Respiratory syncytial virus (RSV)

Answer 1

Definition

Respiratory syncytial virus (RSV) is a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. It can be more serious in young babies, especially to those in certain high-risk groups.

Alternative Names

RSV; Palivizumab; Respiratory Syncytial Virus Immune Globulin

Causes, incidence, and risk factors

RSV is the most common germ that causes lung and airway infections in infants and young children. Most infants have had this infection by age 2. Outbreaks of RSV infections most often begin in the fall and run into the spring.

RSV is spread easily by physical contact. Touching, kissing, and shaking hands with an infected person can spread RSV. The disease spreads from person to person through contact with contaminated tiny droplets or objects that the droplets have touched.

RSV can live for a half an hour or more on hands. The virus can also live for up to 5 hours on countertops and for several hours on used tissues. RSV often spreads very rapidly in crowded households and day care centers.

The infection can occur in people of all ages.

Risks include:

• Attending day care
• Being exposed to tobacco smoke
• Having school-aged siblings
• Living in crowded conditions

Symptoms

• Bluish skin color due to a lack of oxygen (cyanosis)
• Breathing difficulty or labored breathing
• Cough
• Croupy cough (often described as a "seal bark" cough)
• Fever
• Nasal flaring
• Rapid breathing(tachypnea)
• Shortness of breath
• Stuffy nose
• Wheezing

Note: Symptoms vary and differ with age. Infants under age 1 are most severely affected and often have the most trouble breathing. Older children usually have only mild, cold-like symptoms. Symptoms usually appear 4 - 6 days after coming in contact with the virus.

Signs and tests

Rapid tests for this virus can be done on a fluid sample taken from the nose at many hospitals and clinics.

Treatment

Antibiotics do not treat RSV. Mild infections go away without treatment. Infants and children with a severe RSV infection may be admitted to the hospital so they can receive oxygen, humidified air, and fluids by IV.

A breathing machine (ventilator) may be needed.

Expectations (prognosis)

RSV infection can, in rare cases, cause death in infants. However, this is unlikely if the child is seen by a health care provider early in the course of the illness.

More severe RSV disease may be seen in:

• Premature infants
• Infants with chronic lung disease
• Infants whose immune system does not work well
• Infants with certain forms of Heart disease

In older children and adults, the disease will usually be mild.

Some evidence suggests that children who have had RSV bronchiolitis are at increased risk for Asthma.

Complications

In young children, RSV can cause:

• Bronchiolitis
• Croup
• Ear infections
• Lung failure
• Pneumonia

Calling your health care provider

Call your health care provider if breathing difficulties or other symptoms of this disorder appear. Any breathing difficulties in an infant are an emergency. Seek medical attention right away.

Prevention

A simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It is important to make certain that other people, especially caregivers, take precautions to avoid giving RSV to your baby. The following simple steps can help protect your baby:

• Insist that others wash their hands with warm water and soap before touching your baby.
• Have others avoid contact with the baby if they have a cold or fever. If necessary, have them wear a mask.
• Be aware that kissing the baby can spread RSV infection.
• Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.
• Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness.

Parents of high-risk young infants should avoid crowds during outbreaks of RSV. Moderate-to-large outbreaks are often reported in the local news and newspapers to provide parents with an opportunity to avoid exposure.

The drug Synagis (palivizumab) is approved for the prevention of RSV disease in children younger than 24 months who are at high risk for serious RSV disease. Ask your doctor if your child is at high risk for RSV and whether this medicine should be given.

References

Committee on Infectious Diseases. Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics. 2009;124:1694-1701.

Simoes E, Groothuis JR, Carbonell-Estrany X, Rieger C, Mitchell I, Fredrick LM, Kimpen J, et al. Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. J Pediatr. 2007;151:34-42.

Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of bronchiolitis in infants less than 1 year of age presenting with a first time episode. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006 May. 13 p.

Mcintosh K. Respiratory syncytial virus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 257.

Answer 2

Definition

Respiratory syncytial virus (RSV) is a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. It can be more serious in young babies, especially to those in certain high-risk groups.

Alternative Names

RSV; Palivizumab; Respiratory syncytial virus immune globulin

Causes, incidence, and risk factors

RSV is the most common germ that causes lung and airway infections in infants and young children. Most infants have had this infection by age 2. Outbreaks of RSV infections most often begin in the fall and run into the spring.

The infection can occur in people of all ages. The virus spreads through tiny droplets that go into the air when a sick person blows their nose, coughs, or sneezes.

You can catch RSV if:

• A person with RSV sneezes, coughs, or blows their nose near you
• You touch, kiss, or shake hands with someone who is infected by the virus
• You touch your nose, eyes, or mouth after you have touched something contamined by the virus, such as a toy or doorknob.

RSV often spreads very rapidly in crowded households and day care centers. The virus can live for a half an hour or more on hands. The virus can also live for up to 5 hours on countertops and for several hours on used tissues.

The following increase the risk for RSV:

• Attending day care
• Being near tobacco smoke
• Having school-aged brothers or sisters
• Living in crowded conditions

Symptoms

Symptoms vary and differ with age. They usually appear 4 - 6 days after coming in contact with the virus.

Older children usually have only mild, cold-like symptoms, such as cough, stuffy nose, or low-grade fever.

Infants under age 1 may have more severe symptoms and often have the most trouble breathing.

In general, RSV symptoms include:

• Bluish skin color due to a lack of oxygen (cyanosis)
• Breathing difficulty or labored breathing
• Cough
• Croupy cough (often described as a "seal bark" cough)
• Fever
• Nasal flaring
• Rapid breathing(tachypnea)
• Shortness of breath
• Stuffy nose
• Wheezing

Signs and tests

Many hospitals and clinics can rapidly test for RSV using a sample of fluid taken from the nose with a cotton swab.

Treatment

Antibiotics do not treat RSV.

Mild infections go away without treatment.

Infants and children with a severe RSV infection may be admitted to the hospital . Treatment will include:

• Oxygen
• Moist (humidified) air
• Fluids through a vein (by IV)

A breathing machine (ventilator) may be needed.

Expectations (prognosis)

Rarely, RSV infection can cause death in infants. However, this is unlikely if the child is seen by a health care provider in the early stages of the disease .

More severe RSV disease may occur in the following infants:

• Premature infants
• Infants with chronic lung disease
• Infants whose immune system does not work well
• Infants with certain forms of heart disease

Complications

In young children, RSV can cause:

• Bronchiolitis
• Croup
• Ear infections
• Lung failure
• Pneumonia

Children who have had RSV bronchiolitis may be more likely to develop asthma.

Calling your health care provider

Call your health care provider if breathing difficulties or other symptoms of this disorder appear. Any breathing difficulties in an infant are an emergency. Seek medical attention right away.

Prevention

A simple way to help prevent RSV infection is to wash your hands often, especially before touching your baby. It is important to make certain that other people, especially caregivers, take steps to avoid giving RSV to your baby.

The following simple steps can help protect your baby from getting sick:

• Insist that others wash their hands with warm water and soap before touching your baby.
• Have others avoid contact with the baby if they have a cold or fever. If necessary, have them wear a mask.
• Be aware that kissing the baby can spread RSV infection.
• Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.
• Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk of RSV illness.

Parents of high-risk young infants should avoid crowds during outbreaks of RSV. Moderate-to-large outbreaks are often reported in the local news and newspapers to provide parents with an opportunity to avoid exposure.

The drug Synagis (palivizumab) is approved for the prevention of RSV disease in children younger than 24 months who are at high risk for serious RSV disease. Ask your doctor if your child should receive this medicine.

References

Committee on Infectious Diseases. Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics. 2009;124:1694-1701.

Respiratory Syncytial Virus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap158.

Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of bronchiolitis in infants less than 1 year of age presenting with a first time episode. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2006 May. 13 p.

Mcintosh K. Respiratory syncytial virus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 257.

Reviewed By

Review Date: 01/24/2011

Neil K. Kaneshiro, MD, MHA, Clinical Assistant Professor of Pediatrics, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.