The U.S. is experiencing a surge in four major viruses: influenza (flu), COVID-19, respiratory syncytial virus (RSV), and norovirus. Dr. Ryan Fulton, section chief of general pediatrics at Carilion Children’s and faculty member at the Virginia Tech Carilion School of Medicine, shares critical insights on how this “quad-demic” is impacting children and what parents need to know.

The current surge

“This year, we’ve seen earlier and more intense surges of RSV and the flu compared to what we’re used to,” Fulton says. “COVID-19 emergency visits are less frequent than during earlier stages of the pandemic, but the virus remains a factor. What’s different now is that more children are presenting with co-infections, such as RSV and flu simultaneously, which increases the risk of complications and hospitalizations.”

Fulton notes that some regions of the U.S. are experiencing more severe outbreaks. “Areas with lower vaccination rates, colder weather, and higher population density are seeing higher infection rates. These factors make it easier for respiratory viruses to spread,” he says.

Who is most at risk?

Infants and young children, particularly those under 6 months old, are at the highest risk for severe illness from these viruses. “Children with underlying conditions like asthma, heart disease, or immune system deficiencies are especially vulnerable,” Fulton says. “Unvaccinated children and families face a greater risk of severe outcomes from flu and COVID-19 due to the lack of vaccine protection.”

Prevention strategies

“Frequent handwashing with soap and water is of the most effective ways to protect children,” Fulton advises. “Teaching kids not to touch their faces, staying up to date on flu and COVID-19 vaccinations, and avoiding close contact with sick individuals are all solid preventive measures. Regularly disinfecting high-touch surfaces, such as doorknobs and toys, also helps reduce the spread.”

If children do become ill, keeping them home from school or daycare is essential to prevent the spreading of any viruses further. “At Carilion Children’s, we have response plans in place to manage potential pediatric surges,” Fulton says. “Maintaining communication between public health officials and health care providers is key to tracking and mitigating outbreaks early in the season.”

Recognizing symptoms

Flu, COVID-19, and RSV share many symptoms, whereas norovirus primarily affects the gastrointestinal system.

  • Influenza: “Flu symptoms often include high fever, cough, sore throat, congestion, muscle aches, and fatigue. Some children may also experience vomiting or diarrhea,” Fulton says. 

  • RSV: “This virus typically causes a runny nose, cough, sneezing, fever, and wheezing,” Fulton says. “In infants, symptoms can be more subtle, such as poor feeding, irritability, or pauses in breathing. We’re particularly concerned about infants because RSV can significantly impact their ability to eat and breathe.”

  • COVID-19: “Symptoms can vary, but the most common include fever, cough, sore throat, fatigue, congestion, and in some cases, loss of taste or smell,” Fulton says.

  • Norovirus: “Unlike the other three, norovirus primarily causes gastrointestinal distress, including vomiting, diarrhea, nausea, and stomach pain, sometimes accompanied by fever or body aches,” Fulton says.

New treatments and vaccines on the horizon

Fulton says it’s important to stay informed about emerging treatments and vaccines. “For RSV, new monoclonal antibodies like nirsevimab are now available for infants and high-risk groups, and maternal vaccines can help protect newborns. These vaccines are specifically targeted for babies born during RSV season, which spans from October to March,” he says.

“For the flu, researchers are developing broader-spectrum vaccines to offer better protection against multiple strains,” Fulton says. “COVID-19 vaccines continue to be updated to address emerging variants, with intranasal vaccines being explored as a potential way to enhance immunity directly at the virus’s entry point.”

About Fulton
Ryan Fulton serves as section chief of general pediatrics at Carilion Children’s. Originally from North Carolina but born in Ohio, he earned his medical degree in 2013 from the Edward Via Virginia College of Osteopathic Medicine. He completed his residency at the Virginia Tech Carilion School of Medicine, where he now serves as faculty. Passionate about quality improvement and advocacy, Fulton mentors residents and faculty in developing initiatives that positively impact both patients and the broader community.

Interview
To schedule an interview with Fulton, contact Margaret Ashburn in the media relations office at mkashburn@vt.edu or 540-529-0814.

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