Respiratory virus still ‘very serious disease’ for children

DUSTIN SOLBERG

February 29, 2008 at 8:56AM AKST

On a hallway computer, Dr. Matt Hirschfeld has brought up a stark image.

It’s an X-ray image of a toddler’s chest, and except for the feeding tube trailing off the screen, everything appears to be in order.

But Hirschfeld says a close look reveals lungs speckled white with extra fluid. And the normal arc of the diaphragm – the thin muscle wall between the chest and abdomen – is forced flat by the child’s hyper-inflated lungs.

These are symptoms of the relatively common respiratory syncytial virus, known as RSV. An adult infected with the respiratory virus might experience symptoms similar to those of the common cold. But for children not yet 2 years old, it’s another story.

"It can be a very serious disease," Hirschfeld says. "Kids still die of it."

Down the hall, 17-month-old Glenn Smart is eating real food again. It’s his 21st day in the Alaska Native Medical Center in Anchorage. For two weeks, he breathed with the help of a ventilator, and medication kept him from waking.

After all those tense days at his bedside, on this day, something was different.

"He woke up happy. He kept smiling," says his mother, Kalila Smart.

Recent weeks have been tense. Young Glenn turned blue at one point as they tried to leave their Southwest Alaska village of Kasigluk. His infected lungs couldn’t supply the oxygen his ailing body needed.

After nearly three weeks on a ventilator, he’s eating Cheerios again, and it seems he’ll be home again soon, where he can again play with pots and pans on the kitchen floor.

The medical center has admitted more than 100 children with RSV into its hospital rooms. This includes only the most serious cases and doesn’t include those children treated as outpatients at the clinic.

"This is a pretty typical year," Hirschfeld says, for the hospital’s pediatric unit.

Patients have come from across Alaska, though the Yukon-Kuskokwim Health Corp. reports that it has seen a "higher than normal caseload of patients with RSV this year." Last year, the Arctic Slope seemed to lead the state in RSV cases.

Hirschfeld says the cases seemed to originate in Anchorage this year.

"First, it seemed like Anchorage kids got sick first, and then it moved into the Bush," he says.

The virus is not new, nor does it appear in rural Alaska more often than urban Alaska. Alaska does have a longer RSV season than the rest of the United States, however. Each year, it catches families by surprise.

Glenn’s parents, Kalila and Stephan Smart, said they had heard of RSV. But Glenn’s early symptoms first appeared like a regular cold and a fever.

While these are among the symptoms of RSV, it doesn’t always present the same symptoms. Sometimes a child will have no fever. In some cases, the first indication of the viral infection is a sudden apnea – a temporary halted breathing.

Other symptoms include fast breathing – 50-60 breaths per minute – and aggressive belly breathing that draws on accessory muscles to fill the lungs with air.

There is no commonly used vaccine to prevent the illness, but one with the brand name Synagis is available for especially vulnerable children. This includes some babies born prematurely, and those with some serious heart or lung conditions.

A one-month treatment – scheduled monthly for the length of the seven-month RSV season – is about $900. The vaccine, with the generic name palivizumab, does not prevent a child from contracting the virus but it does prevent the harmful bronchial infection.

Dustin Solberg can be reached at (907) 348-2480 or toll free at (800) 770-9830, ext. 480.