Science
Wave of RSV, particularly dangerous for babies, sweeping across U.S.; doctors urge vaccination
A wave of the highly contagious respiratory syncytial virus is sweeping across the United States — sending greater numbers of babies and toddlers to the hospital, recent data show.
The onset of RSV comes as the country heads into the wider fall-and-winter respiratory virus season, also typically marked by increased circulation of ailments such as COVID-19 and the flu. But RSV, the leading cause of infant hospitalization nationwide, presents particular risk for the youngest babies, a major reason health experts recommend pregnant women either get vaccinated near their delivery date or immunize their newborns.
“This is the perfect time to get your vaccine for RSV if you have never gotten one,” the Los Angeles County Department of Public Health said in a statement to The Times.
RSV can spread through coughs or sneezes but also by touching a contaminated surface, such as a door handle, and then touching your face before washing your hands, health officials warn.
For the week ending Oct. 11, about 1.2% of emergency room visits nationwide among infants younger than 1 were due to RSV — up from 0.4% a month earlier, according to data posted by PopHIVE, a project led by the Yale School of Public Health.
“An RSV wave is starting to take hold,” epidemiologists Katelyn Jetelina and Hannah Totte wrote in the blog Your Local Epidemiologist.
RSV can be dangerous for infants, older adults and people with certain medical conditions, according to the U.S. Centers for Disease Control and Prevention. RSV can cause pneumonia, as well as a severe inflammation of the lungs’ small airways, known as bronchiolitis, the California Department of Public Health said.
“The issue with kids is that their airways are so small that when it causes inflammation in the airways, it’s just very hard to breathe,” said Dr. Peter Chin-Hong, a UC San Francisco infectious diseases expert. “So they come in with wheezing … and that’s why they get into trouble.”
Nationally, RSV kills up to 300 children under age 5 annually, and can send up to 80,000 to the hospital. Among seniors age 65 and older, the virus can cause up to 10,000 deaths in a typical year and as many as 160,000 hospitalizations, according to the CDC.
“I think it’s been kind of invisible, mainly because until recently … people wouldn’t test — we couldn’t test for RSV until the age of molecular diagnostics,” Chin-Hong said. “So it has been kind of an invisible epidemic.”
RSV is “kind of a bronze medalist of respiratory viruses, with COVID and influenza No. 1 and No. 2, duking it out, and RSV is No. 3 for older adults,” he added. In general, RSV is the first to emerge during the fall-and-winter virus season, followed by flu then COVID, Chin-Hong said.
Before immunizations became available, about 2% to 3% of young infants were hospitalized for RSV annually, according to the CDC. Most children who are hospitalized for acute respiratory disease caused by RSV were previously healthy, according to a study published by the journal Pediatrics.
They may require oxygen or intravenous fluid or even be put on a ventilator to help them breathe, according to the CDC.
Unlike the flu and COVID-19, there are no antiviral drugs to treat RSV once infection sets in.
For now, the combined activity of respiratory illness from RSV, flu and COVID-19 is considered “very low” in California, state health officials said.
But “we are starting to see the beginnings of respiratory virus season,” the L.A. County Department of Public Health said.
Health officials in Santa Clara County, Northern California’s most populous, are already reporting “medium” levels of RSV in the wastewater of San José, Palo Alto and Sunnyvale.
Now is exactly the time to get vaccinated if you haven’t already — “especially before respiratory virus activity potentially increases later,” said Dr. Regina Chinsio-Kwong, the Orange County health officer.
RSV immunizations are recommended for pregnant women between 32 and 36 weeks of gestational age — about one to two months before their estimated delivery date — as well as for everyone age 75 and up and those age 50 to 74 with underlying medical conditions such as diabetes, cancer, kidney disease, weakened immune systems, asthma or heart disease. Vaccines are also recommended for individuals who live in a nursing home or long-term-care facility.
If a pregnant woman wasn’t vaccinated against RSV, officials recommend her infant get immunized.
RSV vaccinations are fairly new, being introduced in 2023. There are now three brands — Pfizer’s Abrysvo and GSK’s Arexvy were licensed in May 2023, and Moderna’s mResvia in June 2024. All three can be used for older adults, but only the Pfizer vaccine is available for pregnant women.
Infants were also able to get immunized starting that year through monoclonal antibodies, which aren’t technically vaccines but function similarly in this case.
Older adults who already received an RSV vaccination generally don’t need to get another one.
The arrival of those vaccines followed a particularly brutal 2022-23 respiratory virus season when California was slammed by a hospital-straining “tripledemic” of RSV, flu and COVID.
Unlike the RSV shots, flu and COVID vaccinations are generally recommended ahead of every fall-and-winter virus respiratory season. Older adults, those age 65 and up, can get the COVID vaccination every six months, according to the California Department of Public Health.
People can get the RSV, flu and COVID vaccinations all during the same visit to a healthcare provider, Chinsio-Kwong said.
“Receiving all eligible vaccines at once is considered best practice, as it helps avoid missed opportunities due to scheduling challenges,” she said.
Studies have shown the RSV immunizations are effective.
During last year’s respiratory virus season, there were significant reductions in the RSV hospitalization rate for babies, data show. Data also show RSV vaccines were effective in preventing symptomatic illness in older adults.
Chin-Hong said he suggests “everyone should get it” if they are 75 or older, and for those between age 50 and 74 with heart or lung disease or are very immune compromised, “I think the juice is worth the squeeze.”
Annual routine flu vaccines are recommended for everyone who is at least 6 months old.
As for COVID, a vaccine can be given to anyone who wants one. The California Department of Public Health specifically recommends the shots for everyone age 65 and up, babies age 6 months to 23 months, children and teenagers who have never been vaccinated, and people with certain health risk factors and those in close contact with them.
The California Department of Public Health also recommends pregnant women get the COVID vaccination.
After concerns earlier this season about how difficult it might be to get COVID vaccinations, pharmacists and California health officials now say securing the shots is relatively easy.
The controversy arose in the late summer amid confusing guidance coming from agencies overseen by Health and Human Services Secretary Robert F. Kennedy Jr., who has disparaged vaccinations.
There was a period during which the Food and Drug Administration had belatedly approved COVID-19 vaccines only for those age 65 and up and younger people with underlying health conditions. An unprecedented delay in the CDC issuing its own recommendations had the effect of snarling vaccinations for many.
In some states, that meant people were being turned away from getting the COVID vaccine at their local pharmacy, including seniors, even as a late summer surge was raging. And at one point, the powerful CDC Advisory Committee on Immunization Practices nearly recommended the COVID vaccine be available by prescription only.
On Oct. 6, acting CDC Director Jim O’Neill officially lifted the agency’s recommendation that adults under age 65 get the updated COVID-19 vaccine, saying instead that doing so should be based on “individual-based decision-making” in consultation with health professionals.
Now, “patients can go into the pharmacy” and can have conversations on whether to get the COVID-19 vaccine with a professional, Allison Hill, a director of professional affairs for the American Pharmacists Assn., said during a recent webinar.
California also recently clarified state law to make sure that pharmacists can independently administer the COVID vaccine, according to Dr. Erica Pan, director of the state Department of Public Health.
The sun had barely risen over the Pacific Ocean when a small motorboat carrying a team of Indigenous artisans and Mexican biologists dropped anchor in a rocky cove near Bahías de Huatulco.
Mauro Habacuc Avendaño Luis, one of the craftsmen, was the first to wade to shore. With an agility belying his age, he struck out over the boulders exposed by low tide. Crouching on a slippery ledge pounded by surf, he reached inside a crevice between two rocks. There, lodged among the urchins, was a snail with a knobby gray shell the size of a walnut. The sight might not dazzle tourists who travel here to see humpback whales, but for Mr. Avendaño, 85, these drab little mollusks represent a way of life.
Marine snails in the genus Plicopurpura are sacred to the Mixtec people of Pinotepa de Don Luis, a small town in southwestern Oaxaca. Men like Mr. Avendaño have been sustainably “milking” them for radiant purple dye for at least 1,500 years. The color suffuses Mixtec textiles and spiritual beliefs. Called tixinda, it symbolizes fertility and death, as well as mythic ties between lunar cycles, women and the sea.
The future of these traditions — and the fate of the snails — are uncertain. The mollusks are subject to intense poaching pressure despite federal protections intended to protect them. Fishermen break them (and the other mollusks they eat) open and sell the meat to local restaurants. Tourists who comb the beaches pluck snails off the rocks and toss them aside.
A severe earthquake in 2020 thrust formerly submerged parts of their habitat above sea level, fatally tossing other mollusks in the snail’s food web to the air, and making once inaccessible places more available to poachers.
Decades ago, dense clusters of snails the size of doorknobs were easy to find, according to Mr. Avendaño. “Full of snails,” he said, sweeping a calloused, violet-stained hand across the coves. Now, most of the snails he finds are small, just over an inch, and yield only a few milliliters of dye.
new video loaded: This Parrot Has No Beak, But Is at the Top of the Pecking Order
By Meg Felling and Carl Zimmer
April 20, 2026
For months now, menopausal women across the U.S. have been unable to fill prescriptions for the estradiol patch, a long-established and safe hormone treatment. The news media has whipped up a frenzy over this scarcity, warning of a long-lasting nationwide shortage. The problem is real — but the explanations in the media coverage miss the mark. Real solutions depend on an accurate understanding of the causes.
Reporters, pharmaceutical companies and even some doctors have blamed women for causing the shortage, saying they were inspired by a “menopause moment” that has driven unprecedented demand. Such framing does a dangerous disservice to essential health advocacy.
In this narrative, there has been unprecedented demand, and it is explained in part by the Food and Drug Administration’s recent removal of the “black-box warning” from estradiol patches’ packaging. That inaccurate (and, quite frankly, terrifying) label had been required since a 2002 announcement overstated the link between certain menopause hormone treatments and breast cancer. Right-sizing and rewording the warning was long overdue. But the trouble with this narrative is that even after the black-box warning was removed, there has not been unprecedented demand.
Around 40% of menopausal women were prescribed hormone treatments in some form before the 2002 announcement. Use plummeted in its aftermath, dipping to less than 5% in 2020 and just 1.8% in 2024. According to the most recent data, the number has now settled back at the 5% mark. Unprecedented? Hardly. Modest at best.
Nor is estradiol a new or complex drug; the patch formulation has existed for decades, and generic versions are widely manufactured. There is no exotic ingredient, no rare supply chain dependency, no fluke that explains why women are suddenly being told their pharmacy is out of stock month after month.
The story is far more an indictment of the broken insurance industry: market concentration, perverse incentives and the consequences of allowing insurance companies to own the pharmacy benefit managers that effectively control drug access for the majority of users. Three companies — CVS Caremark, Express Scripts and OptumRx — manage 79% of all prescription drug claims in the United States. Those companies are wholly owned subsidiaries of three insurance behemoths: CVS Health, Cigna and UnitedHealth Group, respectively. This means that the same corporation that sells you your insurance plan also decides which drugs get covered, at what price, and whether your pharmacy can stock them. This is called vertical integration. In another era, we might have called it a cartel. The resulting problems are not unique to hormone treatments; they have affected widely used medications including blood thinners, inhalers and antibiotics. When a low-cost generic such as estradiol — a medication with no blockbuster profit margins and no patent protection — runs into friction in this system, the friction is not random. It is structural. Every decision in that chain is filtered through the same corporate profit motive. And when the drug in question is an off-patent estradiol patch that has negligible profit margins because of generic competition but requires logistical investment to keep consistently in stock? The math on “how much does this company care about ensuring access” is not complicated.
Unfortunately, there is little financial incentive to ensure smooth, consistent access. There is, however, significant financial incentive to steer patients toward branded alternatives, or simply to let supply tighten — because the companies aren’t losing much profit if sales of that product dwindle. This is not a conspiracy theory: The Federal Trade Commission noted this dynamic in a report that documented how pharmacy benefit managers’ practices inflate costs, reduce competition and harm patient access, particularly for independent pharmacies and for generic drugs.
Any claim that the estradiol patch shortage is meaningfully caused by more women now demanding hormone treatments is a distraction. It is also misogyny, pure and simple, to imply that the solution to the shortage is for women’s health advocates to dial it down and for women to temper their expectations. The scarcity of estradiol patches is the outcome of a broken system refusing to provide adequate supply.
Meanwhile, there are a few strategies to cope.
- Ask your prescriber about alternatives. Estradiol is available in multiple formulations, including gel, spray, cream, oral tablet, vaginal ring and weekly transdermal patch, which is a different product from the twice-weekly patch and may be more consistently available depending on manufacturer and region.
- Consider an online pharmacy. Many are doing a good job locating and filling these prescriptions from outside the pharmacy benefit manager system.
- Call ahead. Patch shortages are inconsistent across regions and distributors. A call to pharmacies in your area, or a broader geographic radius if you’re able, can locate stock that your regular pharmacy doesn’t have.
- Consider a compounding pharmacy. These sources can sometimes meet needs when commercially manufactured products are inaccessible. The hormones used are the same FDA-regulated bulk ingredients.
Beyond those Band-Aid solutions, more Americans need to fight for systemic change. The FTC report exists because Congress asked for it and committed to legislation that will address at least some of the problems. The FDA took action to change the labeling on estrogen in the face of citizen and medical experts’ pressure; it should do more now to demand transparency from patch manufacturers.
Most importantly, it is on all of us to call out the cracks in the current system. Instead of repeating “there’s a patch shortage” or a “surge in demand,” say that a shockingly small minority of menopausal women still even get hormonal treatments prescribed at all, and three drug companies control the vast majority of claims in this country. Those are the real problems that need real solutions.
Jennifer Weiss-Wolf, the executive director of the Birnbaum Women’s Leadership Center at New York University School of Law, is the author of the forthcoming book “When in Menopause: A User’s Manual & Citizen’s Guide.” Suzanne Gilberg, an obstetrician and gynecologist in Los Angeles, is the author of “Menopause Bootcamp.”
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