Respiratory Syncytial Virus Infection – RSV Infection
The respiratory syncytial virus, commonly known as RSV, can cause lung infections. These infections are usually mild in healthy adults but can be serious in young children or in people with weak immune systems.
What is going on in the body?
RSV can cause infections in the nose, throat, windpipe, smaller airways called bronchioles, and the lungs. RSV infection typically causes mild, coldlike symptoms in adults and older children. In premature infants or children younger than 1 year, RSV can cause pneumonia or a lower airway infection called bronchiolitis. RSV can also cause pneumonia in people with weak immune systems, such as those receiving chemotherapy for cancer.
What are the causes and risks of the infection?
RSV is highly contagious and is spread from person to person. RSV is spread through contact with infected secretions from the eyes, nose, and mouth. These secretions are usually spread to the hands and then to objects that the contaminated hands touch. When a person touches these objects, he or she may acquire the infection.
Children younger than 1 year are most commonly affected. This is partially due to their tendency to place objects in their mouths. Children in day care centers are at a higher risk of infection than children who do not attend day care. RSV tends to occur in large outbreaks, called epidemics, which affect many children. RSV usually occurs between late fall and early spring, with most cases in the winter.
RSV is a particular risk for:
children younger than 1 year
children with serious heart disorders such as congenital heart disease
children with lung problems, such as cystic fibrosis, an inherited disorder causing the secretion of thick mucus in the airways
anyone with a weak immune system, or immunodeficiency disorder
adults with chronic lung problems, such as a chronic lung disorder called emphysema
Symptoms & Signs
What are the signs and symptoms of the infection?
The most common symptoms of RSV are those of the common cold:
These are often the only symptoms in healthy adults and children older than 1 year.
More severe symptoms can occur in the very young, the very old, people with chronic disease, and individuals with weak immune systems. These include:
difficulty breathing. In infants, this can often be recognized by fast breathing or wheezing, which is an abnormal sound made while breathing out. Abnormal chest movements during breathing or labored breathing are other clues. In serious cases, an infant may stop breathing, which is known as apnea.
redness of the eyes due to inflammation known as conjunctivitis
ear pain. An infant may be fussy or tug or pull on his or her ear to show ear pain.
cyanosis, a bluish tint to the skin, which occurs only in very severe cases
Diagnosis & Tests
How is the infection diagnosed?
Diagnosis starts with the history and physical exam. This may be all that is needed to make the diagnosis. Given the common symptoms, RSV is likely if the child is younger than 1 year, if it is winter, and if there is a current outbreak of RSV in the community. A chest X-ray may help with the diagnosis and rule out other causes for the symptoms.
If needed, a special test called an immune assay can be done on nose or lung secretions to detect RSV. This is commonly done when children are admitted to a hospital so that outbreaks within the hospital can be limited.
Prevention & Expectations
What can be done to prevent the infection?
Avoiding those who are sick may prevent some cases. Frequent hand washing may also help prevent some cases. Children in day care centers are more likely to acquire RSV infection because of the constant exposure to other children who may have the infection.
RSV is most common from late fall through early spring of each year. Children who have chronic disease, immune disorders, or a history of prematurity may have a monthly shot of palivizumab during RSV season to help prevent serious infection. This medication is made up of proteins that can prevent infection for a limited period of time. It is used only in children who are at high risk of having severe problems if they do get infected with RSV.
Most cases of RSV cannot be prevented. A routine vaccine may be available soon.
What are the long-term effects of the infection?
RSV accounts for as many as 125,000 hospitalizations of children under the age of one every year. Up to 2% of these children may die from the infection or its complications. If a person requires a ventilator to help with breathing, the severe infection as well as the ventilator can cause permanent damage to the lungs.
Most people, however, recover completely from RSV and have no long-term effects. Children who develop breathing problems because of RSV may have a slightly increased likelihood of developing asthma later in life.
What are the risks to others?
RSV is highly contagious. When an outbreak of RSV occurs, up to 50% of the infants in a community may be affected.
Treatment & Monitoring
What are the treatments for the infection?
Adults and older children with RSV usually do not need treatment. Over-the-counter medications to relieve symptoms can be used as needed. Infants with RSV or those with weak immune systems may be admitted to the hospital for monitoring and treatment.
Treatment for RSV often involves the use of humidified or moistened oxygen. Special medications, such as albuterol, can be mixed with the oxygen to help open the airways. Fluids can be given through an intravenous line (IV), a thin tube connected to a vein in the arm. In severe cases, antibiotics, usually a medication called ribavarin, may be given. In rare cases, a person may need to be connected to an ventilator.
What are the side effects of the treatments?
Most treatments for RSV have few side effects. Ribavarin is not given routinely for RSV infections. This is because it is often not effective and sometimes makes breathing worse. Ventilators can rarely cause lung damage or a new infection.
What happens after treatment for the infection?
Most people recover completely and return to normal activities as soon as they feel able. A person may still have the virus in his or her secretions for 1-2 weeks after symptoms go away. This is important to remember in terms of spreading the infection. Children in day care may be asked to stay home for a few days to prevent an outbreak.
How is the infection monitored?
Those with severe breathing difficulty need close monitoring in a hospital until the condition improves. For those at home with RSV, any new or worsening symptoms should be reported immediately to the healthcare provider.