Respiratory Syncytial Virus (RSV) is one of the most important causes of respiratory illness in children, especially those less than 1 year of age.  The illness occurs in yearly outbreaks (usually during Winter in the United States) and can cause respiratory distress and/or pneumonia in infants.  For most children and adults, RSV acts like a "bad cold," with symptoms including cough, fever, sore throat, runny nose and generally not feeling well.  Illness occurs about 4 days after exposure to respiratory droplets from a sick child - from a sneeze, cough, or dirty hands.  Symptoms typically last about 1 week but may last longer.  There is no specific medicine or vaccine available for RSV currently.  A sample of "snot" can be tested to confirm the diagnosis.

Where does the name RSV come from?

Respiratory syncytial virus.  The term "syncytial" is derived from the tendency for RSV-infected cells to clump together, forming one large cell called a "syncytia" ("syn" means "together" and "cyt" means "cell").

What causes RSV?

The respiratory syncytial virus (RSV) was discovered in 1956. 

Who gets RSV?

The virus is found world-wide and can affect infants, children and adults.  Infection is less common in infants less than 6 weeks of age (due to protection from mother's antibodies) but can be severe in any child less than 1 year of age.  Almost all children have had RSV at least once prior to 2 years of age.  RSV occurs in the Winter months in the United States and is very contagious.  When one child becomes sick in a family or daycare center, the others are likely to catch the illness also.  Reinfection with the virus is common.

What are the symptoms of RSV?

About 75% of infected infants will have a mild respiratory illness.  A small percentage of infants will develop complications such as pneumonia, bronchiolitis (inflammation of the smaall airways in the lungs), or breathing difficulty.

• Cough
• Fever (usually mild and sometimes not present)
• Sore throat
• Runny nose
• Generally not feeling well

Red Flags (seek medical care immediately)

• Severe or persistent symptoms
• Breathing difficulty or rapid breathing
• Inward movement of the chest with breathing (extreme effort during inhalation)
• Blue or pale appearance
• Premature babies and young infants with RSV
• Ill-appearing child
• Not drinking fluids or not keeping them down
• Decreased urine output
• Excessive sleepiness, confusion or unusual behavior
• Children with other chronic diseases (i.e., lung disease, heart disease)

How is RSV diagnosed?

 

The history provided by the patient is usually all that is needed.   Rapid tests for influenza, parainfluenza, RSV and adenovirus can be done.  If a sore throat is a predominant feature then a rapid test for Strep may be necessary.  Blood tests and a chest x-ray can help determine if a serious infection is present, although this is usually not necessary.

 

How is RSV treated?

 

Lots of fluids and rest.  For infants, saline drops can be placed in the nose and suctioned out with a bulb suction device. 

 

If breathing problems are present (especially in infants less than 1 year of age) then the child will likely need to be admitted to the hospital. 

 

Treatment for severe infection may include:

• Extra oxygen given with a nasal canula (or a breathing machine if necessary)
• Intravenous fluids
• "Breathing treatments" with racemic epinephrine
• Treatment for reactive airway disease or asthma (if present)
• Antibiotics (only if a bacterial infection is suspected)

Other medicines may be used to treat the symptoms:

• Fever & sore throat - ibuprophen and acetaminophen.  These medicines usually make the child feel better and reduce sore throat, making it easier for the child to drink lots of fluids.
• Nasal congestion or runny nose - decongestants (*see note below), antihistamines (like Benadryl) may help but they are usually avoided due to the sedation side effect
• Cough - cough medicines (*see note below)

*Note - cough and decongestant medicines are not recommended for infants and don't work well in children less than 2 years old.

Aspirin should NOT be used due to the risk of Reye syndrome.

What are the possible complications of RSV?

• Ear infection (otitis media)
• Pneumonia
• Chronic asthma, if present, may be worse long-term
• Some researchers believe RSV infection as an infant may increase the risk of developing asthma

Can RSV be prevented?

 

There is no vaccine available for RSV, but this is being researched.  The risk of developing RSV can be reduced by frequent hand washing, good hygiene, a healthy lifestyle and avoiding contact with infected children.  Premature and high-risk infants may be given antibodies to RSV with monthly shots (i.e., Synagis, a.k.a - palivizumab).

 

DrTummy's experience...

 

You can ask any pediatrician about RSV and they will have 100 stories to tell.  This virus is extremely common.  During "RSV season" pediatric hospitals are filled with infants and toddlers with this illness.  Most kids with RSV don't require an admission to the hospital and even among those that do, most recover without major intervention.  Some kids stay in the hospital for a week or more and some need intensive care.