Viral Season Update: Illness and Volume Trends, and Helpful Resources for Our Community

As with past viral seasons, our goal is to share information and resources with our larger community as we all work together to care for patients during this busy time.

Viral Trends and Hospital Volumes

• ED Volumes: Volumes remain variable, but at times, extremely high, resulting in longer wait times for patients and families. The viruses contributing to these numbers are parainfluenza and rhinovirus. We continue to care for high numbers of pediatric patients with mental and behavioral health emergencies in our Emergency Department and/or psychiatry inpatient unit. Please do not hesitate to send patients to the ED when you have emergent concerns.
• Measles: The US confirmed case count is up to 1,046 as of May 27. There have been 14 separate outbreaks (defined as 3 or more related cases) and 3 deaths in the U.S. 96% of cases were unvaccinated or of unknown vaccine status. Due to underreporting, the true number is likely higher. We are on track to have the highest number of measles cases in the U.S. since 1992. At our current vaccination rate, measles will become endemic in the US. Encourage vaccination – infants age 6-11 months who are traveling internationally or domestically to a region with an outbreak may receive an MMR, children age 12+ months traveling internationally may receive their 2nd MMR 28+ days after the first dose. Because measles is so contagious, potential measles patients can easily expose everyone in the ED. At Seattle Children’s we have patients who may have measles enter the ED by an alternate route to avoid exposing other patients. If you are considering sending a patient for evaluation or treatment of measles, please call Mission Control at 206-987-8899 before sending the patient – they will work with our teams to facilitate evaluation while reducing exposure. See helpful resources below as we remain vigilant around infection prevention.
• Influenza: Local and national Influenza activity is low. In our ED, most positives are influenza B. Influenza B typically occurs in the spring and usually (but not always) contributes less to ED surge. We continue to monitor national highly pathogenic Avian Influenza A(H5N1) news, which has been quiet lately – hopefully this is good news.
• RSV: RSV positives remain just above interseasonal baselines and activity is low.
• SARS-CoV-2: In our hospital, COVID positives remain low. COVID variants are currently dominated by LP8.1 and XEC, with XFC quickly emerging. These variants are still in the JN.1 lineage. Screening at airports is starting to see NB.1.8.1, which is the variant that has been linked to a surge in East Asia. It is still not clear what the seasonality of COVID-19 will ultimately look like. As much of the population has immunity to JN.1, the next wave may be dictated by a change in the variant picture or may occur in the summer as immunity wanes.
• Mpox: The ongoing outbreak in Central and East Africa continues. Mpox testing is available at Seattle Children’s – if you feel your patient may have Mpox and want them tested, please call Mission Control at 206-987-8899.
• Other Respiratory Viruses: Rhino/enterovirus positives are the most common non-flu/non-RSV positives. Seasonal coronavirus, adenovirus, and HMPV positives continue to be elevated. Although none of these typically cause large waves individually, combined, they drive the latter half of our busy season.
• Mycoplasma: Activity has been slightly elevated since late summer but is waning and near baseline levels.
• Pertussis: There has been an increase in pertussis activity state and nation-wide over the course of the year, including two children in Louisiana who have died from the virus. We had been having 0-2 positives per week for several months. Continue to encourage vaccination.
• Norovirus and Rotavirus: Norovirus activity remains high but is past peak and continues to slowly fall. Rotavirus activity has been fluctuating this year and is currently elevated.

Special Pathogens Team Update

Seattle Children’s has a special pathogens team that is continuously monitoring worldwide outbreaks to keep our staff, patients and community providers informed. There is currently an alert for Lassa Fever in Nigeria.

If you are treating a patient with recent (within the last month) travel to areas mentioned above and suspect a related illness, please contact your local public health department.

If you are referring an ill patient that needs urgent evaluation to Seattle Children’s, please call Mission Control at 206-987-8899 before sending the patient.

Measles Resources

• Webinar Recording: Measles Community Response
• Measles One-Pager for Healthcare Providers (AAP)
• Measles - For Healthcare Professionals (CDC)
• Measles Specimen Collection Instructions for RT-PCR (DOH)
• Measles Specimen Collection Instructions for Serology (DOH)
• Immunization Schedules (CDC)
• Safety Information for Measles, Mumps, Rubella (MMR) Vaccines (CDC)
• Recognizing Measles in Your Patients (Pediatric Pandemic Network)
• Vitamin A and Measles Vaccine Talking Point (Pediatric Pandemic Network)
• Measles FAQ for Families & Caregivers (Pediatric Pandemic Network)

How You Can Help

• Review our recent Special Update regarding a Mental Health ED Patient Surge for information specific to mental and behavior health ED visits.
• As ED volumes remain high, consider reminding families of your clinic’s resources and procedures for urgent and after-hours patient needs to help direct them to the most appropriate site of care.
• Encourage families to review our ED vs. Urgent Care guide to find the most appropriate care setting – we have options for in-person and virtual urgent care, orthopedic urgent care, and psychiatric urgent care.
• Families should be prepared that, if viral testing is deemed clinically appropriate, it will typically be performed using a panel that identifies only influenza, RSV, and COVID-19.
• Before sending your patient to the ED, contact our Mission Control team with as much notice as possible at 206-987-8899. This helps us plan for your patient’s arrival, especially if there are concerns for communicable diseases.

Additional Resources

• Advise patient families to utilize our library of Barton Schmitt patient education handouts on hundreds of conditions including COVID-19, influenza and RSV.