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Test one, two, three, one, two, three, four, five.

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That's pretty good.

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Well, hey y'all, welcome back to another episode of Your Mom on Drugs.

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You've got me, the son, and we've got the mom on drugs.

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Hi, I'm Jennifer Seltzer once again.

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And I'm Josh Klaus once again.

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We hope that you're having a great day.

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We are here in the winter in Texas, which is a really nice day.

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Wherever y'all are listening, we hope you're having nice, clear, sunny skies,

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but we know that winter is not always the nice, temperate weather that we get down here in Texas.

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I mean, you grew up in Virginia, mom.

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I did.

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So what was winter like when you grew up there?

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Well, as a kid, February, usually that's when we had our snow slush.

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So as a kid, you thought it was great, but I'm glad I didn't have to drive and work in it because that would be not fun.

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Isn't it amazing as a kid, you perceive as pleasures and as an adult, you're like, I'm going to have to clean that.

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It's going to get into the house.

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I'm going to slide off the road. Yeah. So all that good stuff.

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What did you like to do in the slush when you were a kid?

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Because I lived in Virginia Beach, so it didn't stay for a really long time.

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Boy, you know, I don't remember.

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I really don't remember what we did.

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I'm sure we got out and threw snowballs or something, you know, so snowmen or something.

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Somehow I remember like riding bikes, but I think that was rain in the summertime.

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So it's really sad when you get older and you can't remember all the little memories kind of just kind of get messed together.

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And you're like, I don't remember what I did.

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But you know what? If you ask my brother, I bet he wouldn't remember.

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We'll bring him in next time to see what he has to say.

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We'll speak in a winter.

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Winter is a time when everybody gets indoors to huddle in to escape the cold.

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And during those times, these little things called viruses come out and they love a party and they love to spread amongst not just mammals and plants, but also humans as well.

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So today we're going to be talking about a virus in particular that's kind of had an uptick over the past couple of years.

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A virus called RSV or as a respiratory respiratory syncytial virus.

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Yeah, we're going to talk about why it's named that way further into the podcast.

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But I'm going to hand it over to the mom on drugs, Dr.

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Jennifer Seltzer, and she's going to kind of give an overview of what RSV is.

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You guys might have heard of it, but I'm going to let her go a little bit further.

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So, mom, what is RSV?

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Well, we're going to start with just a little bit of kind of intro kind of background stuff, because I found when I was in pharmacy school, we really didn't talk about this virus that much.

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Back then, it was really just a young infant virus and there wasn't really a lot to do for it and stuff.

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So but interestingly, this virus was identified in 1956 in chimpanzees and that and these chimpanzees had respiratory or, you know, cold like symptoms.

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So that initially they called it chimpanzee carriza agent carriza, meaning like stuffy or runny nose and stuff.

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But in the 1960s, they renamed it respiratory syncytial virus because the virus formed these giant what they call syncytia in tissue cultures.

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And so what a syncytia is, it's like it's a you think about what you think about a cell in general and it has one nucleus in it, which is kind of the center like operating system, like the brain of the cell per se.

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Well, these cells would kind of merge. So multiple cells would merge together and they'd have one cell with them.

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They'd have multiple nuclei in it. So that's what the names is. That's where the names and Cisha came from.

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And so I thought that was really interesting. And again, like I said, it became a most significant viral infection for infants and small children, especially respiratory tract infections.

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That's primarily what the symptoms are. And it usually we start seeing respiratory syncytial virus.

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Usually it could start as early as mid September and it could it peaks December to February and then it wanes and you could even sometimes see it last through mid May.

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That's the normal season for respiratory syncytial virus. But this was so interesting with the pandemic with the with the covert pandemic.

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If we all remember, I mean, now it seems like a little bit of a while ago, but while we were in it, it was not it was like every day.

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So remember, I know, I know we all remember how we were kind of in a lockdown kind of mentality and we stayed away from people a lot before the vaccines came out or people just said to heck with it.

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And so in that time, if I don't know if you all remember this or not, but also a lot of other illnesses were not seen like flu was low respiratory syncytial virus was low.

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So they all kind of went away kind of because we were all staying away from other people.

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Well, when we started lightening our restrictions, then the other viruses started showing up again while respiratory syncytial virus. When it started coming back, it started coming back in 2021.

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Well, it peaked. It started showing up in the spring for the first cases, and then it peaked in July.

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So people were not expecting that at all, you know, and stuff. And so then for so since 2021. It's not shown the same seasonal pattern, like it had shown before the pandemic.

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But there is one study now that showed like in 2020 September of 2023, the cases started increasing again in September. So it's almost like we've almost normalized again. So it's going to it's going to follow its normal pattern as far as September to May again, most likely.

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That's a really good point. It's almost kind of like I always think of like a weather analogy, like you can have like you have we have seasons in the world and depending on where you live, but depending on some abnormal weather event.

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But I know last year, we had like a really massive volcano eruption, which put a lot of water vapor and and methane into the atmosphere.

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We also had an El Nino event last year, too. And that's basically just the warming of the Pacific Ocean is called Enso. And when that happens, you just basically increase the warming patterns, you know, across the globe and certain parts of the globe.

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So with those two things combined, we actually had a hotter than really hot summer, especially here in Texas. So it might seem really extreme, but just based on additional factors, those come in.

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So it's really interesting how that also plays in fact with viruses as well. It was really fascinating.

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So to have that time period where there was like no illness, you know, it's like because everybody stayed away from each other. But anyway, so but not anymore.

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All those illnesses are bad. So.

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And so anyway, so some some key characteristics of respiratory syncytial virus, although I said that it is very common in young children, it really can occur in people of all ages.

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It makes people the sickest, though those that are younger than two years of age and those that are over 65 years of age, especially if there are some other coordinating conditions or underlying conditions that they have.

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And we'll get to that in a little bit. Usually in adults that are fairly healthy, respiratory syncytial virus looks just pretty much like a common cold as long as it stays in the upper respiratory tract.

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The upper respiratory tract is going to be your nose, mouth, the soft, you know, soft, you get upper trachea maybe.

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But when you get lower respiratory tract infections, you're talking about getting into the lower trachea, your lungs, your bronchials, which are the little air sacs inside your lungs and stuff.

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And you can get a lot sicker than as well, too. So.

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You can. But respiratory syncytial virus can make you fairly sick if if you are predisposed to that so you can get hospitalized or you can even die as a result of that.

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The usually there are about 60,000 to 160,000 cases of respiratory syncytial virus in Americans who are hospitalized every year.

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So I may not have said that right. So 60,000 to 160,000 patients are hospitalized with respiratory syncytial virus each year with 6000 to 10,000 deaths according in patients over 65 years of age.

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It was almost like a 10 to 15 percent death rate amongst people who are hospitalized and then potentially pass away.

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So again, now, when you put that number against the whole population of the United States, it's not a huge number.

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But for those people who are suffering with this, it's significant.

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So, yeah, and if there's a way to diminish that number, especially in the vulnerable populations, you want to take, you know, you want to take any precaution that you can and know that if you're in these risks,

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especially if you're I mean, imagine you're a new parent and you have an infant and babies.

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Yeah. And so they're going to get they could get pretty sick.

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Yeah. And it's just you just you'd want to prevent a horrible tragedy to have to go through something like that.

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And kiddos respiratory syncytial virus causes cold like symptoms.

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But it also can go to the lower respiratory tract as well.

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So they a lot of times can get bronchiolitis or pneumonia. So you're getting infections in that lower part in your lung area of it and especially in higher risk populations.

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And I'll talk about higher risk populations and kiddos in just a second.

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In in those children less than five years of age, there are two point five. I'm sorry. There are two point one million outpatient visits per year for kiddos that have RSV like symptoms.

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So significantly more than folks who are older. Right.

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And there are fifty eight thousand to eighty thousand hospitalizations each year in the same age group. So it's a it's a little bit less hospitalizations than so they're more so in seeing their pediatrician or private care provider.

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And think to our as we're younger, we've got a newer immune system as well, too.

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So it may operate maybe a little bit better as well, too. Although this is something that they've never seen before, too.

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So it's just, you know, again, it's it's you know, it's again, it's data. I didn't look into how all the data were collected as far as those numbers, as far as hospitalizations and what kind of populations that we're looking at and stuff.

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But so the baby, the infant and young children populations that are at greater risk for a severe RSV are premature infants.

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So those babies born before thirty six weeks gestation infants, even infants that are six months, six months of age and younger, they're going to be at a greater risk.

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Those that are younger than two years of age with chronic lung disease or congenital heart disease.

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That means they were born with some type of a heart heart problem, heart issue.

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Children that have a weakened or suppressed immune system and those who have neuromuscular disorders or congenital anomaly.

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So they've they may have been born with some sort of defect.

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And we're thinking about people, especially that have problems clearing mucosa or having problems with swallowing.

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And this is this is in addition to patients who have kids that have cystic fibrosis.

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So it could be maybe a cerebral palsy patient.

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You know, that's what that's what comes up in my mind.

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As far as adults who have chronic medical conditions that are more likely to have problems with respiratory syncytial virus, we're talking about older patients who are frail,

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older, older adult patients older than 60 years, 60 years of age are going to may have more severe disease because again, our immune systems are getting older as well, too.

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So they may not be as robust as they were when we were in our 20s.

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Patients also.

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Oh, my gosh, this is such a big deal.

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If you live in a long term care or nursing home facility, it's again, you're putting that herd of people together.

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So it's just so easy to transmit viruses in that way because you're in that confined space under other underlying diseases and adults that may predispose someone to a more severe case of RSV include lung disease like chronic obstructive pulmonary disease or COPD or asthma, diabetes, neurologic conditions,

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kidney disorders, liver disorders, blood disorders, being immune compromised, let's say our cancer patients that have to take chemotherapy that, you know, obviously wipes out their immune systems and any other thing that a physician might see or a health care provider might see that might predispose a patient to an increased risk of RSV.

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Again, as we know, we do know that RSV can make asthma, COPD and congestive heart failure worse. So just because it puts an extra stress on the body and stuff.

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Yeah. So it seems that with older patients, obviously, things just break down over time, you know, we're just old cars.

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And, and I think a lot of these things seem to be, you can lower the risk of things like kidney disease and liver disease by, you know, maintaining an active and healthy lifestyle by getting exercise, sleeping well, sociability.

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But, you know, sometimes bad things can happen. And so, and we're really talking about severe RSV, rather than an upper respiratory tract or lower respiratory tract.

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So, you know, Joshua started out this presentation like what is RSV. So let's transition to what it is. So again, we talked about it's called respiratory syncytial virus. So it's a virus.

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It's an enveloped RNA virus. It's in the family, you know, scientists love to put, give us really big names. So we've got a family of viruses. That's right. We've got a family of viruses. It's called paramyxoviridae.

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Paramyxoviridae. So this, the respiratory syncytial virus is in that family. And there are going to be some other more familiar viruses in that family as well too, including para influenza virus. So it's not influenza virus, but para influenza virus, which again causes a respiratory tract illness.

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And with that, you have, you can have upper and lower respiratory tracts. It usually happens in kids, but mostly it happens in young children. It's also associated with croup. If you've ever heard of croup with kids, it's that barking cough that kids can have when they're little and stuff.

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It's also in the same class is mumps, which is the remember we, we, we since have a vaccine for mumps, but for those of us that are older that actually got mumps, you know, you had fever with it feeling kind of bad.

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You would have muscle aches and then you had pain tenderness and swelling in your parotid salivary glands. So it's not your lymph nodes in your neck area, but your neck felt swollen because you have these salivary glands that would get infected with the virus.

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And so that was kind of a key characteristic for them, that particular illness. Yeah. Just to get folks who are listening to this, your parotid salivary glands are like along the sides of your neck, kind of in line with your shoulder. Is that kind of where you're pointing to? I believe so. Yeah.

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Cause your carotids are more towards like the front of your neck, right? So the parotids, I actually never heard of this, is like towards the side of your neck. Are those the things that the physician will feel when they're checking your lymph nodes? No, the lymph nodes are different. The lymph nodes are different. So, but they may, I'm not exactly sure. I'll have to, the next time I go to the doctor, I'll ask, are you feeling the parotid glands or are you feeling the lymph nodes? You know, so I don't know if you can feel the lymph nodes. I'm not sure cause they're usually buried more deep inside. Well, imagine if they're swollen, maybe.

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There's a tenderness there, which is what I always guess. Right. Yeah. Yeah.

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And then the other disease that's also in this class is measles, not, not German measles, but measles. And so measles is different from German measles. Measles is, again, it's a disease that was associated with, it's like a respiratory illness. You would have fever and feel kind of bad, but it had this, this 3C,

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kind of, kind of cohort that went along with it. It was cough, carriza, which means like runny or stuffy nose and conjunctivitis, which is pink eye. Like we did, we, we, you know, it's an infection in your eyes as well too. And then you have a rash as well too. So with measles and stuff. So anyway, so all that to say that RSV is in this same family of viruses.

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Gotcha. And yeah, just taking it over from, from mom. When we talk about viruses, I'm just going to talk about just for anybody who wants to geek out on mechanisms. So yeah, these are, I can't stress of how tiny these things are.

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I mean, so RSV has a genome, which is its genetic material, basically the instructions to make itself. It is only 10 genes, big, tiny. Just to give you a context, humans, we have around 20 to 30,000 genes in our genome. And that's in every cell.

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So if you think about it, we have, you know, about, we have trillions of cells and you encompassing our whole body. And in every one of those cells, we have 20,000 genes. So this tiny little virus just has 10 genes inside of it. And usually most viruses.

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They're, they're all different from each other in the way that they express themselves, just like animals are different from each other. But if you think about a mammal, why do we call a mammal, a mammal? It's got mammary glands. So it's able to express milk to feed its young.

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It has fur to basically insulate itself. It's also, they don't always have four legs, but they have, you know, four appendages. So there's commonalities between them, but they all have different strategies to live and survive and to reproduce. And the same thing with viruses.

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The thing about viruses is that they can't reproduce on their own. So they need to go inside of a host and, and basically use the machinery that that host already uses to make more of itself.

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Because with humans, we make our own cells. So like if, if a red blood cell is kind of on the fritz, we will actually destroy it. And by we, I just mean our body will destroy it. And then it'll generate a new one by something called mitosis, which just generates new cells.

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So viruses cannot do this, but they take advantage of the fact that these cells can. And so they will sneakily get inside of one of these cells. And then they will basically start to reproduce over and over and over and over again, until the volume of the cell has expanded so much that the cell can't contain itself anymore.

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And it bursts in a term we call apoptosis.

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And those viruses from will start even just starting with one might even turn into 10,000 viruses and then those 10,000 viruses are going to go infect one cell and you can see how this exponential growth is going to happen, which is why something like a pandemic or an outbreak can happen

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so quickly, then sometimes even before you can do anything about it because these things spread so quickly.

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Now every virus is different. And with RSV, it's got this nice shell, we call it a protein shell or a capsid that has these nice little keys on it and then we call them antigens and essentially these antigens are going to kind of run into things until something kind of fits into a lock.

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It's kind of like a lock and key mechanism. And if the fit is great, then essentially it'll stop moving or kind of stay still lock into that mechanism. And then basically activate a pathway for it to get inside of the cell.

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Now the proteins of interest here are FNG.

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Just like the lovely Dr. Seltzer said are FNG. I don't know why they're called that.

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I'm sorry, I don't either. There's a lot of other things on the outside of RSV virus too.

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Yeah, like we said, there's 10 genes, so each one of those genes codes for, actually one of them codes for two proteins, but basically it's like a one to one ratio. But the two ones that are important for us are FNG. These are the ones that essentially our cells grab onto and they let inside.

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There's some variability with the G protein, but with RSV, essentially you get like two flavors. We call them serotypes, but we'll just pretend they're two flavors and there's flavor A and flavor B.

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And flavor A tends to be more prominent in the populations. Actually B is the one you see more often, about 67% of the time. But there's also flavor B that is 43% of the time.

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53. Sorry, 53. Well, those percentages don't seem to make sense because it adds up more than 100. I know.

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So whatever 67. But both the A and B subgroups of RSV can happen at the same time in a season. So, you know. True. But it's like at the end of the day, they should all add up to like 100%. They should.

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Yeah. Anyways, whatever the percentage is, serotype A tends to be the most prevalent type. But with protein F, this is something that's conserved, meaning that it's the same between both viruses and it stays relatively constant.

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This is going to become important later for treatment. But essentially the G protein changes. And this is a cool strategy with viruses because they also know, and I'm putting no in quotes because they have no brain, they have no consciousness, they don't know what's going on.

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They just are just trying to survive. They are always fighting against their host immune system and the immune system is always trying to catch them out and be like, aha, you're type A.

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I know exactly which immune cell to release to get you and catch you before you go out and spread and infect other cells.

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I'm like, ooh, maybe I should shift my receptor from A to B and then maybe you won't be able to catch me as quickly. So there's always this like cat and mouse game between anything that's infecting you versus the thing that's trying to protect you against being infected.

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So that's just a little basic virology. And obviously when you get infected, if you have immunity to this thing, it doesn't prevent you from getting infected, but it will lessen the time and the symptoms in which you actually get this virus.

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And there will just be a curve. There'll be an amount of time compared to somebody who just got RSV or if you've encountered RSV 12 times in your life, your body should be able to respond to that relatively quickly and you might not even feel symptoms.

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Or if you do feel symptoms, it'll be very mild. So there's this really interesting kind of dose response curve for getting a virus and depending on your exposure and your immune system's response to it, of how that happens.

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So yeah, just to piggyback on that just a little bit before we just kind of go into, you know, how the disease is transmitted and stuff.

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So with the G protein on RSV, that is the protein that is going to bind to the host cell receptor. So it's going to hook onto the cell or it's going to bind to it, but then this F protein, it kind of acts like a, I think about a clasp for a necklace or maybe a mouse trap or whatever.

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But so it comes in and then it causes fusion. So it's like there's this pre-F protein and then the post-F protein. So it's like it gets, as soon as it hits the G protein binds to the host cell, then the F protein finds its little niche and then it like spring loads and then it becomes the post-F because it kind of fuses onto the cell and then there it is.

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Gotcha. So it's like a latch. We forget how mechanical a lot of these things are. Like it's just, these are things are so made of atoms. They still have to work the way that things work in the real world.

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So when we talk about the vaccines that have come out, they're actually going to be targeting this F protein area. We'll get more into that in just a little bit.

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Yeah. And just like different viruses will infect different cells and these viruses, I mean, they will get into your muscle cells and they won't do anything because there's receptors in your muscle cell. They don't have it.

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But there are certain cells in your respiratory pathway that we call them epithelial cells and essentially they're kind of like the lining of your respiratory tract and there are certain cells within these epithelial cells that do certain jobs.

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Some of them are just like basal cells. They just kind of chill out. Some of them are goblet cells and like a goblet of like, I don't know if like you've seen King Arthur or something like that, but they hold fluid and actually goblet cells are responsible for making mucus.

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So crazy enough, like RSV actually doesn't stimulate more mucus creation. What it does is that it infects basal cells and then causes a change within the cells to turn into goblet cells and then goblet cells make mucus.

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So then there's actually just more goblet cells to make mucus. So if that's in your lower respiratory tract, it's just going to get super clogged up.

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And because it's in your lower respiratory tract, those pathways are super narrow. So it's going to be really hard to clear them, which is why you feel really congested.

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It's why it takes a long time, even after the virus is gone, to get a lot of that debris out of your lower respiratory tract.

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And that can cause problems because your lower respiratory tract is where you do a lot of oxygen diffusion.

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And if you don't exchange gases readily, a lot of your other organs are going to suffer, which is why you get a lot of these comorbidities of other things going wrong in your body.

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OK, so RSV is primarily transmitted by contact, touching somebody or a surface that has been infected with it. And it usually happens, you've got both large droplets, inoculation, and small droplet transmission.

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So large droplets come from, you can usually get them in your eyes, nose, or mouth, and usually it comes from a cough.

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A single cough can generate up to 3,000 large droplets.

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And then airborne transmission, or the finer respiratory droplets, that's going to come from coughing or sneezing and talking or even just breathing.

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And then those smaller droplets remain airborne much longer than the large droplets.

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And these RSV viruses can survive for different durations on different surfaces.

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So for example, non-porous surfaces like countertops, glass, plastic, or metal, they can last for up to six hours.

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On a porous surface like paper or cardboard or fabric, they can last for up to two hours.

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They can last for up to 30 minutes on skin and on rubber gloves, on surgical gloves, they can last up for five hours. Just some little pearls there for you.

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Yeah, important to clean every now and then.

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So that's right, use those Clorox wipes and stuff.

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But also it seems like the way it happens is by droplets. So even if it's on these surfaces, they would still need to get into some type of droplet for you to inhale them to get into their airway.

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Right. But it's like, again, that droplet will have transmitted that virus by coughing, just talking, and then it gets spread all over this microphone that I'm talking through right now.

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So when a person breathes in the RSV virus, then it goes through the mucous membranes, like the nose and the mouth.

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And then it's going to, like Josh talks about, it infects the airway cells in the upper respiratory tract.

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And then it can spread to the lower respiratory tract, which is going to be your trachea, your bronchi, and your lungs.

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And then it's going to reach those bronchioles, which are those little air sacs in your lungs, and it replicates or reproduces very well there.

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And then again, we talked about how it attaches with the G protein and the F protein.

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And another interesting thing is that the virus makes the tiny blood vessels in the lungs leak.

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And so that can also increase mucous production.

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So then and so then with that, you can also kind of kick in your immune system.

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So things that have that come alive in your body when you kick in your immune system, things like histamine and other inflammatory cells.

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And they're going to help to try to fight that off, but they can also cause swelling.

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So swelling in your air airway is not always good because that's going to cause things like wheezing, difficulty breathing.

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It can also contribute to developing pneumonia as well, too.

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So and it also the other thing I don't know if anybody's heard of surfactants.

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Surfactant is something that babies for sure, as they're developing in their mama's tummies,

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they need for their lungs to mature before they can get born so they can breathe OK.

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The surfactant in our lungs helps our lungs keep from collapsing when we breathe in and out.

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So it's a very important substance.

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So with this virus, it can also damage the surfactant.

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So then it also will contribute to us wheezing or having difficulty breathing.

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So as long as the virus stays in the upper upper respiratory tract, we're OK.

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But when it gets into the lower respiratory tract, it does make us a lot sicker.

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Yeah, that's something we call surface tension.

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And it's like if you've ever seen like a water strider on a lake or a river or something like that,

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and the insect can actually walk on water because you compare to their weight.

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The water has a certain surface tension that can support their weight.

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But if something disrupts that, let's say I throw a rock in the water and it creates a wave,

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it's going to disrupt that water and potentially disrupt the surface tension so that even though that fly

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or that insect, the strider is the same weight, the surface tension is disrupted and it might fall into the water.

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So same with your lungs. If you disrupt that, then, yeah, essentially the strength of breathing in

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might outweigh the expansion that happens inside of your lungs and disrupts gas exchange.

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Right. So once once this is all going on in your lungs, you become infectious yourself.

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For adults, usually you're going to shed virus for three to seven days after you've been infected.

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With infants, young babies, it can be up to three weeks, two to three weeks. So they're going to shed it longer.

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And as with most viruses, we are often we're mostly contagious before we even know we have we have the virus.

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Yeah, and even sometimes after. Right.

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And then 40 percent of people won't even know they won't even have symptoms, but they're still contagious.

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And I did read one interesting fact that by the time kiddos are two years old, we've all had RSV.

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And so we've all had RSV, you know, but you can get it more than once and stuff.

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So so like we talked about the clinical picture, what does it look like when you get RSV?

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Usually that you have stages of symptoms, just like when you get a common cold, you may have a runny nose or decreased appetite.

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You can have coughing, sneezing. You could have a fever and you could have some wheezing, but not all necessarily at once.

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With young infants, new babies, young babies, because they can't communicate with us as well.

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What you may see is just a baby that's a little more irritable.

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They may not have as much of an appetite and they may you may notice some breathing difficulties with them.

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If if, like I said, the infection is limited to the upper airways, it's going to look more like a common cold.

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But in previously uninfected individuals in young infants or in older adults or in immunocompromised patients,

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you may have you have a greater chance for that virus to spread to your lower respiratory tract and make you more sicker.

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And that makes sense, just because if you're a young infant or an older adult, your immune system isn't going to be as strong.

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And therefore, it's gotten time to go from the upper down to the lower.

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So things that may happen in adults when you know, if it if it does progress are things like pneumonia or respiratory failure.

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Asthma and COPD may be exacerbated. Your congestive heart failure may get exacerbated.

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You may get bronchiolitis and you could have worsening heart symptoms.

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It could it could in patients who are sick enough, you could have rhythm differences in your heart or you could have a heart attack.

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So, yeah. So so we want to try to manage this as well as possible.

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Yeah, it seems like these symptoms can be pretty severe,

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but it doesn't seem like we have a like a rapid RSV test like we did for for for SARS-CoV-2.

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So how is this thing diagnosed? Well, actually, there is actually a test.

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So because the clinical symptoms are pretty nonspecific, it can look like other viral respiratory infections.

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So most of us that get this, who knows, maybe we've already had it this this winter and stuff.

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But most of us will not need an RSV test because it looks like a cold where it's self-limiting and we are OK.

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But you may require confirmation of whether or not you got RSV for certainly for

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in particular patient populations because you're trying to rule out which direction do we go.

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Do they have the flu? Do they have covid? Do they have RSV?

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So you're going to try to figure out which one. So because treatments and managements are going to be a little bit different.

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So you're if you're going to if you're going to try to diagnose it with a test,

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you want to do it within the first few days of symptom development.

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Let me start with first infants and young children.

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So there actually is a rapid RSV antigen test. Yeah.

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So for for babies and so and the reason that you can do an antigen to antigen test.

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So you're swabbing their their nasal cavity for virus because they produce a whole lot more virus than older kids and adults do.

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So that's why that rapid antigen test is going to work for them well.

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And then you can get a response. You can get results from that test in an hour or less.

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So that's a quick test for babies. And it's 80 to 90 percent sensitive to tell us.

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Yes, this is actually RSV. Can you remind our listeners?

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What does it mean to be sensitive?

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And I think it means like your ability to detect true positives versus false positives.

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Yes, that's it. Yes. So and I so it's like that makes a lot of sense because if you're producing a lot more of a viral load,

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the likelihood of you actually coming into contact with this virus compared to a false flag seems to be higher.

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Right. Absolutely. There's another test. It's called the real time reverse transcription polymerase chain reaction or the RT PCR test.

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And you can also do this in kiddos. But this is the one that you can in infants.

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But you're also going to do it in the in the maybe young infants or older children or adults.

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This is the one that you do because it looks for genetic material in the virus as a sample.

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It's not looking for actual viruses itself, but genetic material.

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So you can find smaller amounts of material than the antigen test. And with using this test, again, you take a sample, then you do have to send this one to a lab.

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And usually what I read, I think you can get the results back within the same 24 hour time period.

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And that's good. Yeah. And just why maybe for those of you who went through the covid pandemic of 2020 is like you might have gotten a PCR test polymerase chain reaction.

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But the reason we call it RT was reverse transcriptase is because this is an RNA virus and covid was a DNA virus.

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So in order to turn RNA into DNA, because the way that PCR works is essentially you take a piece of DNA and then you amplify it over and over and over and over and over and over again so that you can actually detect to see if it's actually within the sample.

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So you're basically trying to pull a signal out of the noise. And when you do PCR, the problem with this, though, is that you can have genetic material inside of you, even after you've been infected and you've cleared the virus.

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So like they can just be leftover and residual. So it's really, really sensitive, but it's not really specific. So you can you can essentially that's the trade off here.

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And also it takes a longer time because a full day versus one hour. It's like and as we've talked about earlier, the viruses move fast. So you might need to get an antigen test.

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But, you know, talk to your health care provider so you might be best for you. But there's always trade offs with tests versus like when you what information are you actually looking for?

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And sometimes just knowing that you have the genetic material inside of you doesn't always guarantee that you're in the midst of having an infectious episode.

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But if it's if it's coupled with symptoms that are, you know, look like the virus most, you know, then you can feel pretty confident that that's what you've got going on.

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That's fair. I just remember with COVID, like you could get a positive result even months after.

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Right. We're not even talking about like in the midst of the disease right now.

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So, yeah, and they don't do viral cultures of this very often because of RSV very often because they're not a viral cultures are just not a sensitive.

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OK. And I'm not a virologist, so I can't tell you why they're not a sensitive. But that's what the literature says.

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So then now we've talked kind of about what the disease is and, you know, how you get it and all that good stuff. So now how do you treat it?

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I think we're all wondering to know. Yeah, there you go.

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I got this virus inside of me. Yeah. So, yeah. Well, unfortunately, there aren't any antivirals that you can prescribe to get rid of RSV and antibiotics.

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For sure. You do not want to prescribe for the virus because, remember, antibiotics are for bacteria, not for viruses.

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So if you've got a if you've got a bacteria, in fact, a bacterial infection on top of a viral infection, then you could see yourself taking antibiotic.

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But antibiotics are only for bacterial infections, not for viral infections.

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So the way that most patients that don't get really sick are managed when they have RSV is going to be supportive care.

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So you're going to take if you've got a fever, you're going to take fever reducing agents such as a sediment of in which is Tylenol or ibuprofen, which is Motrin.

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Or you could take a leave, which is an approximate. So any of those types of agents for little babies,

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you can use that bulb syringe that everybody gets when they have their baby, you know, that you suck.

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You can suck the snot out of their nose because they produce so much. Yeah.

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So that you can help them breathe better. Cool mist humidifiers are going to help with babies and anybody else, really, to help breathe better.

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You want to drink fluids to prevent dehydration because the faster that you're breathing, then you can get rid of moisture and liquid in your body more readily.

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And so you want to replace that and then always make sure that you talk to a health care provider prior to purchasing and or giving cold medications to young children,

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because there are restrictions on giving certain medications to children, especially I believe it's under four years of age and maybe it's even some under two years of age.

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So it's very different than it was when I was a kid where they just gave us everything. So and my kids, too.

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So so there's restrictions. So you want to make sure that you follow your health care providers guidance as far as what to give your child and what will help that baby the best.

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If you notice that either your infant, your young child or your adult that you're caring for is having difficult breathe difficulty breathing or they're just not eating.

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You may they may be it may be necessary to get help from your health care provider or take them to the ER and stuff because you don't want them to you know that the first time that they're going to get a lot sicker.

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So you want to make sure you kind of get on them because they might need intravenous fluids to help with dehydration or they may need oxygen to help them with breathing.

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Yeah, because this is an infection of the lungs. So if you're not getting enough oxygen, that could be a bad thing.

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So the other thing. So so OK. So basically that's the gist of what we can do to treat the disease.

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But there are things that we can do to prevent the disease. First of all, we're going to talk about just some general methods.

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This is for every, you know, everyday activity to just prevent transmitting infections of all kinds, really.

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First of all, if you're sick, stay home. You think you're you think you feel OK, but you are still an you are still a source of infection.

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And so while you think you feel pretty OK, but what if you go out and you you you transmit it to a small newborn baby because parents happen to be out or an older individual?

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You don't even know. But you could have made somebody really sick. So you want to stay home.

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That's a really good point of just like just because it's not bad for you doesn't mean it might not be bad for really bad for someone else.

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And I can't I can't stress this enough. Please cover your coughs and sneezes.

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So with a tissue or in your shoulder, but not just into the air itself, because again, this is transmitted by droplets.

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Remember, so people walking by can breathe in that air that you just sneezed and it's like, you know, oh, my gosh, if you're sick, don't let somebody ride in the car with you, you know, because that's a you're an enclosed system.

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And they could easily get ill that way. You want to avoid touching your face with unwashed hands.

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You want to avoid close contact with others, shaking hands, sharing cups or silverware, things like that.

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And you want to clean frequently used surfaces, doorknobs, mobile devices, don't share your phone and then and then wash your hands.

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And if in our in our in our data that we will post with this podcast, I've I've I've included a link on when and how to wash your hands.

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That's given by the Centers for Disease Control, because we got probably indoctrinated with this when we had covid.

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But it's there. It's like really make sure you wash your hands before and after you prepare food, if you change diapers, if you've gone to the bathroom and just, you know, you know, you after you blow your nose, you know, that you are your cough or sneeze.

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Wash, wash your hands, you know, it should make sense. And there's that whole 20 second washing your hands, you lather with the soap.

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And you sing Happy Birthday twice. Yes. So yeah. So don't forget that. So and then you'll help to to minimize spreading diseases and stuff, especially viruses.

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So then so that so in the last year, two vaccines have come out for respiratory syncytial virus. So some of y'all may have seen some commercials on TV about talking about RSV because I'm sure you like before like this last year or so nobody was really thinking about RSV that much.

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But unless you actually contracted it. But so so it was it was a little problematic creating a vaccine for RSV early on.

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Researchers would target that post protein, the post the post activated protein, the post form.

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And so you think about it, it's already spring loaded, it already spring is already attached. And so they're trying to create a vaccine to prevent replication.

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But it wasn't you. That doesn't make any sense, does it? Because it was already going to be the system was already activated. So those vaccines didn't work very well.

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So they figured out how to create a vaccine for the pre fusion F protein form. And those have been shown to be a little bit more effective. And we'll get into the little bits of details in them in just a minute.

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So remember, the F protein helps control and and and the viral entry into the cell. And it has relatively stable genetic variability.

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So it's not going to change like Josh talked about with the G protein. And there's been some evidence where some monoclonal antibodies were given to high risk infants and that helped to present prevent RSV.

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So yeah, and I read that that the the duration in which those last the efficacy of it was around five months, which is perfect for the RSV season, especially during the winter.

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So, and you remember, just basic immunology as well as like antibodies are the things that attach to antigens. Remember, antigens are the things on the outside of the virus and antibodies attached to these to send a signal to the immune system to say, hey, look over here, we've caught something that we think you might think is interesting.

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And young infants don't have, you know, natural, innate immunity to this virus yet because they haven't seen it. So when you are giving these antibodies to these young infants, you're basically help priming their immune system to respond to this so that the severity of the disease is going to be less than normally would in a in a naive immune system.

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So, yeah, so basically the young it's not really a vaccine. It's just like this injection of antibodies, because most of the time when you give somebody a vaccine, your body itself creates the monoclonal antibodies, but you're just kind of cutting out the middle man.

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But the problem with that is that when you give them these antibodies, they don't kind of develop their own natural immunity to it so they still have to be exposed to the virus to develop a natural immunity as well.

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Okay, and we're going to talk about that just more than just a little bit, just, just a minute. So, first of all, let's hold my horse.

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Oh, no, that's okay. No, that's that's a good that's a good. And you wet your whistle kind of thing about the information that's coming. So let's first of all talk about immunizations that are available for adults that are 60 years of age and older again, these

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vaccines are targeted for older adults because younger people are going to be able to unless they've got some underlying condition are probably going to be able to just handle this virus just fine.

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So, one of the, one of the first viruses, I mean, I'm sorry, one of the first vaccines that was created is based on that pre F that pre fusion F protein, and it was created by Pfizer and it's called a brisvot, a brisvot.

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And it again this vaccine is its active immunization to prevent lower respiratory tract infection, caused by RSV.

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It's given as a single inter muscular dose so into the muscle and it's usually given at the beginning of RSV season which is going to be anywhere from mid September to mid November.

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So it's only 20% effective and preventing lower respiratory tract disease in the first. So again this vaccine, this vaccine only came out last year in 2023.

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So we don't have a lot of data to show us how effective it is. And again, it, it's been used in both.

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We're in the southern hemisphere.

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We're in the north, we're in the northern hemisphere sorry Lord, that just gave out how dumb I am as geography. So, so we're in the northern hemisphere. And then there's the southern hemisphere as well too and so I believe it was in the southern hemisphere

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that they were able to you see it for two seasons, and we've only been able to see it for one season as far as uses concerned, but so we see that we saw that this vaccine was almost 90% effective in the first season, and it was about 79% effective in the

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second season so far. And that's really good, because the flu vaccine is is on average only about 50% effective every season so this is not bad at all.

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So, and it also showed that it reduced the need to have health care provider intervention for the patients to prevent lower respiratory tract disease and about 80% of patients so that's really good so it's a, it looks like it's good.

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So there are some adverse effects there's always adverse effects. Again, you're going to get the key adverse effects in when you get an injection are going to be injection site reaction so you're going to have pain at the injection site.

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You may have some muscle pain, you may get, you may get a slight fever or headache or you may have some fatigue. It's, it's, it's symptoms that we, you could have redness or swelling at the injection site as well too.

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It's things that we've seen with other vaccines as well too.

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So the two things that have happened with RSV vaccine with a brisvot that may be a little concerning are that there were a few cases of atrial fibrillation that developed, which is a rapid heartbeat.

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It's a heart condition that makes your the top part of your heart beat faster so it makes your heartbeat not effective. It was in, it happened in 10 vaccine patients and four controls but this was a lesson point 1% incidence, but because we've only given it for one to two

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seasons, there's just some concern about giving it to patients that you know that may have underlying heart disease or a fib already. So, and when you have patient studies that small.

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It's hard to tell if you've powered that study sufficiently to cut up the noise like, like, a lot of times with with studies, like, you don't know if somebody, if they have that you know atrial fibrillation, if that was going to normally happen anyway, which is why you want to have a lot of people in a study so that you can kind of pick up the

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noise from the signal.

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So it's easy, it's easy to do a caveat with small numbers of studies like that but it'll be good to go forward is if a lot of people are getting this vaccine.

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Over the next couple years you can monitor a large population, and to see who might have had these episodes and who haven't and hopefully it's not statistically significant right and like like Josh said, the more data, we have the more we'll be able to make it more

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conclusive, you know, or intelligent or fat oriented decision about whether or not patients with atrial fibrillation should get this vaccine or not.

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Right. And if you, you also just have to compare the numbers like if something is 80% effective or 90% effective. Yeah, with a first shot. That means that nine out of 10 people are going to lower the severity of RSV. Now you could be one of those 10 people where it doesn't work, you know, you could also be the point 1% where it kind of speeds up your heart a little bit.

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So, I always want to keep in mind with everybody is just like when you're looking at statistics, and you look at a high number, it means that all this is automatically going to work it's like no it just, it is more likely that you'll be one of the people that it will benefit, but there's

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a less than chance that it might be a person that it doesn't benefit, and there could even be a smaller chance where actually causes a side effect that's not common.

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And just like in life, we all take risks, and we all are essentially going through life making decisions you know just because you drive in a car and you wear a seatbelt and you don't text and drive.

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It doesn't guarantee you're not going to get in a car crash. Right. You could even not wear a seatbelt text and drive, and it doesn't guarantee you don't get in a car crash but if you compare a population of 1000 people who do the bad behavior versus the good behavior.

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You might see a 15% increase in risk, if you don't wear your seatbelt and text and drive, getting in a car crash. So, it's, it's really just talking about risk and reward and and how those numbers compound and then you just have to ask yourself.

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What seems the most likely outcome, but then if an outcome happens you have to also be equally rational and say well I was also one of the people who just got unlucky, and they're just unlucky people in life.

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And that's not an answer that everybody wants to hear. They, they, they want everything to work 100% of the time, especially if they're accruing risk but sometimes that's just the way life is because you don't have perfect information, unfortunately, right.

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Another adverse effect that that was seen with this vaccine was there are these inflammatory neurologic events and they happened within about 40, about 40 days after the patient received the vaccine and it's the one of the, I don't know if any, it's one of the diseases

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called Guillain-Barre syndrome, and it's a it's a disease of the nerves and so you'll start and you'll lose, you'll get, you'll start with paralysis usually it's in the feet and it, and it's, you don't know how far it's going to go in any person but it could go all the way up and affect your lungs and your breathing as well too.

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So, it's nothing to sneeze at for sure it's something to be concerned with and there was then another disease that was very similar to that. So again these neurologic inflammatory conditions there were three cases of that so with the atrial fibrillation that was seen and these neurologic issues

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the vaccine right now is recommended only to be given to those patients who are high risk for having significant complications with RSV.

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So that would be basically individuals who are over 65 with some of those other comorbidities. Right, like heart disease or, you know, lung disease that type of thing so immunocompromised, you know that kind of thing.

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Yes. There's a second virus, as I mean, I really mean vaccine. There's a second vaccine that was also created and was was developed and and came on the market in 2023, and it's called a Rex V.

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And it also is an RSV vaccine that targets the pre f protein, but it also is what they call. It's got an adjuvant in it, which means that it's supposedly designed to beef up your immunogenicity to help produce long term protection.

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And again the purpose of this vaccine is a very similar is the same as the, the brisk of vaccine you're going to it's active immunization to protect against lower respiratory infected lower respiratory tract infection caused by RSV.

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And it's a single endomuscular dose given during giving it given at the beginning of RSV season or at least early on in the season, somewhere between September and November.

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And it's a rate of effectiveness and preventing lower respiratory tract of the disease in the first season. It's, it's efficacy dropped to about 50 per 656% in the second season so it's still effective but not the numbers weren't quite as robust as that one with

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the RSV, though. And it also had about a 78% efficacy rate and preventing the need for health care providers to intervene to help take care of patients as well to the adverse effects were pretty much identical with this including the a fib cases,

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and those inflammatory those neurologic inflammatory events. So again, the recommendation is to save this vaccine for those that are older that are at higher risk vaccines, these vaccines are not approved for use in infants and young children,

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and what has been shown is that this particular type of vaccine can actually worsen the respiratory disease, and I did not dive into the mechanism behind that but so vaccines are not recommended for your infants and children.

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At this particular time one hasn't been hasn't been created. Yeah, you're like what on earth do we do for the kids. Great question. So, so there's two things that can be done.

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One is not the vaccine and only the abris the vaccine so the Pfizer that the, the Brexite virus is created by GlaxoSmithKline, the abris virus, the abris vaccine is created by Pfizer.

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The Pfizer vaccine the abris vo vaccine is is also approved for use in pregnant women who between 32 to 36 weeks gestation during RSV season. So if a mama is pregnant at 32 to 36 weeks during RSV season so you know mid September to mid May, then they are

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recommended to use this for getting the abris vo vaccine. It's been shown that there could be pre term births. Again, not enough not enough patient data to definitively say this, but there were some pre term births associated with giving the vaccine so it's recommended

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to give this vaccine in a pregnant mom before the before 32 weeks just gestation so anytime after 32 weeks, and usually it's like 32 to 36 week time period, and by getting the vaccine, then they can that then that immunity can be transferred to their newborn

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when the babies delivered, and they, because they will start developing some natural immunity to RSV.

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So it's a good idea to do that as well. So for babies there is also as Josh was mentioning earlier, there is an antibody that can be administered to babies. If they're younger than eight months of age.

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You're going to recommend this antibody, it's you're going to recommend it to those that whose mama did not receive that RSV vaccination during pregnancy. If you don't know the moms RSV vaccination status, or if the mom got the vaccine, and it was less than 14 days before

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the baby was born because obviously it's not going to have had enough time for to have a great impact on the baby so you're going to give those babies, this antibody. And also the antibody is also recommended for infants, eight to 19 months of age.

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If in the second RSV season, if they have chronic lung disease due to prematurity, or they're severely immunocompromised they have cystic fibrosis, or if they're American Indian or Native Alaskan those those individuals are more prone to develop RSV as babies.

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And so the name of this antibody is called your civil map. The trade name is Bay Fortis, and it's given directly to the baby, and they're going to get protection against RSV like, like Joshua said, you're giving them the antibody, their body is not creating the antibody so

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this you're giving them the actual antibody their body is not producing it. So but it still works. And if you give it during the RSV season, and mostly it's well tolerated some you always want to look out for hypersensitivity reactions as the baby, baby, overly hyper, are they having

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an adverse allergic reaction to this, and you can, you could have a little rash associated with this antibody and you can have an injection site reaction as well too. So, brilliant.

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Okay, well I think we should close out with maybe some misunderstandings and myths around RSV that people might have heard, we can correct for it, or as there's they're thinking as they've listened to us they may say well what about this.

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So yeah so there's, there's eight of them, actually that I've that I've identified, or that the literature is identified first of all is that people think that getting respiratory sensational viruses just like getting a cold.

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And hopefully we've told you that yeah it can look like a cold but no it's not in every patient just like getting a cold. So it could start like one, but it can get worse.

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And so you want to. So, it's so you're, you want to, you know, be sensitive and cognizant of that.

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The second common misunderstanding is that besides vaccines there's no way to prevent RSV, and hopefully we've shown you that there are some ways such as staying home and sick washing your hands, you know, keeping away from people, cleaning your areas, sneezing into your arm

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those kinds of things can also help prevent RSV.

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The third one is that RSV is dangerous only for premature babies. And we've discussed that no that's not the case that older adults can also have some significant morbidity and mortality associated with this virus if not managed appropriately.

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For the, for the fourth one RSV will run its course so you don't need to see your doctor when you're sick.

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And that's not true. You should especially if your symptoms start like a cold but then start changing and getting a little worse for sure let your health care provider know, because they may be able to give you some things to do to keep you from from having to go to the

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hospital, so make sure you touch base with your, your health care provider especially with newborn babies as well to you know if they're just not looking right talk to your talk to your physician so that they can kind of give you some guidance.

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You can also get one of those rapid tests to especially for your infant, right, so you kind of know, right, and you can make an appropriate decision. Absolutely. That's a great point Josh.

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The next point number six is that RSV can it is only happens and you only get it in the winter months. And obviously we've shown you that you can get it in the fall as well as in the spring, but more more cases happen in the winter months.

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Number seven, that the RSV effects after you've had it are short lived. And actually this is not the case in, especially children that develop bronchiolitis from RSV they may have problems with wheezing for a number of years.

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And there's also has been some stuff shown that school age children that were hospitalized for RSV when they were young as an infant or young child, they may have an increased risk of developing asthma or effects on what their lung function as they get older,

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so it can have a long standing effect on it and stuff. And finally, that RSV only impacts those that get sick and anybody that has had a sick kiddo or cares for an aging parent knows that it doesn't just affect the patient, it affects the family around them.

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And those that care, you may have to miss work or change your lifestyle to care for that sick child so it definitely affects more than just that that patient that's sick so again, many reasons to just be aware of RSV as well as ways to keep it maybe to prevent it if you use some

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some good healthy practices to prevent disease.

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Thank you guys, great advice. And I really hope that this information that we provided on the episode today will help you prevent RSV and if you do get it, it'll maybe help you make some good decisions, either at home or how to ask your health care provider, so that you can get back to

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being healthy sooner rather than later.

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Thank you so much again for listening to us on Your Mom on Drugs. My name is Josh Klaus. And I'm Jenny Seltzer.

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See you next time. Thanks y'all. Thank you.