INSIDE WVSMA
Editor ’ s Letter
Respiratory Triple Threat
Linda S . Nield , MD
Typically , a triple threat is a positive concept , referring to a performer who excels at acting , dancing , and singing . Unfortunately , the triple threat at this time of year refers to the more ominous performers , which include the respiratory syncytial virus ( RSV ), the influenza virus , and the severe acute respiratory syndrome coronavirus 2 ( COVID-19 ). Although COVID-19 has been dominant in medical literature and lay media since it arrived in 2020 , publications about RSV and influenza have been consistently present for the past 50 years .
For a large part of my career as a pediatrician , I had considered influenza as mainly a health concern of the elderly and RSV as mainly a health concern of the very young . A quick PubMed search with the terms RSV / infants / children versus RSV / elderly / adults reveals that from 1973-2023 , the number of results when using the RSV / infants / children terminology is three times the number of results for the RSV / elderly / adults search . However , when limiting the search to the more recent years of 2020-2023 , the number of articles involving children and RSV is only double the number of articles involving adults and RSV . These findings provide evidence that there has been more recent attention given to RSV in the adult population . This increased attention to RSV in the elderly ( as opposed to children ) in both the medical and lay media is reminiscent of the attention in the early 2000s paid to the morbidity and mortality of influenza in infants less than six months of age ( as opposed to adults ).
It was not until 2002 that the Advisory Committee on Immunization Practices initially encouraged the use of the flu vaccine in children aged 6 months to 23 months . Statistics revealed that hospitalization rates among children less than 12 months of age were similar to rates for patients aged 65 years and older . 1 Eventually in 2010 , the recommendation was to vaccinate all individuals over the age of 6 months . 2 In comparison , the United States Food and Drug Administration approved the first RSV vaccine for patients aged 60 years or older in May 2023 . As we have witnessed during the pandemic , the vaccinations for COVID-19 and recommendations concerning their use have evolved and been evolving since first manufactured . Of course , to keep current for this season and every season about the vaccination recommendations to prevent the respiratory triple threat viruses , the reader is referred to the Centers for Disease Control and Prevention website .
The four scientific articles contained in this issue of the journal are all case reports , and to fit in with the respiratory triple threat season , three concern disorders requiring the expertise of pulmonologists . McGuire and Al-Qatarneh describe the course of a one-month-old boy with cardiofacio-cutaneous syndrome who required tracheostomy and long-term ventilation . 3 Shah et al ’ s report of their four-yearold patient teaches the reader about the cerebrospinal fluid maker for narcolepsy ( low levels of hypocretin ), 4 while Hagen and Rajjoub present their patient with familial pulmonary fibrosis . 5 Moving into the gastrointestinal tract for the final case report in the issue , Nakao et al provide the history of their elderly patient with the rare entity of perforated jejunal diverticulitis . 6
REFERENCES
1 . Center for Disease Control and Prevention . Prevention and control of influenza : recommendations of the Advisory Committee on Immunization Practices ( ACIP ). MMWR Morb Mortal Wkly Rep 2002 ; 51 ( RR-3 ).
2 . Centers for Disease Control and Prevention . Press Release : CDC ’ s Advisory Committee on Immunizations Recommends Annual Influenza Vaccination . February 24 , 2010 . Available at : https :// www . cdc . gov / media / pressrel / 2010 / r100224 . htm . Accessed on October 4 , 2023 .
3 . McGuire JA , Al-Qatarneh S . Cardio-Facio-Cutaneous Syndrome with an Unusual Presentation of Respiratory Failure Requiring Tracheostomy and Long-Term Ventilation . WV Med J . 2023 ; 119 ( 4 ): 16-17 .
4 . Shah S , Rehman R , Mousattat Y , Bishara J . Narcolepsy in a 4-Year-Old . WV Med J . 2023 ; 119 ( 4 ): 18-20 .
5 . Hagen R , Rajjoub S . Familial Pulmonary Fibrosis : A Case Report . WV Med J . 2023 ; 119 ( 4 ): 21-23 .
6 . Nakao Y , Thompson E , Mattingly J , Wolfer R . Perforated Jejunal Diverticulitis : A Rare Cause of Abdominal Pain . WV Med J . 2023 ; 119 ( 4 ): 24-27 .
6 • www . wvsma . org