Provider News

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

January 10, 2025

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

Outside view of Seattle Children's hospital

  • ED Volumes: Our ED volumes have been down slightly (relative to the viral season), which is typical when school is out. We anticipate volumes will increase as children have returned to school.
  • Influenza: Influenza activity is high to very high nationally. Locally, we have not yet reached peak and anticipate that will continue for the next four weeks. We continue to monitor national Highly Pathogenic Avian Influenza A(H5N1) news. To date, human-to-human transmission has not been identified in the U.S. If you are concerned, you should contact public health and infection prevention. PPE is gown, gloves, eye protection and N95 or equivalent.
  • RSV: RSV positives continue to be at high levels but have likely not peaked. Anecdotally, many of the patients we have seen with severe RSV did not receive indicated Nirsevimab or maternal vaccine. The latest data indicates that nirsevimab reduces RSV-associated medical visits by more than 80% and reduces severity of illness in patients who are admitted. Encourage patients to get the vaccine if available and eligible.
  • SARS-CoV-2: Local COVID positivity is low, but we continue to see rising wastewater activity. The Midwest is now in the High activity range and the West is in the moderate range.
  • Mpox: The ongoing outbreak in Central and East Africa continues. It is caused by the more virulent Clade Ia subvariant. Clade II mpox is still being diagnosed weekly in WA, although rates are much lower than 2022. 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 at Seattle Children’s. Adenovirus, seasonal Coronavirus and Parainfluenza are at moderate levels. Human metapneumovirus and Parainfluenza 3 typically cause our post-RSV census elevations and typically start in the late winter and early spring.
  • Measles: Measles remains active nationally and internationally. Contact infection prevention and public health if you suspect a case.
  • Mycoplasma: We continue to see a slight increase in Mycoplasma activity but the positivity rate has been stable without significant increases over the past 12 weeks.
  • Pertussis: There has been an increase in pertussis activity state and nation-wide over the course of the year. However, we have not seen any trends in our local data and have been averaging 0-2 positives per week for the past four months, which is a small increase from last year.
  • Norovirus and Rotavirus: Norovirus positivity is high. Positivity reported to the CDC is nearly 25%. Rotavirus activity is low.
  • Human metapneumovirus (HMPV): You may have read or heard about elevated rates of HMPV in China. As many in pediatrics are aware, this virus circulates across the world every year and causes upper and lower respiratory infections, much like RSV and other respiratory viruses. In our part of the world, HMPV rates currently remain low, but we expect HMPV activity to increase later this season.

Tips for Treating RSV/Bronchiolitis

With RSV rates currently high in the community, we would like to remind providers that we offer several resources for caring for patients in primary care and supporting families with education materials.

  • Bronchiolitis: Rest Is Best! offers information for providers on diagnosis, treatment, medication and more.
  • Family-facing Bronchiolitis Care Packet  
  • Video for parents on caring for children with bronchiolitis and RSV (included in the care packets above)
  • Bronchiolitis pathway for providers
  • Provider treatment tips:
    • Bronchiolitis is a viral illness needing supportive care measures.
    • Timeline of symptoms: increasing symptoms for two to three days with very slow resolution from day 6 to 22+.
    • During height of symptoms (days 2- 6): clinical course varies minute to minute, clinical decisions and interventions should only be considered for sustained changes in clinical presentation.
    • Viral swab testing and CXRs do not alter the clinical course or parent satisfaction in care and can lead to over prescription of antibiotics (25% of children with bronchiolitis will have atelectasis on CXR)
    • Albuterol is not helpful for bronchiolitis and may lead to side effects (tachycardia, iatrogenic V/Q mismatch, increased cost, or implications for future illnesses, i.e., excess albuterol prescribing in the future.

How You Can Help

  • As ED volumes increase, 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. In appropriate instances, we may be able to directly admit your patient to the hospital or arrange an urgent ambulatory clinic visit in lieu of an ED visit.

Resources