While infection does contribute to the immune “library,” modern vaccines offer a safer, more reliable way to add to that protection without the risks of serious illness, hospitalization or long-term complications.

As flu activity increases across the U.S. this winter, experts emphasize that vaccines remain one of the strongest tools for maintaining health and preserving natural immunity over a lifetime.

Vaccine decisions start with informed conversations

“Vaccination is an individual decision, but the impact of the vaccine protects both the individual and their family cohort, work cohort. If they're in school, it can protect that community,” says Doug Kasper, MD, infectious disease specialist with OSF HealthCare. “We want people to be as educated as possible and make the best decision for themself. That's really going to come down to a discussion with them and their medical provider.”

For older generations who remember “just getting the measles,” today’s medical guidance recognizes that while infection can create immunity, it also carries significant risks – and vaccines provide a much safer pathway to the same immune protection.

How flu vaccines strengthen natural immunity

“Flu vaccines, historically, never match up perfectly to all the influenza strains that circulate in the community. What we do know is that immunity is cumulative; it's a library across a person's life and it has all of their prior infections and vaccines. It builds up over time,” Dr. Kasper says.

He explains that vaccines support and expand your natural immune memory.

“Receiving a seasonal flu vaccine, while the protection it may provide in any year may be different; over time there are benefits to doing this activity, so that you have a robust variety of immunity. As the seasonal infections change, you may be protected from something that happened in the past.”

This means vaccines don't replace natural immunity – they contribute to it, adding layers of defense that reduce the severity of illness and strengthen long-term protection.

Why vaccines remain a powerful community tool

Vaccines benefit individuals, but they also help stabilize the entire health system.

“When we talk about vaccination, we talk about it at a population level. We would like every individual to not get sick, but we also know that with hospitals, urgent cares and emergency departments, that we are trying to keep the system functional,” Dr. Kasper says. “We do that by getting as few people sick as possible, and vaccines are a very useful tool to help the individual help their community and help the medical system.”

A season of multiple circulating viruses

As families enter the stretch leading up to Christmas, flu activity is increasing on both coasts – often a preview of what will soon reach the Midwest.

COVID-19 continues to circulate year-round, RSV season is underway and Central Illinois is just beginning to see early influenza activity. Early surveillance suggests this year’s flu vaccine may not be a perfect match, but even imperfect vaccines help reduce severity, hospitalizations and complications. They also continue contributing to the “immune library” that protects people long-term.

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What is RSV and who’s at risk

“RSV is a virus, one of the most common viruses in the pediatric population. It usually attacks the upper airway and the lungs,” says Kelsey Grimes, DO, outpatient pediatrician with OSF HealthCare. “It leads to a lot of inflammation and excess secretions. Oftentimes we get a runny nose, stuffy nose and an increased work of breathing, also known as respiratory distress. That’s the part that usually leads to us seeing them in the office, or them going to the emergency department and being hospitalized.”

RSV is the leading cause of hospitalization among U.S. infants, with the Centers for Disease Control and Prevention estimating around 58,000 to 80,000 hospitalizations and 100 to 500 deaths each year in children under five. The virus can lead to severe illnesses like bronchiolitis and pneumonia.

Prevention tools now available

In the fall of 2023, two major preventive products became available in the U.S.:

• A maternal vaccine administered during pregnancy (given between 32-36 weeks’ gestation)
• A long-acting monoclonal antibody for infants (0-7 months old) and some children (8-19 months old) at higher risk
• While these preventive products do not stop RSV infection entirely, their goal is to drastically reduce the severity of symptoms.

These tools mark a major shift in RSV prevention, including the monoclonal antibody product known as Beyfortus (also referred to as nirsevimab). The American Academy of Pediatrics reports that nirsevimab is expected to reduce the risk of severe RSV disease by about 80%.

What the data show: Fewer hospitalizations

“There’s still RSV. But we have seen a drastic decrease in hospitalizations and ICU stays, which is usually when kids get the increased work of breathing and need oxygen and support. When they're really little, it's hard for them to suck, swallow and breathe because of all the mucus and inflammation,” Dr. Grimes adds. “So sometimes even if they aren't being admitted for oxygen, it's because they're dehydrated.”

Recent surveillance data underscore how significant that decrease is. An analysis of the 2024-25 RSV season – the first with widespread availability of both maternal vaccination and the infant antibody – found hospitalization rates among infants 0-7 months old fell by approximately 28% to 43% compared to 2018-20 (pre-pandemic) seasons.

For the youngest infants (0-2 months), the declines were even sharper, around 45% to 52%.

These data signal that many severe RSV cases in infants may now be preventable, a major public-health milestone.

Side effects and practical details

“Most common side effects are local redness, swelling and pain to the area. We aren’t seeing any systemic signs with this injection,” says Dr. Grimes. “Some other vaccines have an increased risk of fevers, but with this vaccine, we’re just seeing, potentially, some localized effect from where the needle went into the thigh.”

Additional supportive measures for babies with RSV symptoms include suctioning the nose, using humidifiers or steam from hot showers, nasal saline spray and watching for secondary bacterial infections.

General prevention: stay home when sick, cough into your elbow, wash and sanitize hands and avoid contact with others when appropriate.

Why this matters

Because infants are especially vulnerable, and because RSV has long been the top reason for hospitalization among U.S. babies, these preventive tools arrive at a critical moment. The Centers for Disease Control and Prevention (CDC) recommends that eligible infants receive protection as early in the RSV season as possible, ideally within the first week of life if born during RSV season.

Key takeaways for parents

• If you’re pregnant, especially in your third trimester, ask your provider about the maternal RSV vaccine.
• After your baby is born, if they’re under 8 months or have certain health conditions, ask about monoclonal antibody protection.
• Even with these tools, everyday precautions still help: hand hygiene, limiting exposure to sick contacts and monitoring for signs of worsening breathing or dehydration.
• Early treatment and care matter: If your baby is working harder to breathe, has decreased feeding, or seems dehydrated, seek medical attention promptly.

OSF OnCall, the digital arm of OSF HealthCare, offers virtual urgent care, a great option for people to be seen without ever stepping foot into an office. Virtual visits can allow your child to be seen and receive a treatment plan in less than half an hour. Additionally, OSF OnCall offers at-home monitoring for babies and toddlers with respiratory illnesses.

Difficulty breathing, or respiratory distress, is a medical emergency. If this happens with your child, take them to the nearest emergency department immediately.

Video Interview Clips

You’ve likely heard of bronchitis, an illness that impacts the larger lung airways and leaves you feeling short of breath and just generally yucky.

This fall and winter, here’s another respiratory illness with “bronch” in the name to be aware of, especially if you have young kids: bronchiolitis. It’s an ailment that Awad Alyami, MD, an OSF HealthCare pediatrician, sees often this time of year.

The basics

Dr. Alyami says bronchiolitis is an infection of the bronchioles, or the small airways that branch out in the lungs.

“When they become infected, there is a lot of mucus. It makes it harder to breathe,” Dr. Alyami explains.

Other symptoms include fever, runny nose, cough and dehydration. Bronchiolitis is “easily spread,” Dr. Alyami says, through respiratory droplets, like when you cough. The illness is most common in children, especially kids under two. Other high-risk groups include babies born prematurely, with chronic lung disease, with heart disease present at birth and with immune system deficiencies.

“There are also environmental risk factors, like babies who are exposed to smoke and babies who attend day care,” Dr. Alyami adds. Attending day care, he explains, will expose a child to illnesses, no matter how clean the place is.

Cause, diagnosis and treatment

Dr. Alyami says other viruses like influenza and COVID-19 can cause bronchiolitis, but respiratory syncytial virus (RSV) is the most common cause.

“You need to see a doctor if your baby has trouble breathing at any time,” Dr. Alyami advises. “Or if your baby is younger than three months and they have a fever. Or if they are older than three months and they have a fever for more than three days. Or if the child has signs of dehydration, like if they are making fewer wet diapers than normal.”

Unlike the flu and COVID-19, there is no test for bronchiolitis. But, a health care provider may swab your nose anyway to see if you have another virus. Other tests like a chest x-ray may be done. And the provider will also examine you and ask about your health history to come up with a diagnosis.

Treatment involves making you feel comfortable until symptoms resolve.

“One of the most important things is nose suction as needed,” Dr. Alyami says. “When we suction the nose and keep it clean, it’s easier to breathe.”

A bulb suction is the most common device to do this. When you’re really stuffed up, you can use nasal spray or drops to make the secretion thinner. Then, use the suction. You can also use a humidifier if your home’s air is dry. Dr. Alyami says these devices and medicines are widely available in retail stores.

You can treat the fever with over-the-counter medication. Drink fluids to stay hydrated.

“Typically, day three to day five are the peak of symptoms,” Dr. Alyami says. “After five days, they start to improve. Symptoms can last seven to 14 days. And typically, the cough lingers for a little longer.”

In serious cases, your child may have low oxygen and need to be admitted to the hospital. There, doctors will use an oxygen tube inserted into the nostrils to help breathing. In rare cases, a doctor will put a breathing tube down the child’s throat.

Prevention

Want your child to avoid all this? Preach healthy habits, especially in fall and winter when respiratory illnesses peak. Wash your hands thoroughly. Cough and sneeze into your elbow or a tissue. If you’re sick, stay away from others.

Dr. Alyami adds that since RSV is the main cause of bronchiolitis, you should look into the RSV vaccine. This cold weather season, the vaccine is available for certain groups, like older adults, infants and pregnant women. Talk to your primary care provider if you have questions.

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“It’s important for parents and caregivers to know the signs of labored breathing, also known as respiratory distress,” says Kelsey Grimes, DO, outpatient pediatrician at OSF HealthCare. “This understanding can help them know when it's time for their children to receive immediate medical attention.”

When to seek help

OSF HealthCare has multiple options to use if your child is in respiratory distress.

“During work-time hours, you can call your outpatient pediatrician's office, or primary care provider's office, and try to get a same-day appointment,” Dr. Grimes says. “In that, OSF also has a pediatric nurse triage line where a nurse can provide guidance or recommendations based on the symptoms you tell them. In the evenings, we have the pediatric after hours clinic (2806 Knoxville Ave. Peoria, Illinois), which is a good option.”

Additionally, OSF has multiple OSF OnCall Urgent Care and OSF PromptCare locations. But oftentimes if you're concerned about breathing for your child, the OSF HealthCare Children's Hospital of Illinois pediatric emergency department or calling 9-1-1 is the right first step.”

Why labored breathing happens

“If your child has labored breathing, oftentimes in the pediatric population, the most common cause is a viral infection. With viral infections you get a lot of inflammation, mucus, snot, phlegm – all of that,” Dr. Grimes says. “Kids' airways are smaller. So, inflammation, even on the mild side, makes those airways even smaller. Then when they're plugged up with mucus, or phlegm, they are going to really struggle to breathe.”

Children with significant breathing difficulty may need oxygen support to help them recover. This can be done using high-flow oxygen therapy (HFOT), which delivers air and oxygen down into their respiratory tract. In these cases, hospitalization is required.

At home, nasal saline and suction may be recommended, as well as controlling fevers with Tylenol or Motrin.

Rhinovirus, RSV (respiratory syncytial virus) and influenza, among other virus strains, are common culprits that can cause labored breathing. When treated properly, symptoms should begin to improve after three to four days. However, if symptoms worsen, it could indicate an underlying bacterial infection. This may require antibiotics or even hospitalization, depending on the child’s age and severity of illness.

Protecting kids from germs

“Regular hand hygiene and making sure when we touch surfaces (doorknobs, countertops, etc.) that we're not rubbing our eyes or mouth after,” Dr. Grimes says. “Don't share drinks or bites of food. Do anything you can do to try and prevent germ exposure. It’s hard, because a lot of these kids are in day care, preschool and kindergarten. So, there are no boundaries, and the kids are up close and personal there. You try your best for good hygiene, but in the end, they are probably going to be exposed.”

Signs of respiratory distress

Dr. Grimes says the most important thing to watch out for is how fast your child is breathing. Respiratory distress can cause a child to breathe much faster, or sometimes slower, than normal.

Retraction breathing, or the visible “sucking in” of the skin between or below the ribs, is another red flag.

“This happens because the muscle underlying the skin is really contracting, working hard to get that air in and back out,” Dr. Grimes explains.

Retraction breathing can happen under the rib cage (subcostal), between the ribs (intercostal), above the collarbones (supraclavicular) or at the base of the neck (tracheal tugging). Flaring nostrils are also a warning sign.

Other concerning symptoms include:

• Drooling in children who are past the teething stage
• Blue discoloration around the mouth
• Head bobbing with each breath (an emergency sign)
• Sitting forward and extending the neck in a “sniffing position” to ease breathing
• Wheezing when breathing out
• Grunting when exhaling
• Lethargic behavior (confused, drowsy)

Care and comfort at home

For viral infections, medical teams focus on supportive care, especially fever control.

For babies 2 months old or younger, any high or low temperature warrants an emergency department visit. Do not give Tylenol at this age.

Once babies are over 2 months old, Tylenol may be given in the appropriate dose based on weight, always under guidance from your pediatrician. Once over 6 months of age, babies can receive Motrin, as their kidneys are more developed. Both medications can be given every six hours as needed.

“When kids are having fevers, signs of labored breathing increase as well,” Dr. Grimes notes.

Hydration is also extremely important. “Really make sure to push fluids when your kids are sick. Hydration is key in recovery.”

Parents can help clear their child’s airway by using nasal saline followed by gentle suction. Humidifiers can help loosen mucus, and standing in a steamy bathroom with the shower running hot can offer short-term relief.

The bottom line

Labored breathing can be a sign of serious illness, and early action is the best protection. Parents and caregivers who recognize the warning signs and know when to call their pediatrician or seek emergency care, can help ensure their child receives timely, life-saving support.

Making sure your child receives the recommended childhood vaccines is another way to ensure your child is protected against respiratory illness.

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OSF On Call, the digital health arm of Peoria, Illinois-based OSF HealthCare has enrolled nearly 80 more babies and toddlers in a program to monitor at home, those with respiratory illness. The program provides support for patients with a pediatric respiratory virus. Enrollment offers a connection to OSF OnCall care teams 24/7 and monitoring tools that will aid in proactive response to worsening respiratory virus symptoms, keeping infants and toddlers out of the hospital.

September through January of this year, the program enrolled 966 children compared to 890 a year ago. This comes as the Illinois Department of Public Health (IDPH) announced that after a one-week dip, the state’s overall respiratory illness level has ticked up again from Moderate to High, driven by a notable increase in emergency department (ED) visits and hospital admissions for flu.

The program requires a referral from a medical provider and is for babies and toddlers 5 and under with a confirmed diagnosis. Referrals can be made by providers in a hospital emergency department, OSF OnCall Urgent Care, OSF PromptCare, medical offices, or following hospital discharge.

Mary Stapel, MD, lead physician for Community Care for OSF HealthCare Saint Francis Medical Center says RSV and other respiratory infections can often be managed at home.

“For the more common cold type symptoms, we can recommend the conservative treatments at home nasal saline with some suctioning, a cool mist humidifier you know, just kind of frequent, small feedings to optimize keeping that child hydrated.”

Clinical Digital Care Supervisor Rose Smith, RN, says OSF OnCall was able to implement its 24/7 digitally enabled, at-home support program for RSV so quickly two years ago because of its experience with similar monitoring to help patients with chronic conditions such as diabetes and heart failure. Smith says parents and caregivers have loved it.

“They love having support anytime in the day, however they want to do it – text message, phone call, anything. They can send us pictures. We've really kind of taken that to tailor what parents need to feel comfortable taking their children home, you know, from a clinic; from the hospital during the scary time.”

An OSF OnCall software application provides education and notifications to report relevant signs/symptoms over 10 days. Smith says upon enrollment, parents or guardians receive a care kit for at-home use from their provider following a visit or a digital community health worker can deliver one.

“So we have a pulse oximeter to monitor oxygen levels and their heart rate and then we have a thermometer, and we also provide saline spray, and then a bulb syringe. A lot of parents, when their babies are born, they use them in the hospital, but they might not know that they can use them to help relieve any secretions especially before feeding their children.”

Smith adds, it’s also important to clear the nose before a nap or bedtime. Parents also receive step-by-step written instructions as well as a video demonstration for how to use what’s provided in the kit.

Smith says parents who have a child in the program can request a video visit at any time. The OSF OnCall nurse will also recommend a video visit if needed.

“If they think their child looks off, we just have another set of eyes. The providers will look at it (to see if they need a higher level of care). Sometimes our nurses can tell the parents you know, ‘We think they need to be seen. Can we do a video visit just before you take your child out, especially now that it's colder out?’ You know, we don't want them if they're having trouble breathing to go outside, but we really just focus on what works best to still get them the care that they need.”

Dr. Stapel advises making sure you and everyone around you practices good hand hygiene, coughs into the inside of their elbow, and stays home from parties and other obligations if you are sick.

If you suspect your child has symptoms of RSV, the flu, or some other respiratory virus that don’t appear life-threatening, you can reach out to your pediatrician, primary care provider or OSF OnCall Urgent Care which also has a virtual visit option anytime.

Dr. Mary Stapel

Rose Smith

B-roll for OSF OnCall at-home pediatric respiratory monitoring