages 5 through 11 years old.

Kristyna Wentz-Graff / OPB

Wastewater data for the Portland metro area isn’t showing a major spike either. While there could be future surges in transmission and infections, how sick people get may be tempered because few people will be experiencing the virus for the first time.

A recent CDC study estimated that nearly 97% of the U.S. population has some degree of immunity from vaccination, prior infection or both.

“We have a lot of really good long term herd immunity from severe disease because of how many people have gotten vaccinated now,” said Ryan Hassan, a pediatrician and the medical director for Boost Oregon, a nonprofit that educates people about vaccination.

The vast majority of children do just fine with COVID, but some kids do have rare, more serious presentations of it, including COVID croup (a type of severe cough), neurological conditions or long COVID symptoms.

While he’s not expecting a big COVID surge this year, Hassan is still encouraging his patients to get an updated booster when it becomes available later in the fall.

COVID will continue to evolve, and immunity can wane over time. Having a recent booster is a decent hedge against significant illness due to new variants and the possibility of long COVID. It can help you avoid the hassle of missing work and the discomfort — or, depending on your experience, misery — when you’re sick.

There is no word yet on when people can get the reformulated booster. A CDC advisory committee is scheduled to vote on its approval Sept. 12.

Respiratory syncytial virus, or RSV, is a common childhood virus. It’s mild for older children but can be dangerous to infants who are getting it for the first time. Their smaller airways and lungs can easily plug up with mucus. It’s the most common cause of intensive care unit admission at hospitals for children younger than 1 in the United States.

This year, for the first time, there’s a treatment that’s been approved broadly for babies 8 months and younger that significantly decreases the risks from an RSV infection.

The new therapy is a monoclonal antibody known by the brand name Beyfortus, or the generic name Nirsevimab. Given as a single shot, it provides five months of protection against RSV. In clinical trials, it had few side effects and reduced the number of RSV cases that led to pneumonia, bronchiolitis or medical care for the infant by 75%. For people who want a deeper dive, Brown University economist and parenting author Emily Oster has this overview.

Elena Pitzel, 10, of Milwaukie shows off her bandage after receiving a vaccination at a pediatric COVID-19 vaccine clinic held at Clackamas Town Center, Nov. 10, 2021 in Happy Valley, Ore. The clinic was offered by the Clackamas County’s Department of Public Health and offered Pfizer-BioNTech vaccines for children ages 5 through 11 years old.

Kristyna Wentz-Graff / OPB

Last fall when Oregon experienced an unusually early and large spike in RSV hospitalizations, Dr. Wendy Hasson was worrying about her own newborn at home while trying to figure out how to add more beds and capacity in the pediatric intensive care unit at Randall Children’s Hospital in Portland, where she’s the medical director.

Hasson said if this antibody shot had been available for her infant last year, “I would have been hammering down the door to get this therapy.”

RSV cases in the U.S. dropped sharply during the first two years of the COVID-19 pandemic, likely due to measures that slowed much disease spread like masking and social distancing. Cases rebounded hard last year.

Hasson said she can’t predict what will happen with RSV this respiratory season. There are too many unknowns. However, the Southern Hemisphere, which can offer some clues because their respiratory season happens earlier, has had a pretty high RSV season for a second year in a row.

“I’m preparing myself for there to be a pretty significant RSV season again,” she said.

Hasson said the vast majority of infants survive RSV, including those who need ICU care. But it’s a traumatic experience that any family would want to avoid. The sickest infants may need to be placed on a ventilator and spend weeks recovering from the infection.

Having such a serious infection can make it harder for an infant to breast or bottle feed and breathe well longer term. It can also stress families that need to take significant time off work while their child is recovering.

“It can affect your family weeks, months or years down the road,” Hasson said.

The monoclonal antibody preventative treatment has received full federal approval. The Oregon Health Authority will be providing it to Oregon Health Plan members, tribal members and uninsured infants for free. For everyone else, it will be available on the commercial market, through health care providers, clinics, health systems and pharmacies.

Providers in Oregon started ordering the treatment in August. Hasson hasn’t heard what the general timeline is for delivery, and didn’t know of any clinics that have received it yet.

“If you go into your pediatrics clinic, it’s probably not available yet, but it may be in the coming weeks,” she said.

Last year, flu season hit the United States early. In Oregon, flu cases peaked in December.

The 2023 flu shot is available and recommended for everyone 6 months and older. September is a good time to get it, as an early shot gives children and adult immune systems time to develop antibodies before transmission rises.

For kids 12 and younger, the flu shot is given in two doses, four weeks apart. Since kids won’t have immunity till they get that second dose, experts recommend starting the cycle soon. Children 12 and older only need one shot.

The shot is widely available at most places you get health care, and you can go online to book an appointment at many retail pharmacies like Fred Meyer and Walgreens.

“We know it’s gonna be pretty terrible because it’s terrible every year,” said Hassan, with Boost Oregon.

There’s an alphabet soup of other common viruses that might give children a fever and a respiratory infection, or in more serious cases, croup or bronchitis.

Most of them are treated the same, Hassan said. Kids generally just need rest and home care, but pediatricians can help manage symptoms for sicker children with fluids, steroids or breathing support.

Pediatricians don’t worry much about most of the common illnesses.

What they do worry about is the suite of more serious viruses and bacteria that are now rare thanks to routine childhood vaccinations, but that can cause serious disability and death in children who are unvaccinated.

Last year, just 69% of 2-year-olds in Oregon were up to date on the official childhood vaccination series. Hasson said at Randall ICU, she’s seen children die or lose their functionality due to vaccine-preventable illnesses like pertussis and some bacterial infections.

Oregon’s childhood vaccination rates have long trailed the national average, and between 2018 and 2022 they’ve fallen by an additional percentage point or two for various vaccines.

The measles, mumps and rubella vaccine is a good example. The percentage of Oregon 2-year-olds who have it fell from a high of 91% in 2019 to 87% in 2022.

Measles is extremely contagious. It’s considered eradicated in the U.S., but it’s regularly reintroduced from other parts of the world. Oregon, for example, reported a case in March.

Hassan said with a vaccination rate just 87%, it’s much more likely that a single introduced case of measles could start a chain of transmission and an outbreak among unvaccinated and immunocompromised people.

“It’s a mathematical guarantee,” he said. “I don’t know when it’ll be, but it’ll happen unless we get our vaccination rates up.”

Hassan said it’s normal and understandable to be afraid of shots, or to be anxious about something that causes your child some pain or discomfort.

In his practice, he’s found devices like the Shot Blocker and Buzzy Bee helpful for kids — and their parents — who have more trouble with vaccination. Those devices stimulate neurons in a child’s arm in the area around where a shot is given, so they don’t feel the pain as much.

“It’s a minor thing but it’s huge for the kid who has to get the shot, especially if they’re really afraid of needles. It’s like, well, you can actually take most of this away.”

Funding, staff shortages, literacy, safety and more are on the minds of students, families and educators as they head back to school.

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An Oregon-based pediatrician weighs in on how to care for children with RSV during what some doctors have called the biggest season for the respiratory virus they’ve seen in their careers.

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Tags: Health, Vaccines, School, Education, COVID-19