Usually Mild Virus Hits Hard Among Infants

An outbreak of a flu-like respiratory virus that is especially dangerous for infants is rapidly spreading in Orange County and has left four babies in intensive care on respirators, health officials said Friday.

Although the disease, respiratory syncytial virus, or RSV, ordinarily is no more severe than a bad cold or influenza, doctors warned that it can progress into pneumonia or other potentially fatal diseases if left unchecked, especially in babies or children with chronic respiratory ailments.

“It really isn’t a cause for alarm--it’s an extremely common infection,” said Dr. Gary Goodman, an intensive-care pediatrician at Childrens Hospital of Orange County. “But unfortunately, a few children are uniquely susceptible.”

Most children who contract the disease are usually treated in outpatient clinics and released, Goodman said. But “an alarming number” of babies, perhaps as many as 15, have been admitted to the intensive care unit at CHOC since December, he said.

Four of those babies--two with prior health problems, and two who were healthy before contracting RSV--are still in the hospital, Goodman said. All four are being periodically treated with ventilators.

Other hospitals reported that as many as twice the number of children are being treated for RSV and other respiratory ailments, compared to last winter. At Kaiser Permanente’s Anaheim Medical Center, about 4,200 children a month are being treated for a wide variety of illnesses, up from 2,500 a month in a comparable period last year.

“We would definitely term it an outbreak, and it could go to an epidemic,” said Marilyn Gallagher, an infection control practitioner at Kaiser.

State and county health officials, while expressing concern about the RSV outbreak, stopped short of warning the public about the potential for an epidemic.

“I don’t know how likely it is to have an RSV epidemic that would be serious,” said Orange County epidemiologist Dr. Thomas Prendergast. “But we’re obviously concerned about anything that makes a bunch of people sick.”

Dr. Robert Murray, an epidemiologist in the infectious disease branch of the California Department of Health Services, said no one has declared an epidemic of RSV. But he noted that it is “one of the leading causes of bronchial infection in infants” and that a physician should be consulted for any baby who has contracted a respiratory illness.

The only treatment for RSV is ribavirin, an anti-viral drug administered in a spray mist. David Calef, a spokesman for ICN Pharmaceuticals in Costa Mesa, said a 60% increase in ribavirin sales nationwide in 1989, compared to 1988, suggests that the outbreak could have spread beyond Southern California. ICN markets ribavirin under the brand-name Virazole.

While no one could explain why the RSV outbreak is so severe this year, doctors said the disease has spread so rapidly because it is easier to transmit than other viruses.

“The primary mode of transmission of this virus is hand to hand, not by sneezing or coughing,” said Dr. Harris R. Stutman, director of pediatric infectious disease treatment at Memorial Miller Children’s Hospital in Long Beach. “People (with viruses) often touch their faces or rub their noses or eyes and then touch someone else. If you have to rub your eyes or nose, you ought to wash your hands, especially if you’re handling infants.”

Stutman said 143 children with RSV have been hospitalized at Memorial Miller for an average of three to five days since December. About 10 of them were placed on respirators in the intensive care unit, with two still in the hospital.

Lynda Baas, an administrator in the urgent care department at Kaiser in Anaheim, said that while the increased number of pediatric patients there cannot be attributed solely to RSV, “we have admitted a lot of kids to the hospital with (RSV) symptoms.”

The symptoms are similar to a bad cold. They include labored or rapid breathing, sneezing, coughing, wheezing and low-grade fever, doctors said. The virus can strike anyone, but children under age 2, whose immune systems are not fully developed, are apt to feel the worst effects.

“It’s always the younger kids that get worse,” said Dr. Erna Wong, a pediatrician at Kaiser. “A certain percentage of them get hospitalized because of poor feeding and not being able to keep foods down. Some kids have stopped breathing. But that’s just part of the spectrum. For other kids, it’s just a cold.”

Even in infants, Goodman said, most RSV victims won’t become severely ill. He estimated that one of every 100 RSV sufferers will require hospitalization, and that 10% to 15% of those hospitalized will require intensive care.

“The one message I’d like to get out is there’s no need for panic,” Goodman said. “We’re certainly seeing an increased number of hospitalizations, but the vast majority of babies are not going to have a serious or life-threatening illness.”

But for the parents of children who do require hospitalization, the experience can be harrowing. Denise Zanelli, 27, of Brea recalled that she thought her 8-month-old son, Dylan, was suffering from an ordinary cold, but his condition sharply deteriorated on Christmas Eve.

“It got so bad overnight on Christmas Eve that I knew there was no messing around--we had to get him to the hospital,” Zanelli said. “He just went bad fast. He was coughing and scratching his face because his nose was so congested, and his eyes were real puffy.”

At the hospital, doctors immediately administered oxygen to Dylan and drained the fluid from his lungs, which were “filling up,” Zanelli said. The baby remains hospitalized at CHOC, where he continues to receive oxygen treatment.

Zanelli’s concern was heightened by the fact that Dylan, who was a premature baby, weighed just 1 pound 10 ounces at birth and has a heart murmur.

“We were real scared because of his heart condition,” she said. “He’s a real pale little kid anyway, but he went like a gray-blue. The RSV really made his heart have to work overtime.”

While there are few preventive measures to stop children from getting RSV, Kaiser administrator Baas said bed rest and plenty of fluids are recommended for children who do contract it.

If fever increases, or if babies have trouble eating and breathing at the same time, a physician should be consulted. Goodman said the virus, under normal circumstances, usually runs its course in about a week to 10 days.