It’s that time of year again. It’s time for young and old alike to battle the usual winter sniffle and sneezes. It’s also time to be on the look out for an illness that mimics a simple cold, but one that can put your little ones in the hospital. It is Respiratory Syncytial Virus (RSV). It was discovered in 1955, but the burden of this infectious agent on all of the population is only now beginning to be fully appreciated.
WHAT IS RSV?
Respiratory syncytial virus (RSV) infection is a viral disease of the lungs. It is spread from respiratory secretions through close contact with infected persons or contact with contaminated surfaces or objects. It is one of the most important causes of lower respiratory tract illness in infants and young children. RSV affects nearly all babies by the age of 2. RSV has been traditionally thought of as a disease afflicting young children, but it is now recognized as a common cause of mild respiratory disease in adults. RSV can occur when infections material contacts eyes, mouth and nose and possibly through the inhalation of droplets generated by a cough or sneeze.
WHERE AND WHEN DOES RSV OCCUR?
RSV infections occur worldwide. Most children are infected at least once by age 2 and continue to be re-infected throughout life. In temperate climates, RSV infections usually occur in the winter. Peaks occur in January and February in the United States.
WHO IS AT RISK?
The National Center for Infectious Diseases and the Center for Disease Control recommend that during the RSV season, health care providers should consider RSV as a cause of acute respiratory disease in both children and adults.
RSV does not usually occur until a baby is 4 to 6 weeks old, but because premature babies are born before receiving all of the mother’s immunities, they are more susceptible. Babies can also be re-infected with the virus. Babies with chronic lung disease are also at increased risk of developing RSV.
THE SIGNS AND SYMPTOMS
RSV infections can range from very mild illness to serious lower respiratory tract infections, including pneumonia, which occurs mostly in the very young, the very old and those with weakened immune systems. Symptoms can last for a few days to several weeks.
Signs and symptoms in young children are usually mild and similar to a cold. They include stuffy nose, cough, and sometimes ear infection. In older children and adults, RSV causes upper respiratory infection involving the nose, throat, or sinuses. Other symptoms include apnea, listlessness, fever, poor feeding, wheezing, retractions (pulling in) of the chest wall and rapid breathing.
They symptoms of RSV may resemble other conditions or medical problems. Always consult a physician for proper diagnosis.
HOW IS RSV DIAGNOSED?
Due to RSV resembling other infections it is sometimes hard to diagnose. Clues that help in the diagnosis are illness in other family members, other babies in the hospital nursery or the time of year may provide clues. In addition to a complete medical history and physical examination a test of the respiratory secretions may show the presence of a virus.
RSV may be diagnosed by cell culture techniques or by the identification of viral antigen through rapid diagnosis techniques. Rapid diagnosis is important for the initiation of the proper infection control procedures and for possible antiviral chemotherapy. The diagnosis may be backed by serological tests but the results take an extended period of time to come in.
Although chest radiographs are rarely characteristic or necessary in diagnosing RSV infection, they have been used to determine the severity of the illness.
WHAT IS THE TREATMENT FOR RSV?
Most people with mild RSV infections usually get better without treatment. Those with more serious infections are sometimes treated in the hospital with the anti-virus drug Ribavirin. Specific treatment will be determined by the physician depending on age, overall health, medical history and tolerance for specific medications, procedures or therapies.
There are no medications used to treat the virus itself. Treatment involves treating the effects of the virus on the respiratory system. Antibiotics are not useful because a virus causes the illness.
Treatment may include supplemental oxygen, intravenous fluids (to prevent dehydration), tube feedings, bronchodilator medications (to open the airways), antiviral medications and prevention of RSV.
HOW IS RSV PREVENTED?
There is currently no RSV vaccine. The best ways to prevent the spread of RSV are to cover coughs and sneezes, wash hands often and thoroughly and dispose of used tissues properly.
Immune globulin intravenous (IGIV) treatment has recently been approved to prevent RSV infection in high-risk infants. Also RespiGam has been approved by the FDA for the prevention of RSV in children less than 24 months with a chronic lung disease called bronchopulmonary dysplasia or a history of premature birth. RespiGam is made from plasma of protective antibodies against RSV. These antibodies do not prevent RSV but they help protect against the most serious consequences of RSV.
Other means of protection for limited periods may be possible immunization of the mother before the birth of the infant or chemoprophylaxis of high-risk infants may be feasible. Prevention of the nosocomial spread of RSV is of most importance because many hospitalized infants have underlying conditions which make them susceptible to severe RSV infection.
Other prevention methods include procedures to isolate infected infants and assigning nursing personnel to care for either infected infants or uninfected infants but not both at the same time. Patient visits should be limited during epidemic periods.
Each year as many as 125,000 infants are hospitalized because of RSV complications, as many as 2% of these children will die. RSV is extremely contagious and if one of your children has it, assume the others will soon. Know what you can do to prevent RSV, and be familiar with the signs and symptoms.