RSV stands for „Respiratory Syncytial Virus,” which is the major cause of respiratory illness in infants and children. It is a common virus, causing an infection of the lungs and respiratory tract, especially among children who get infected by the age of two.

Many healthy people exposed to the virus get only mild symptoms, but in young infants and people with weakened immune systems, it can cause severe infection. Even though RSV is a common cause of lower respiratory tract infections in babies and young children, the full spectrum of disease severity and clinical manifestation is not understood. In the United States each year, 100,000 infants younger than 1 year of age are hospitalized because of RSV. The CDC recommends that preventive measures be taken during peak season (October to May) when there are more infections spread.

 

Pathogenesis

RSV is usually confined to the respiratory tract and lymphocytic peribronchiolar infiltration. RSV replicates in the nasopharynx and then binds to the bronchiolar epithelium leading to the necrosis of the cell. Hypersecretion of the mucus occurs, and round cells infiltrate, causing edema in the surrounding submucosa. So, the lumina of the small airways become obstructed. Hyperinflation results from air trapping in the peripheral areas and atelectasis happens when the trapped air is absorbed. Interleukins, chemokines, and leukotrienes are released and lead to inflammation and tissue damage during and after the infection. The recovery of the epithelium starts in the first week of the illness but the ciliated cells do not recover until several weeks after.

 

Is RSV contagious? How and when does it spread?

When parents notice a dry cough, runny nose, and/or fever, they often do not think much of it and send their child to school. Since RSV is spread through direct contact, transmission at daycare or school is one of the most common causes. In rare cases where the preschool or school staff is infected, the virus can spread more quickly and in turn be more severe for children. The respiratory syncytial virus can spread in the following cases:

• An infected person coughs or sneezes, and you get infected droplets from a cough or sneeze in your mouth, nose, or eyes
• You touch an infected surface, like a doorknob or the elevator buttons, and then touch your face without washing your face
• You have direct contact with the virus, like kissing someone that has the virus

 

The RSV infection can usually be transmitted in the course of 3 to 8 days. However, people with a weak immune system and some infants can continue to spread the virus even after the symptoms stop showing, sometimes for as long as four weeks. Children are often exposed to this virus outside their homes, like in schools or in child-care centers. Afterward, they can continue to spread the virus to other members of their families.

The virus lives for a shorter amount of time on soft surfaces, like tissues and hands. RSV typically can survive for a longer period of time on hard surfaces such as tables or crib rails.

 

At what time of the year can you catch the virus?

RSV infections generally occur during the fall, winter, or spring.

Infection prevention techniques include:

• Washing your hands frequently.
• Avoiding exposure. Always cover your mouth or nose when you cough or sneeze. Avoid contact between your baby and people who have cold symptoms.
• Washing toys often.
• Stopping smoke. Babies that are exposed to cigarette smoke have a higher risk of getting RSV. If you do smoke, don’t do it in the house or in the car.
• Cleaning and disinfecting hard surfaces.
• Avoiding crowded places.
• Limit the time high-risk babies and young children stay in daycare, especially from late fall to early spring, when RSV is the most common.

 

Who is at Risk? 

The population at high risk of severe forms include:

• Premature babies
• Young children with a weakened immune system due to medical conditions or medical treatment - such as chronic lung disease or congenital heart disease, neuromuscular disorders, including ones who have difficulty swallowing or clearing mucus secretions
• Young children with congenital heart disease or chronic lung disease
• Adults with compromised immune systems
• Older adults, especially with medical conditions

 

RSV Symptoms

Symptoms of respiratory syncytial virus most commonly make their appearance about four to six days after being exposed to the virus. In older children and adults, RSV usually causes superficial, cold-like signs and symptoms. These mild symptoms include the following:

• Headache
• Sneezing
• Sore throat
• Low-grade fever
• Dry cough
• Congested or runny nose

 

In severe cases of RSV, the infection can spread to the lower respiratory tract, which causes bronchiolitis or pneumonia – the inflammation of small airway passages that enter the lungs. The symptoms are as follows:

• Fever
• Severe cough
• Wheezing – a high-pitched noise that can be heard when exhaling
• Difficulty breathing
• Bluish color of the skin due to the lack of oxygen in the body, also known as cyanosis

 

Symptoms of severe RSV infection in infants:

• Short, shallow breathing
• Severe cough
• Poor feeding
• Tiredness
• Irritability
• RSV symptoms appear in stages and not all at once. Premature infants or people with lung or heart diseases that have a severe or life-threatening form of RSV infection may usually require a hospital stay.

 

How you can make your child feel better at home? 

• Do not allow anybody to smoke anywhere near your child. This might complicate breathing.
• A cool mist vaporizer can help to soothe dry breathing passages. Hot-air vaporizers should be avoided since they can cause scald burns.
• Try to give your child plenty of fluids, such as breast milk or formula for infants (breast milk is known to contain antibodies that can help a baby better fight infections) and milk, natural juices, and water for older children.
• In case of fever, give your child medicine such as acetaminophen or ibuprofen, if older than 6 months. Never give your child aspirin since it could cause Reye’s syndrome, which makes the blood sugar level drop while the levels of ammonia and acidity rise.
• Use saline nasal drops to help loosen mucus in the nose.
• Blow or gently suction your child’s nose frequently.
• Make sure your child gets plenty of rest.
• Give all medications as instructed by your child’s healthcare provider.

 

How can you treat yourself at home?

Some home care remedies for dealing with RSV in adults that can help relieve symptoms and get them on the road to recovery are the following:

• Drinking lots of fluids to prevent dehydration.
• Getting plenty of rest – getting extra sleep at night and reducing your daily activities until you feel better can help make you feel better.
• Take over-the-counter medication for pain relief and to reduce fever (if needed). Always follow your doctor’s guidance on taking over-the-counter medicines, especially if you are taking other medication since drugs can interact with one another and they can cause dangerous effects.
• Use saline nasal drops or sprays to help loosen a stuffy nose.
• Cold mist humidifiers in the bedroom at night can be a huge help for dry or stuffy breathing passages.

 

Complications

Most children get an RSV infection by the time they are two years old. In some cases, RSV will cause a cold-like illness, but it can also cause severe conditions such as bronchiolitis or pneumonia.

Therefore, some children may even require hospitalization. In this case, oxygen, intubation, or mechanical ventilation might be needed. Most improve with this type of treatment and are usually discharged in a few days.

Common complications of the respiratory syncytial virus include:

• Hospitalization: A severe form of RSV may require a hospital stay so the doctors can monitor and treat breathing problems and also administer intravenous (IV) fluids.
• Pneumonia: This infection is one of the most common causes of inflammation of the lungs or the lung airways when it comes to infants. This happens when the virus spreads to the lower respiratory tract. Lung inflammation can be very dangerous for infants, older adults, immunocompromised individuals, or people with heart or lung disease.
• Middle ear infection: Middle ear infection is also known as otitis media, which occurs when germs enter the small space behind the eardrum. This happens more frequently in babies and young children.
• Asthma: There may be a connection between severe RSV infection in children and the chance of developing asthma.
• Repeated infections: Even though you had RSV, you can get infected again. It can even happen during the same RSV season. However, symptoms usually are not as severe as the first time.

 

When should you call the doctor?

Call your doctor if the next symptoms appear:

• High fever – above 100 degrees Fahrenheit or 37.5 degrees Celsius.
• Fever lasting more than two days.
• In case you notice grey or blue-tinted tongue, lips, or skin.
• Difficulty breathing.
• Cold symptoms that have become severe.

In young children, you should look out for:

• Extreme fussiness, decreased alertness
• Dehydration – less than one wet diaper every 8 hours, dry mouth, and crying without tears.
• Coughing continues day and night.
• Poor appetite.

Before your doctor's appointment, you should make a list of:

• Any signs or symptoms that you noticed and when they started.
• Key medical information, like heart or lung problems, or if your child was born prematurely.
• Details about child care, other locations where your family may have been exposed to respiratory infections, for example, crowded places.
• Consider asking your doctor the following questions:

1. What tests may be needed?
2. How long do symptoms usually last?
3. What treatment can be the most effective?
4. What medication is needed?
5. How to make my child feel better at home?
6. Do you have any brochures or printed materials that i can take a look at?
7. Should I isolate my child while infected?

Be very open to your doctor and do not hesitate to ask any additional you may think of during your appointment.

 

What to expect from your doctor?

Your doctor can ask you a number of questions like:

• When did you notice the first symptoms?
• Have you noticed something that seems to improve the symptoms?
• Have you noticed something that seems to worsen symptoms?
• Are the symptoms permanent or do they come and go?
• How bad are the symptoms you are experiencing?
• Is there anyone else in your family ill? What symptoms do they have?

 

How is RSV diagnosed?

Your doctor will ask for your or your child’s medical history and will analyze the signs and symptoms. The physical exam consists in listening to your or your child’s lungs and checking the level of oxygen in a simple finger monitoring test, called pulse oximetry. They may also order blood tests to check for any signs of infection, like a high white blood cell count, or take a swab from your nasal mucosa in order to test for viruses.

In case a more severe illness is suspected, your doctor will order imaging tests, such as X-rays or CT scans, to check the lung’s condition.

 

RSV treatment

Generally, there is no medication that treats the virus itself. So caring for someone with RSV infection involves treating the symptoms and how it affects their respiratory system.

In case the symptoms are mild, prescription treatment is usually not needed. The respiratory syncytial virus usually goes away on its own in one or two weeks, and only symptomatic treatment is required.

As a general rule, antibiotics must not be used to treat viral infections, but they could be prescribed if testing shows you or your child have also bacterial pneumonia or other infection caused by a bacteria.

Young children who develop bronchiolitis may need hospitalization to receive oxygen treatment. If your child is not able to drink liquids because of rapid breathing, they may need to receive intravenous fluids for hydration. In some rare cases, infected babies will require a respirator to help them breathe. Only about 3% of children with RSV infection require hospitalization. Usually, most children can go home after two or three days.

In older adults, especially with a weak immune system, a hospital stay may be needed in case of severe infection. While in the hospital, they can receive oxygen or be put on a ventilator – a breathing machine – to help them breathe or they may need IV fluids to help with hydration.

Pavlivimab (palivizumab) is a drug approved to prevent severe RSV infection in some infants and children that have a high risk for severe infection. This drug does not cure RSV, it is not used to treat kids who already have a severe infection and it can not prevent RSV. Pavlivimab is given as a monthly injection during the course of RSV season. Ask your doctor of this drug is appropriate to prevent RSV infection in your child or in the person you care for.

 

Other types of treatment

• Bronchodilators: treating RSV infection with inhaled bronchodilators such as albuterol and epinephrine can help relieve difficult breathing.
• Corticosteroids: a meta-analysis of steroids, such as PO, IM or IV dexamethasone, PO prednisolone, IM methylprednisolone and IV hydrocortisone, use in RSV infection found a shorter period of stay and duration of symptoms in children under two.
• Ribavirin: this drug is known to inhibit the replication of DNA and RNA viruses and can also help decrease long-term wheezing. It is very expensive and it is contraindicated in pregnancy.

 

Is there a cure for the respiratory syncytial virus?

Until the present, a cure has not been yet discovered. However, scientists and experts continue to learn about this virus and they are looking for ways to prevent the infection or to better manage severe illness.

 

Is there an RSV vaccine available yet?

Currently, there is no vaccine available to prevent RSV. Previous versions, like a formalin-inactivated vaccine, only led to more severe diseases in those exposed to the original disease. A live intravenous vaccine did not demonstrate efficacy and an attenuated vaccine showed no response or even caused symptomatic disease. A cold-adapted live vaccine is currently being evaluated by scientists, as well as a recombinant adenovirus base vaccine that expressed the G protein. Potential future vaccines may take into consideration other surface proteins for mechanisms of prevention.

Many questions remain when it comes to these newer agents, and the full release of data will assist with providing clinical efficacy information and evaluation of the cost-effectiveness of the available agents as they will come on the market.

 

If a person gets respiratory syncytial virus once, can they get it again?

People who catch certain viruses can build a specific immunity to that virus. This can mean that they will not get infected again for a certain period of time or even forever. However, for RSV, it is not the case. It is possible for a person or a child to get RSV infection more than once over their life and even more than once during a single RSV season.

The good thing is that repeated infections tend to be less severe than the first infection. In case you are an older adult (over 65 years old), an adult with a weak immune system or you have heart or lung problems, the RSV infection may be more serious if you get infected again.

 

Is RSV deadly?

Severe forms of RSV infection that lead to conditions like bronchiolitis or pneumonia can lead to death, especially if you have other problems like lung or heart diseases or a weak immune system.

RSV-associated UR death rate was among adults aged 65 years or older at 14.7 per 100 000 (95% CI, 13.8-15.5 per 100 000), followed by children younger than 1 year at 2.4 per 100 000 (95% CI, 2.3-2.5 per 100 000).

 

RSV and COVID-19

Since both respiratory syncytial virus and coronavirus disease 2019 are both types of respiratory viruses, some symptoms can be very similar.

In children, COVID-19 usually causes mild symptoms such as fever, runny nose, and cough. For adults, this virus can cause more severe symptoms and may even include trouble breathing.

Having RSV infection may weaken your immune system and increase the risk of getting COVID-19 (for kids and adults). These two infections may even occur together which can lead to more severe symptoms.

If you present symptoms of any respiratory illness, your doctor may recommend testing for COVID-19.

 

RSV and Influenza

RSV and influenza also share overlapping symptoms — such as cough, sore throat, fever, headache, fatigue, and runny nose — making it hard to distinguish one from another.

One key difference between the two is that the symptoms of influenza usually make their appearance suddenly. On the other hand, RSV symptoms appear more gradually — and often in phases. Also, like COVID-19, it is common for some people who suffer from influenza to have gastrointestinal discomfort, like diarrhea, nausea, or vomiting. These symptoms are not often seen in adults or children with RSV infections.

If your symptoms overlap with those of the flu, your healthcare provider can recommend that you or your child get tested for influenza. If you test positive for the flu, your healthcare team will be able to begin treating you with antiviral medication to help you recover more quickly.

 

Conclusion

RSV is a disease that affects millions of adults and children each year. Supportive care including nutrition, hydration, clearing of nasal secretions, and oxygen, if needed, is considered the best therapy for patients. Good hygiene and contact isolation are very helpful in the prevention of RSV transmission. Those at high risk, who meet inclusion criteria, should be administered palivizumab to prevent severe RSV symptoms. Ribavirin and palivizumab can also be utilized as a treatment in immunocompromised adults or children. Future vaccines could potentially decrease the economic burden of RSV in the healthcare setting.