RSV is a highly contagious virus that causes respiratory infections, particularly in young children. It is spread through contact with respiratory secretions or contaminated surfaces and objects, and the incubation period is between 2-8 days. Symptoms of RSV infection can range from mild, resembling the common cold, to severe, including difficulty breathing, wheezing, irritability, and poor appetite. RSV infections are most common from October to April and can lead to hospitalizations and, in some cases, death, particularly in infants, young children, and those with compromised immune systems or underlying medical conditions. There is no specific antiviral treatment for RSV infection, but in severe cases, ribavirin, a broad-spectrum antiviral medication, may be used. Vaccines for RSV are under development but are not currently available.
The Infection of Respiratory Syncytial Virus (RSV )
RSV infections can occur at any time of year but are most common during the fall and winter months. In the United States, RSV is estimated to be responsible for between 73,400 and 126,300 hospitalizations annually for bronchiolitis and pneumonia in children under one year of age. It is one of the most common viral causes of death in children under five years old, particularly in those under one year old. It is also a common cause of hospital-acquired infection. Children at the highest risk of severe RSV infections include:
- Infants born prematurely
- Term infants under six weeks old
- Children with medical conditions such as chronic lung disease, serious heart conditions, or problems with their immune system
- Immunocompromised adults (such as cancer and bone marrow transplant patients) and elderly patients in long-term care facilities are also at higher risk of severe RSV infections.
Diagnosis of RSV infection can be difficult based on signs and symptoms alone, as there are many viruses that can cause similar respiratory tract infections. Diagnostic tests on respiratory specimens can aid in the diagnosis of RSV, including viral culture, direct fluorescent antibody testing, and molecular methods like reverse transcription polymerase chain reaction (RT-PCR). Rapid antigen diagnostic tests can also be performed at the point of care to quickly identify infected patients.
Management of an RSV infection is generally focused on symptomatic therapy. When an RSV infection becomes more serious and progresses to bronchiolitis, patient management goals are to relieve respiratory distress, alleviate airway obstruction and improve oxygen levels. It is important to normalize body temperature and maintain proper hydration. Treatment with the use of bronchodilators and corticosteroids has not been shown to be effective in the management of bronchiolitis caused by RSV. In severe cases, hospitalization and management in the intensive care unit may be necessary. Supportive care such as oxygen therapy, mechanical ventilation, and respiratory support are the mainstays of treatment.
There is no vaccine available to prevent RSV infection. In some cases, the infection can be severe enough to require hospitalization. Palivizumab (Synagis) is a monoclonal antibody that is used as a preventive measure against severe RSV disease in high-risk infants and children. The medication is administered as a monthly injection during the RSV season.
Additional efforts should include:
- Encouraging good hand hygiene, such as washing hands frequently with soap and water or using hand sanitizer, to help prevent the spread of RSV
- Cleaning and disinfecting frequently touched surfaces, such as toys and doorknobs, to help prevent the spread of RSV
- Isolating infected individuals, especially those in high-risk groups, to help prevent the spread of RSV to others
- Avoiding close contact with individuals who are sick with RSV
- Seeking medical attention if you or a loved one is experiencing severe symptoms or difficulty breathing
- Getting vaccinated against influenza, as the flu can increase the risk of developing serious complications from RSV infection.
Most children recover from RSV infection within a few days to two weeks. However, RSV infection can be severe, particularly in premature infants and children with underlying medical conditions. In these cases, the prognosis may be poor. The death rate for RSV infection in premature infants can be as high as 30%. RSV infection can also lead to recurrent wheezing and the development of asthma.
Recommended Reading and Citations:
Collins P., Chanock R., Murphy B. Fields Virology. Fourth Edition. Volume 1. Chapter 45 – Respiratory Syncytial Virus. Lippincott Williams and Wilkins. (2001)
Thompson, W. et al. Mortality Associated With the Influenza and Respiratory Syncytial Virus in the United States. JAMA, January 8, 2003 – Vol 289, No. 2.
Respiratory Syncytial Virus (RSV). American Academy of Pediatrics http://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Respiratory-Syncytial-Virus-RSV.aspx