Respiratory Syncytial Virus (RSV), also referred to as RSV bronchiolitis, is a common respiratory virus that can affect all ages of people. In older children and adults, the virus causes mostly upper respiratory symptoms similar to that of the common cold. In infants and adults with underlying medical problems, it can cause a serious infection in the lungs.
RSV can affect persons of any age but is most common in infants between 2 and 8 months old, and most children have been infected at least once during the first 2 years of age. Infants can also be re-infected with the virus. Infants who are born prematurely or with chronic lung disease are at an increased risk of developing a more severe form of the illness.
RSV is spread through respiratory secretions from close contact with infected persons or from contact with contaminated surface or objects. Infection can also occur when material containing the virus comes in contact with mucous membranes of the eyes, mouth, or nose, or by inhalation of droplets released from a sneeze or a cough. The incubation period (time from exposure to symptoms) is approximately four to six days.
The early stages of RSV in infants and children can often be mild, and present like a common cold. In children under the age of three, RSV can progress to the lower airways causing coughing and wheezing. Occasionally, the disease progresses to a severe form of respiratory disease requiring hospitalization with interventions to help the child breathe.
Signs and symptoms of respiratory syncytial virus depend on the severity of the disease. Mild disease present with:
- Congestion or runny nose
- Dry cough
- Low-grade fever
- Sore throat
The virus can spread to the lower respiratory tract, causing pneumonia or bronchiolitis, which is an inflammation of the small airway passages entering the lungs. The signs and symptoms of lower respiratory tract disease present with:
- Severe cough
- Wheezing, a high-pitched noise that’s most often noted when breathing out (exhaling)
- Rapid breathing or difficulty breathing, in which you note the child prefers to sit up, rather than lying down
- Cyanosis, or bluish color of the skin due to lack of oxygen
Infants are usually the most affected by the disease. You may notice retractions (chest muscles and skin pulling inward with each breath, which is often a sign that your infant is struggling to breathe. Signs and symptoms of more severe RSV infection in an infant may include:
- Short, shallow, rapid breathing
- Poor feeding
- Lethargy or unusual tiredness
- Irritability, or excessive fussiness
The respiratory syncytial virus is generally diagnosed by obtaining a complete history and physical, although a diagnosis can be difficult because the symptoms can resemble other infections. A test done by nasal swab or nasal wash of the child’s respiratory secretions may show the presence of the virus.
There are no medications used to treat the virus itself. The care of a child with RSV involves treating the effects of the virus on the respiratory system. Because the cause of the illness is viral, antibiotics are not useful. Treatment may include:
- Intravenous fluids to prevent dehydration, especially if feeding poorly
- Nebulizer treatments to open the airways
- Anti-viral medications for very sick or high-risk infants
The medication, Synagis (Palivizumab) can help protect children at high risk of serious complications of the disease. The medication is recommended for infants under the age of one who was born prematurely (before 29 weeks of gestation). It is not recommended for healthy premature infants born after 29 weeks of gestation.
Synagis is recommended for the following children:
- Infants born prematurely with chronic lung disease
- Certain infants under the age of 12 months old with congenital heart disease
- Infants and toddlers under the age of 2 who require at least one month of supplemental oxygen at birth, and continue to require lung-related treatments
- Children aged 2 and younger that may be immunocompromised
There is no vaccine available for RSV, but common-sense precautions can help prevent the spread of the virus. Use these precautions:
- Contacts with your children should wash their hands with warm soapy water before holding your child
- Avoid tobacco exposure, such as smoking, and avoid crowded areas like the mall, church, or gyms
- Vaccinate your child against Influenza starting at 6 months of age
- Wash toys regularly, especially if your child’s playmate is sick
Call your child’s doctor if your child has any of these symptoms:
- High fever and doesn’t look well
- Thick nasal discharge
- A cough that is worsening
- Signs of dehydration (poor oral intake, decreased wet diapers, or listless/lethargic)
- Trouble breathing, retractions, or wheezing
We don’t want to see your child in the emergency room, or even in your primary care provider’s office this winter with RSV. Although RSV can seem impossible to avoid, especially for families with children, it’s important for parents to know some steps they can take on their own to try and reduce their family’s risk of infection.