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It might not be the flu, but something is going around

RSV, Rhinovirus, Parainfluenza and Adenovirus Are Heading Upward

December 12, 2017 By Mary Frost Brooklyn Daily Eagle
Photo: Cheryl Evans, AP file

With the start of flu season, viral infections in the region have been ticking steadily upward over the past several weeks. But the nasal congestion, coughs, fever and body aches you’re experiencing may not be caused by the influenza virus, scientists say.

Dr. Gary Paul Leonardi, director of the Virology Laboratory at Nassau University Medical Center, said there are numerous germs in circulation at this time of year on top of influenza A and B. These include respiratory syncytial virus (RSV), rhinovirus, parainfluenza and adenovirus, all of which cause respiratory infections.

“Every year we get a number of respiratory viruses in circulation, especially in kids. Once any virus gets to a critical level, it starts to spread,” Leonardi told the Brooklyn Eagle.

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The cold, dry winter air keeps viruses alive longer, he said. “People stay inside and come into contact with them. You go to church or the synagogue, you hear coughing.” A sneeze or cough will put “billions of particles into the air.”

According to researchers, one virus that might be responsible for a cough that just keeps hanging on is RSV. Because in most years RSV season overlaps with flu season, the virus has been a bit of a stealth operator. But when scientists separate out its effects, RSV can be seen to have almost the same impact on health as influenza.

Nasal congestion, fever, an “irritating, nonproductive cough,” persistent fatigue and intermittent shortness of breath lasting a month or even two are fairly common with RSV. Most people recover in a week or two, according to the Centers for Disease Control (CDC). But RSV can be a significant cause of respiratory illness, especially for infants, older adults and people with compromised immune systems.

It was only during the ’90s that RSV’s potential for “widespread occurrence with serious clinical impact” was recognized, according to a July 2000 report by Ann Falsey and Edward Walsh in the journal Clinical Microbiology Reviews. The disease is unrecognized by most internists, Falsey and Walsh say, “in part because the possibility of RSV is not considered but also because diagnosis is difficult to make during the acute illness.”


The View from the Clinic

“RSV, parainfluenza, adenovirus — most times as a clinician you don’t know exactly what you’re dealing with,” Dr. Boris Sagalovich, clinical assistant professor at NYU Langone Health in Brooklyn and Queens, told the Eagle. Sagalovich is certified in pulmonology, internal medicine and sleep medicine.

“It’s most important to identify influenza A and B,” he said, because vaccine and treatment are only available for the flu. “The other viruses are not that important to ID,” Sagalovich continued,
“because it doesn’t change the treatment,” namely, supportive care.

Symptoms of influenza include high fever, malaise and joint and muscle pain, Sagalovich said. Within 48 hours of being positively identified, influenza can be treated.

“If Tamiflu is taken within 48 hours, it can be very helpful in cutting the length of the disease and recovery can be much faster,” he said.

One concern with viral infections is the development of complications like sinusitis, bronchitis, pneumonia and new-onset asthma (also called adult-onset asthma). In new-onset asthma, a person who has never experienced asthma before develops the disease.

“It could happen at any age,” Sagalovich said. The victims are often young or middle aged, but Sagalovich says he has seen it in the elderly as well.

“If symptoms worsen over four or five days, [people] need to see a doctor,” he said.

Cases of Flu and RSV Increasing

According to the New York State Department of Health, RSV has been on the increase since October. Confirmed cases were up substantially the week ending Dec. 2 (the latest available data), with 15.9 percent of tests coming back positive. (Only .6 percent of tests came back positive during RSV’s lowest point in June.) Another type of RSV measurement showed even more of an increase.

Confirmed influenza reports were up as well, with an increase of 86 percent across the state during the week ending Dec. 2, with 395 cases — mostly influenza A — logged.

Infections in New York City echo these results, which remain normal for this time of year. Roughly 17 percent of tests for RSV came back positive for the week ending Dec. 2, while about 16 percent tested positive for the flu.

Prevention and Treatment

Both the scientist and the clinician agree on the importance of getting inoculated with the flu vaccine.

“Even if it’s only 40 or 50 percent effective, it’s still something,” Leonardi said. “Why get sick? It might help you.”

Leonardi also says that if you’re sick, you should stay home and not infect other people. “Especially if you have contact with people who are fragile.”

They also both agree on the importance of washing your hands.

“Handwashing is very, very important,” Sagalovich said. If you can’t wash them, sanitize them, he said, adding that people should be “conscious of touching your face with your hands.” Contact with nasal passages and the mouth is how infections gain entry.

Sagalovich also recommends that at the onset of malaise or a mild cough, those in general good health should start to exercise.

“This will improve the immune system, help clear up the nasal passages and help drain bacteria,” he said.

He also recommends taking probiotics during high infection season.

Leonardi says that people need to reduce their stress levels and keep exercising during the cold winter months. Reduced light plus stress leads to lower immune response, he said.

“Eat, sleep and exercise. Stop running around like a lunatic; let things roll off your back,” he said.

As a non-clinician, Leonardi added his own personal prescription.

If you do get sick, “Take a couple shots of whisky, some aspirin and some hot tea. It can’t hurt,” he laughed.

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