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UAB: How to Protect Against “Triple-demic” Viruses This Winter


By Adam Pope

UAB News

This fall and winter, influenza and COVID-19 are gaining an ally as RSV surges across the United States, creating a “triple-demic” of respiratory diseases.

RSV, or respiratory syncytial (sin-SISH-uhl) virus, is a common respiratory virus that usually causes mild, cold-like symptoms.

Jeanne Marrazzo, M.D., director of the University of Alabama at Birmingham Division of Infectious Diseases, said that, even though COVID-19 hospitalizations are in a “pretty good place,” influenza is surging in Alabama and throughout the Southeast.

“We’re seeing a gradual decline in the most recent Omicron surge, and we’re seeing low double-digit COVID hospitalizations at UAB,” Marrazzo said. “This winter, however, we may see new COVID variants, and we’re now seeing increasing influenza hospitalizations and RSV.”


Claudette Poole, M.D., associate program director of Pediatric Infectious Diseases with UAB and Children’s of Alabama, said that, because of the COVID-19 pandemic, RSV cases are “playing a bit of catch-up.”

“We’re now seeing a double volume of influenza and RSV in children who will be exposed and experiencing symptoms,” Poole said.

RSV season, much like flu season, typically runs from October to March; but what is unusual to Poole is that physicians nationwide are seeing a surge in these viruses so early in the season.

“This may give people pause that this could be a long winter of a lot of illness,” she said.

While many advances are being made, unfortunately unlike with flu, there is no vaccine on the market or viable therapeutic course for RSV.

“RSV is a virus that we do not develop lasting immunity to,” Poole said. “As adults, we can continue to contract the same RSV strain year upon year; but it does not cause significant symptoms, basically a mild cold-like illness lasting for a few days. However, it is usually young children, medically fragile individuals or older adults who are more at risk for developing severe disease.”

RSV starts as a respiratory infection, much like a cold; however RSV congestion can lead to infections, most commonly ear infections.

“It can also lead to sinusitis, but that is usually later,” Poole said. “In younger age groups less than 2 years old, RSV can settle in the lungs, and if they struggle to breathe, that is an indication that you need to take your child to the emergency room if your primary care doctor is inaccessible.”


Marrazzo says that, as of Oct. 28, 2022, UAB Hospital is caring for approximately the same number of patients with COVID as those with influenza.

“We are seeing these cases a little bit earlier — and this is a tad bit unusual for this time of year — and that is worrisome,” Marrazzo said.

She adds that a worse-than-average flu season in Australia indicates the United States could experience the same. In addition, she says the data on how effective flu vaccines are is still unclear.

Preventive Measures

“What we do know about the flu vaccine is that it is incredibly effective in lessening the symptoms of flu,” Poole said. “The best thing you and your child can do is to get vaccinated.”

Poole recommends early diagnosis of flu as another preventive measure, because starting an anti-viral treatment will decrease spread and severity.

“You should also stay home from work or school if you are sick,” Poole said. “Good hand hygiene is key.”

Marrazzo adds that women who are pregnant should get their flu vaccine, while

Poole recommends new parents should reduce the amount of exposure for newborns.

“Pregnant women who get influenza have a higher mortality rate than those who get vaccinated,” Marrazzo said. “The children who are more likely to die from influenza are the ones 6 months or younger because they cannot get vaccinated.”

Not too late to get your COVID booster

“Vaccination with the current booster that we have now which is targeted to [Omicron subvariants] likely will help mitigate or help prevent the most severe outcomes of COVID, regardless of what lineages are coming down the line,” Marrazzo said.

Marrazzo adds that those interested in getting boosted should wait about three months after either being infected or receiving a previous booster, citing data that shows immunity begins to lessen after the three-month mark.

At UAB Marrazzo is the C. Glenn Cobbs Endowed Chair in Infectious Diseases.