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Respiratory syncytial virus (RSV)

Respiratory syncytial virus is a common respiratory pathogen (illness causing organism). It is so common that virtually every human is infected multiple times during his or her life. The vast majority of these people will be infected by the age of two. The effects of “RSV” (Respiratory Syncytial Virus) infection vary with age, medical history of the affected individual, as well as other unknown factors.

RSV Upper Respiratory Infection (“Cold”)

In older, otherwise healthy children, RSV illness is usually limited to cold symptoms and low grade fever. In infants and young children with underlying heart and lung illnesses, the illness may be more serious (see below).

RSV Bronchiolitis

Bronchiolitis is a descriptive termwhich refers to swelling in the smaller airways deep inside the chest. The resulting symptoms are similar to those seen in asthma. Frequent cough, wheeze, and low grade fever are common. Most concerning, however, is the limitation of air movement with breathing efforts which accompanies the inflammation of these smaller airways. The inflammation and spasm of the airways seems less responsive to medications usually used for asthma. In severe cases, hospitalization is necessary to provide supplemental oxygen and respiratory support.

RSV pneumonia

RSV induced apnea

Apnea is the cessation of breathing for at least 20 seconds or until symptoms appear. The mechanism by which the Respiratory Syncytial virus, as well as some other viruses, cause apnea is not known. The risk is highest in the younger infants, especially those under six months of age. The likelihood of apnea does not correlate well with the severity of any wheezing that may be present, making this illness especially frightening.

The apnea may respond to stimulation of the infant; however, any infant who seems to take extended pauses between respirations (even if less than 20 seconds) should be taken to the hospital immediately by ambulance.

There is some evidence that theophylline may relieve the apnea; however, most cases will require intubation and mechanical ventilation (the help of a breathing machine) until the illness resolves.

Prevention is key:

  • Keep all toddlers away from your newbornKeep away all older individuals who have cold symptoms Both father and mother should avoid people who have respiratory illnesses, even if they are out in public without the newborn–this helps reduce bringing the virus into the houseGood, frequent hand-washing is essential.

RSV sepsis syndrome

  • Septic shock (overwhelming infection resulting in inadequate blood flow) is a rare consequence of RSV infection, generally occurring in newborns and young infants only. Treatment requires hospitalization and circulatory support which may require intensive care level of treatment.

RSV Prevention

  • Avoidance: Avoidance is the most effective method of preventing RSV illness. No matter how hard you try, your child will most likely be infected by two years of age. Thus, the realistic goal is to prevent infection in the first 3 to 6 months of life (or even later–the later the better) when the illness is more severe. Nevertheless, practicing avoidance throughout one’s lifetime can limit the number of episodes because, unlike some other childhood illnesses, there is no permanent immunity to RSV (i.e. you can get it many times). Rule number one is to keep yourself healthy and free of RSV; parents are one of the most common sources of infected newborns.
  • If possible, delay daycare entry. If not possible, choose a daycare with fewer children and with strict rules regarding staying home in the event of illness.
  • Avoid unnecessary contact with people with cold symptoms
  • Frequent hand-washing; an absolute before meals, but helpful throughout the day.
  • Consider carrying cleansing pads for the fomites you may contact in public places. Fomites are inanimate objects or surfaces upon which bacteria and viruses may survive for short periods of time (e.g. shopping cart handles, elevator buttons, door knobs, stairway railings etc.). Alternatively, carry a handkerchief to use solely for contact with these surfaces, push elevator buttons with keys or a pen.
  • Turn away from those who are coughing or sneezing when in crowded public places. Airborne respiratory droplets may travel 6 to 8 feet.

Immunization

Synagis is the trademark name of palivizumab–a synthetic (non-human) anti-RSV immunoglobulin which is injected intramuscularly. (Synagis replaces “Respigam”, an intravenous form used in previous years.) Synagis is “passive immunization”–meaning that it does not stimulate the immune system of the children who receive it to fight off the virus, but rather provides actual antibodies to directly fight the virus. Because it is not made from human volunteers, the low risk of viral infection accompanying the use of human blood products does not apply here.

  • Immunization is currently only recommended for certain susceptible individuals:
  • 1) Infants who were born prematurely (less than or equal to 35 weeks gestation, and who are less than 6 months old at the start of RSV season.
  • 2) Children less than 2 years of age at the start of RSV season with BPD ( bronchopulmonary+dysplasia).

Treatment

  • Ribavirin is a specific anti-viral agent that exists to combat RSV illness in the already infected individual. However, some controversy exists regarding its use. Currently, it is reserved only for those with severe illness, especially those with underlying heart or lung disease.
  • Most often, treatment is supportive care, care that provides just what the body needs in any particular case. It can be as simple as prn (as needed) over the counter “cold medications.” Sometimes, oral or nebulized bronchodilator (airway-opening) medications are given to improve breathing in those with bronchiolitis. Severe cases may require hospitalization, supplemental oxygen, or even an intensive care setting complete with the use of breathing machines, as necessary.