Health Advisory: Pediatric RSV Surge in Washington State

Actions Requested

  • Be aware: The Washington State Department of Health released a Health Advisory Network (HAN) high-level alert regarding pediatric RSV surge. Read the HAN in the background section below.
  • Be aware: Respiratory virus circulation (influenza, RSV, COVID-19) is increasing in Kitsap County. Emergency department visits attributable to acute respiratory illnesses among patients younger than 18 are at the highest level since March 2020.
  • Communicate with patients about the pediatric RSV surge and appropriate levels of care. Consider using this letter template (Word document), which you can customize and put on your own provider letterhead.
  • Advise families to access the 24/7 nurse hotlines available through their insurance (some numbers are included in the resources section below). Hotlines are often listed on insurance cards.
  • Share patient education materials with families, such as the Bronchiolitis Care Packet PDF from Seattle Children’s Hospital and materials from the American Academy of Pediatrics website.
  • Proactively communicate with parents/caregivers of pediatric patients regarding when and where to seek care if ill with respiratory symptoms. Encourage all patients to be up to date on flu and COVID-19 vaccination.
  • Prevent vaccine-preventable diseases through timely vaccination.
  • Ensure your facility is exercising appropriate respiratory precautions in line with DOH recommendations, including masking of patients and staff regardless of vaccination status, appropriate cleaning, and policies that keep sick staff out of the workplace.
  • Sign up to receive our Respiratory Illness Report, which includes test data from Kitsap’s labs and hospital and hospital emergency room visit data. The report is released weekly during flu season (September through May).


WA Department of Health HAN 11/18/2022:

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory (11-04-2022 CDCHAN-00479) regarding an early surge in pediatric respiratory disease incidence caused by multiple viruses. With increased transmission and impacts on healthcare systems in Washington, this message is being sent to providers to share information and resources.

Pediatric capacity is now remarkably strained on the west side of Washington, with Pediatric ER & ICU crowding currently the most concerning trend.

  • Pediatric ER volumes remain at record high at pediatric specialty hospitals.
  • ER volumes at pediatric hospitals are 200%-300% of baseline capacity with record high ER wait times and waiting room volumes.
  • Significant increase in Influenza activity in western WA is compounding pediatric respiratory surge/capacity issues.
  • Several facilities report a worsening trend and record high levels of pediatric behavioral health patient boarding.

Current Washington State Awareness

DOH has convened the Health and Medical Multi-Agency Coordination Group including Local Health Jurisdictions (LHJs), Tribal Partners, Health Care Coalitions, Washington State Hospital Association, Health Care Providers, and other state agencies to coordinate strategies for mitigating pediatric RSV surge.

Washington Medical Coordination Center (WMCC) is activated and working closely with health care facilities on pediatric load balancing. This effort to be supported by Harborview Pediatric ICU team for triage assistance. WMCC is working with regional “non-pediatric” hospitals with pediatric capacity to manage and receive appropriate transfers in support of the region.

Information for Healthcare Providers

There are multiple viral respiratory diseases that impact children, circulating in the state. The University of Washington Virology Pacific Northwest Respiratory Viral Epidemiology Data show the steep incline in RSV positives over the past 6 weeks.

One public health strategy to mitigate pediatric surge is prevention of disease through vaccination for those diseases that are vaccine preventable.

Proactively communicate with parents/caregivers of pediatric patients regarding when and where to seek care if ill with respiratory symptoms and encourage all patients to be up to date on flu and COVID-19 vaccination.

The Washington State Childhood Vaccine Program (CVP) has plenty of pediatric flu vaccine available to order. Flu vaccine can be ordered at any time throughout the season and as frequently as needed. Please place your flu order in the IIS as you need it and ensure you have enough stock on hand by ordering again before you run out of supply. It can take up to a week to receive vaccine; order early if your supplies are running low.

To better prepare families for treating bronchiolitis at home, Seattle Children’s Hospital has developed a packet of information that providers can share with families as appropriate.

To reduce unnecessary emergency room visits, a template letter for providers to send to their patients about pediatric RSV surge has been developed for use by clinicians.

Adult flu vaccine is still available for purchase. If you need help finding vaccine, visit Influenza Vaccine Availability Tracking System — IVATS – National Adult and Influenza Immunization Summit.

Contacting the Health District

  • Call (360) 728-2235 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.
  • Fax (360) 813-1168.

Additional Resources

Apple Health and Premera Plans Nurse Line Phone Numbers: