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These are the most common ways that kids get RSV

Experts share five tips to keep your family safe and healthy during this RSV surge.

The U.S. is seeing an unprecedented surge in cases of RSV, or respiratory syncytial virus, among children this year. And children's hospitals in many areas of the country are spread exceedingly thin.

More than 20 states are reporting that 80% or more of their pediatric hospital beds are currently occupied. Children are facing extended wait times for medical care, and the situation is only expected to get worse if flu activity increases even more in December, TODAY previously reported. One hospital staffer told TODAY his facility is seeing its worst RSV surge in at least 25 years.

For most kids and adults, RSV is a mild illness causing cold-like symptoms, such as coughing, runny nose and fever, the Centers for Disease Control and Prevention say. Children are usually able to recover within one or two weeks, and the illness is so common that nearly everyone will get it by their second birthday, per the CDC.

But in some cases, particularly among infants and kids with certain underlying health conditions, as well as elderly adults, RSV can be severe and even deadly. A 6-year-old in Michigan died from RSV complications, TODAY reported earlier this month.

Meet the experts

  • Dr. Thomas Murray, associate professor of pediatric infectious diseases at the Yale School of Medicine in New Haven, Connecticut.
  • Dr. Ishminder Kaur, assistant professor of pediatrics in the division of infectious diseases at David Geffen School of Medicine at University of California, Los Angeles.

How does RSV spread?

The virus "typically spreads in young children when they touch contaminated surfaces and then touch their face," Dr. Thomas Murray, associate professor of pediatric infectious diseases at the Yale School of Medicine, told TODAY. This applies to babies, as well as toddlers.

RSV can also be spread to babies and toddlers via large respiratory droplets when someone who has the infection coughs or sneezes, he said. But direct contact with a contaminated surface or an infected person's "respiratory secretions" is the most common route of infection, Murray said.

"A lot of times it happens by self-inoculation," Dr. Ishminder Kaur, assistant professor of pediatrics in the division of infectious diseases at UCLA’s David Geffen School of Medicine, told TODAY. "So, you touch a contaminated surface and then you inoculate yourself by touching your eyes, nose or mouth," she said.

Where are kids most likely to pick up RSV?

The most common way for RSV to spread among children is through contact with contaminated surfaces or objects. That can happen when, say, "one kid is sick and they touch their nose then play with a toy," Murray explained. "The toy is now contaminated and another kid comes along, plays with the same toy, touches their nose and that's how you spread RSV."

He pointed to a 2013 study in the Journal of Clinical Virology that tracked the transmission of RSV within a few child care facilities at Fort Lewis Army Base in Washington. Over three winter seasons, the researchers honed in on RSV clusters in two classrooms. And, within six days of the first RSV case, half the kids in both classrooms had the illness.

RSV also spreads if someone with the virus visits your home, for instance, and "contaminates your surroundings unknowingly," Kaur said.

Some of the most frequent scenarios in which kids (and potentially adults) pick up RSV can include:

  • Shared toys at school or day care.
  • Tables or silverware in communal dining areas.
  • Playground equipment.
  • Phones, tablets and other devices if shared.
  • Doorknobs, elevator buttons, light switches and other frequently touched surfaces.

Some of the most common locations that kids go to where they can get RSV are:

  • School
  • Day care
  • Playground
  • At home

Children who are sick with RSV can also pass the virus on to their parents and other household members.

"A parent who's caring for a young child and frequently helping them blow their nose, hugging or snuggling — anything like that can put you at risk," Murray said.

Why are we seeing such a huge surge in RSV this year?

It's not totally clear why we're seeing such a large number of RSV cases and hospitalizations this year, the experts said.

One factor may have been the precautions that people took for COVID-19, which also prevented kids from getting other common illnesses, including RSV. As a result, RSV rates were abnormally low for the last few years, albeit with an unusual off-season spike here and there.

"Children have just not been exposed to a lot of these respiratory viruses over several years," Kaur explained.

As a result, "you have a large number of children that are now susceptible to the infection that otherwise would not have been because they would have gotten it already," Murray said.

And it's not just about RSV, Kaur said. "Now they're being exposed to RSV and several other viruses," she said. "So sometimes children come in and they have two or three respiratory viruses — and even just with RSV, they're getting fairly sick."

How to prevent RSV in kids and adults

  • Wash hands frequently. "No conversation about RSV is complete without hand hygiene," Kaur said. That's because good hand hygiene, meaning washing your hands properly before and after engaging in certain activities, is one of the best ways to protect yourself and those around you from RSV.
  • Practice good respiratory etiquette, which means covering your nose and mouth with a tissue when coughing or sneezing and then throwing the tissue out and washing your hands, the CDC says. It's really about "controlling your secretions and not coughing on others," Murray explained.
  • Keep sick kids home. "The most important thing right now — given the surge that we're seeing — is that if your child is sick with respiratory symptoms, they really should stay away from other children," Murray said. And if you know RSV or other illnesses are circulating in your area, think about taking kids out of day care if you have the ability to do so, Kaur said.
  • Consider masking up. Because RSV primarily spreads via contact rather than COVID-style aerosol spread, a mask isn't necessarily going to be the main way people can protect themselves from RSV. But masks can still be useful because "when people have a mask on, they tend not to touch their nose and mouth as much," Murray said. So a mask can help keep you from getting infected in that way.
  • Consider monoclonal antibodies for high-risk children. For young kids and babies who are at higher risk for severe RSV, there is a monoclonal antibody therapy (palivizumab) available that can help protect them, Kaur said.

With flu and COVID-19 surges likely around the corner, another important way to protect your family this winter is to get vaccinated against both of those viruses, as there's no RSV vaccine yet, TODAY previously reported. Getting a flu shot, as well as vaccinated and boosted against COVID, reduces the risk of severe illness and the likelihood that you or your child will need to go to the hospital and put further strain on an already overwhelmed health care system.