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Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is a virus that causes infection of the lungs and breathing passages. It can infect the same person several times during a lifetime, causing more severe illnesses (like pneumonia) in infancy, but only a common cold in adulthood. RSV is very contagious and causes infection of the lungs and breathing passages. RSV can also affect the mouth, nose and throat. While RSV is most common in infants and young children, it can cause respiratory illness throughout life, especially among those with compromised respiratory, cardiac, or immune systems and the elderly.

After each RSV infection, the body forms some immunity to the virus, but that immunity is never complete. Re-infections occur, but they usually are less severe than earlier RSV attacks. RSV passes from person to person through infected nasal and oral fluids. It can enter the body when eyes or nose are touched.

Symptoms of RSV can be mild and include:

  • Cough
  • Stuffy or runny nose
  • Mild sore throat
  • Fever

Additional symptoms can include:

  • Decreased interest in surroundings.
  • Listlessness
  • Irritability
  • Poor appetite
  • Apnea

 

Who is affected by RSV?

Respiratory Syncytial Virus affects people of all ages but is the most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age. Illness begins most frequently with fever, runny nose, cough, and sometimes wheezing. During their first RSV infection, between 25% and 40% of infants and young children have signs or symptoms of bronchiolitis or pneumonia, and 0.5% to 2% require hospitalization. Most children recover from illness in 8 to 15 days.

Those at risk for severe RSV include:

  • The majority of children hospitalized for RSV infection are males under 6 months of age.
  • Crowding siblings in day care exposure.

RSV also causes repeated infections throughout life, usually associated with moderate-to-severe cold-like symptoms; however, severe lower respiratory tract disease may occur at any age, especially among the elderly or among those with compromised cardiac, pulmonary, or immune systems. In fact a recent study found that more than 78 percent of RSV-associated underlying respiratory and circulatory deaths occurred among people aged 65 and older.

 

When are you most susceptible?

RSV infections primarily occur during annual community outbreaks during the winter months.  The timing and severity of outbreaks in a community vary from year to year. RSV spreads rapidly among children during the outbreaks, and most children will have serologic evidence of RSV infection by 2 years of age.

For infants and children born prematurely (35 weeks gestation or less), RSV can cause very serious respiratory tract disease and even death.  Children born prematurely often have underdeveloped lungs and many have not received enough antibodies from their mother to help them fight off RSV disease once they have been exposed to it.  Premature children who are infected with RSV disease often need to be hospitalized.

Underlying conditions for risk:

  • Prematurity
  • Another underlying respiratory condition like cystic fibrosis
  • Congenital heart disease
  • Immunosuppressant

Call 911 or your doctor if:

  • Your baby is breathing very fast (>60x per minute)
  • Your baby is making grunting noises
  • Your child has the inability to speak, cry or make sounds
  • Flaming nostrils
  • Skin color that is gray molted or blue
  • Wheezing that last more than one hour in a baby
  • Wheezing that last more than one hour for an infant less than three months old.
  • Breathing stops for 15-20 seconds

 

Diagnosis and Treatment

Standard tests exist to diagnose RSV disease. For children with mild disease, no specific treatment is necessary other than the treatment of symptoms (e.g., acetaminophen to reduce fever). Children with severe disease may require oxygen therapy and sometimes mechanical ventilation. Ribavirin aerosol may be used in the treatment of some patients with severe disease. Some investigators have used a combination of immune globulin intravenous (IGIV) with high titers of neutralizing RSV antibody (RSV-IGIV) and ribavirin to treat patients with compromised immune systems.
Prevention

Development of an RSV vaccine is a high research priority, but none is yet available. Current prevention options include good infection-control practices. Frequent handwashing and not sharing items such as cups, glasses, and utensils with persons who have RSV illness should decrease the spread of virus to others. Excluding children with colds or other respiratory illnesses (without fever) who are well enough to attend child care or school settings will probably not decrease the transmission of RSV, since it is often spread in the early stages of illness.

The U.S. Food and Drug Administration has licensed products (RespiGam and Synagis) to prevent serious RSV disease in children under age two who have lung problems due to prematurity or bronchopulmonary dysplasia. Although both products must be given in five monthly doses, the newer product, Synagis, is given intramuscularly, and is more concentrated than RespiGam, an advantage since infants with certain pulmonary diseases may retain excess fluids.

 

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