Health officials are warning of an early rise in cases of respiratory syncytial virus and influenza in Hawaii, similar to trends observed across the U.S.

An early October spike in RSV among younger children has reportedly been keeping hospitals busy in several regions of the nation, pushing some to near capacity in mainland cities.

Hawaii health officials are concerned that the concurrent rise of RSV, along with flu season, and the continuation of COVID-19 will pose a triple threat to the health care system this winter.

“Many respiratory viruses are circulating in our community, including RSV, COVID-19, and influenza,” said state Epidemiologist Dr. Sarah Kemble in a statement. “We urge all eligible individuals to get vaccinated against COVID-19 and influenza and take simple preventive measures that stop the spread of respiratory viruses.”

RSV is a common respiratory virus that usually causes mild, coldlike symptoms, according to the state Department of Health. Most children get an RSV infection by age 2. While RSV cases typically peak in November and December, Kemble said, they can occur year-round in Hawaii.

Symptoms include fever, cough, sore throat, sneezing and wheezing. For infants there may be irritability and decreased appetite.

While most people recover in a week or two, children under the age of 5, particularly younger infants, as well as older adults with underlying medical conditions, can become severely ill. Some in Hawaii have landed in the hospital, and some in intensive care, Kemble said.

Currently, approximately 1 in 4 tests for RSV in Hawaii are coming back positive, according to Caroline Pratt, DOH disease investigations branch chief, higher than this time in 2021.

“We are seeing a higher number of positives earlier than we usually do in the season,” said Pratt during a virtual news conference, “and this does suggest both a higher level of detected cases and probably undetected RSV infections in the community.”

At the same time, influenza activity in Hawaii is increasing, with 5.8% of 3,886 specimens in the one-week period of Oct. 16-22 coming back positive. During that same week, 6.4% of 14,927 COVID- 19 tests statewide were positive.

What can Hawaii residents do?

Getting vaccinated for COVID-19 and flu should be the top priority, said health officials, along with good hand-washing hygiene, staying home from school and work when sick so as not to spread the virus — and wearing masks.

“Masking still works,” said Pratt. “Just like it does for COVID, it works for other respiratory viruses as well, so that is still an effective prevention measure.”

There is no vaccine for RSV yet, but COVID-19 and flu vaccines are available for all Americans ages 6 months and older. The new bivalent booster targeting omicron subvariant BA.5 is available to Americans ages 5 and older if it has been at least two months since the final dose of their primary series or previous booster.

DOH said that in 2020 and 2021, RSV and flu cases declined sharply due to COVID-19 mitigation measures that also prevented the spread of these viruses. Since these measures were relaxed, however, RSV cases have been rising.

Kemble said DOH is concerned that illness from RSV may be a little more severe this year, and continues to monitor the situation.

Hawaii hospitals are able to manage the rise in cases, so far, although staffing shortages continue to pose a challenge statewide.

The Kapiolani Medical Center for Women & Children is not experiencing overcapacity like some mainland hospitals, according to Dr. Shilpa Patel, chief quality officer, in an earlier interview, and is prepared to increase staff and resources if necessary.

“We are monitoring the latest data, and the number of children admitted to Kapiolani with RSV has been declining week over week compared to the beginning of October,” said Hawaii Pacific Health in a statement. “Kapiolani continues to be able to provide care for our patients in Hawaii.”

HPH physicians, however, remind families to continue taking preventive measures — washing hands, not going out when sick, and cleaning high- contact areas — to help keep everyone healthy.

To find COVID-19 vaccinations and bivalent boosters, visit HawaiiCOVID19.com/vaccine.