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Respiratory Diseases in Winter
Q: What are the respiratory diseases that are going around in our New England community this winter? How are they treated, and how can they be prevented?
A: During the winter months, Respiratory Syncytial Virus (RSV) and influenza (flu) are widespread among children, especially in the first two years of life. With so many kids in child care settings, children's exposure to these viruses and others is increasing. Good handwashing and avoiding direct contact is a good way to minimize exposure.
Winter respiratory diseases prompt a lot of phone calls and visits to physician's offices. Families become alarmed when a child has signs and symptoms beyond the simple runny nose and sore throat, such as high fever, prolonged cough, choking on mucus, wheezing, trouble breathing, loss of sleep, poor appetite, not acting right, or just lasting longer than usual. The younger the child, the more problematic the illness can be. If there are underlying diseases, such as heart and lung diseases or prematurity -- this places the child at greater risk for complications that may require treatment in the hospital.
These illnesses are viral, so there is no magic medicine. A variety of cough and cold medications are used by parents to relieve the symptoms, often with little success. In some centers, RSV can be treated with a medicine called ribovarin, but it's not a cure. It is used infrequently because it is felt by some to have only a modest effect on the illness, is difficult to administer, and is quite expensive. Children's Hospital, Boston, uses ribovarin only in patients with extremely severe symptoms, underlying immune deficiencies, or significant heart and lung disease.
There is a flu vaccine that is recommended to be given in the fall for those kids and adults who wouldn't handle the flu well. No vaccine is available to prevent RSV. However, for the first time, Respigam, an antibody that can prevent RSV lung disease, such as bronchiolitis, has been newly approved. It is currently used for a limited group of patients -- specifically high risk infants. Please discuss this with your infant's doctor if he falls into this group.
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Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.