Respiratory Syncytial Virus Infection (RSV)

When It's More Than Just a Common Cold - Respiratory Tract Infection

Almost all children get RSV (Respiratory Syncytial Virus Infection) before they are 24 months of age. Most healthy children recover quickly without treatment. However, some children develop severe illnesses requiring hospitalization. In fact, about one out of every 10 infants hospitalized for respiratory tract infections has RSV infection. "Each year in the United States, an estimated 58,000-80,000 children younger than 5 years old are hospitalized due to RSV infection." (cdc.gov)

Most healthy children recover quickly without treatment. However, some children get very sick with RSV. If you think your child might have RSV, call your doctor right away. You may need to bring your child to the doctor's office for a complete diagnosis. Your doctor or healthcare provider will ask questions about your child's symptoms and medical history. The doctor may do blood tests and chest x-rays to check for problems.

Early Symptoms of RSV

The most common symptom of RSV is a runny nose. Other early signs of RSV infection include decreased appetite, cough, and trouble sleeping.

RSV symptoms in infants

Infants younger than six months are most likely to develop severe lower respiratory tract disease caused by Respiratory Syncytial Virus (RSV). Symptoms include coughing, wheezing, difficulty breathing, fever, and irritability. Most children recover within one week without treatment. However, some babies do not respond well to standard treatments and require hospitalization.

In older infants and toddlers, RSV causes upper respiratory illness such as colds and flu-like symptoms. Older children usually recover quickly without medical care.

RSV symptoms in babies

The most common cause of respiratory illness in children under 2 years old is Respiratory Syncytial Virus (RSV). This virus usually affects infants younger than one year old. Most people recover within about five to seven days without treatment. However, some babies develop severe cold symptoms such as wheezing, fast breathing, chest congestion, cough, and fever. These symptoms could lead to bronchiolitis and pneumonia.

If you notice your baby or Infant younger than six months is having trouble feeding and sleeping due to wheezing or struggling to breathe, it could mean something serious. But what exactly does it mean? And how do you know if your child needs help?

When to see a doctor: Here are some signs to watch out for:

• Wheezing - (a whistling sound heard with breathing)
• Labored breathing — the ribs seem to suck inward when the infant inhales. Their ribs pull in with each breath (retractions).
• You feel like your child cannot catch their breath.
• Breathing very fast — more than 60 breaths a minute (tachypnea)
• Your child is lethargic and struggles to talk, feed, or cry.
• Low-grade fevers
• Nasal congestion
• Sneezing
• chest congestion
• Cough, sore throat, and fatigue
• fever and irritability

If your baby has any of these symptoms, you should immediately see your baby's doctor or health care provider. Your doctor may ask questions about your health history, such as whether you had a cold recently. They may perform a physical examination, looking for signs of illness or bacterial infection. The doctor or healthcare provider can diagnose RSV by taking a fluid sample from the nose or throat with a nasopharyngeal swab (NP). A rapid test that detects monoclonal antibodies against the viral infection is available at many drugstores. If your child is having difficulty breathing, they may require albuterol nebulizer treatment, oxygen therapy, or a bronchoscopy.

What can I do to protect my infant?

The American Academy of Pediatrics (AAP) recommends that children who are at high risk for RSVP receive a monthly vaccine to protect them from contracting RSV. If your baby is at high risk for developing RSV, talk to his/her doctor about whether he/she needs to be vaccinated against RSV.

To prevent RSV, the AAP recommends that all babies, especially premature infants or preterm infants:

• Be breastfed
• Be protected from contact with smoke
• Not go to childcare with lots of children during their first winter season
• Not having contact with sick people
• Make sure that family members clean their hands or disinfect them using an alcohol-based product before and after they touch a baby who has RSV.

What can I do to protect my family?

Wash your hands often.

Washing your hands will help protect you from germs. Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.

Keep your hands off your face.

Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way.

Avoid close contact with sick people.

Avoid close contact, such as kissing, sharing cups, or eating utensils with people with cold-like symptoms.

Cover your coughs and sneezes.

Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward.

Clean and disinfect surfaces.

Clean and disinfect surfaces and objects that people frequently touch, such as toys, doorknobs, and mobile devices. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, droplets containing germs can land on surfaces and objects when they cough or sneeze.

Stay home when you are sick.

If possible, stay home from work, school, and public areas when you are sick. Staying home will help protect others from catching your severe illness.

Vaccines

There is currently no vaccine for RSV infection, but researchers are working hard to develop a vaccine. If you are concerned about your risk for RSV, talk to your healthcare provider.

Take steps to relieve symptoms.

There is no specific treatment for respiratory syncytial virus (RSV) infection. Treatment focuses on relieving symptoms and preventing complications through supportive care. Most infections go away on their own in a week or so. Fever, runny nose, sneezing, coughing, sore throat, and body aches are common symptoms. Over-the-counter medications such as ibuprofen (Advil, Motrin), acetaminophen (Tylenol), or naproxen (Aleve) can help relieve the fever and pain. Do not give aspirin to children because it could cause Reye syndrome. Children younger than 4 months old should not take cough medicines containing dextromethorphan (Robitussin) because it could cause serious side effects. They can quickly become dehydrated and stop breathing. Do not use prescription drugs unless directed by your doctor.

Things to avoid in Infants

• Avoid giving your baby aspirin, ibuprofen, or acetaminophen because they increase the risk of bleeding in the stomach.
• Avoid giving your baby cough medicines containing dextromethorphan (Robitussin)
• Don't smoke during pregnancy.

No medication treats the virus itself. Treating a baby who has been diagnosed with RSV requires treating the symptoms and how they affect your baby's respiratory tract.

Most infants and toddlers can be cared for at their parents' homes.

• To remove sticky nasal fluids from baby, use a bulb syringes and saline solution.
• To help baby breathe better, use a humidifier to create moisture in the air.
• Keep your baby hydrated by giving her small amounts of water throughout the day.
• Use non-aspirin fever reducers such as acetaminophen. Check the label and follow all directions carefully.

Babies who have a more severe infection may require hospitalization, which may involve the treatments listed below.

• Supplemental oxygen
• IV fluids
• Medications or mechanical ventilation procedures (intubation) to open their airways

Infection in Children: How is respiratory syncytial virus (RSV) spread?

RSV is easily spread from one child to another. You can get them from droplets in the air if someone sick coughs, sneezes, or talks. You can also get these infections from sharing toys, utensils, towels, or even playing with children.

RSV is one of the most common causes of bronchiolitis and pneumonia in babies under age 2. RSV is responsible for about half of all hospitalization cases for lower respiratory tract infections in children under 5 years old. Most people recover without treatment, but some develop serious complications such as wheezing and breathing problems.

The best way to prevent RSV is to avoid contact with infected people. If you are pregnant, make sure to keep your infant away from others during cold and flu season. Also, don't expose your infant to smoke or secondhand smoke. And remember, if you're caring for someone else's newborn, ask them how they want to handle RSV prevention.

RSV and Bronchiolitis

Bronchiolitis is a common childhood respiratory infection that causes inflammation of the small airways in the lungs. These airways are called bronchioles. When the bronchioles become swollen and inflamed, mucus builds up inside them. This makes breathing difficult because it blocks airflow into and out of the lungs, causing shortness of breath.

The most common cause of bronchiolitis is the respiratory syncytial virus (RSV), which is spread through coughing and sneezing. Children usually catch RSV during the cold season, especially around December and January. In rare instances, children can develop severe symptoms such as pneumonia.

"About 30% of children with bronchiolitis later do develop asthma. Also likely if they have bronchiolitis more than 2 times." (seattlechildrens.org)

RSV in Older Adults and Adults with Chronic Medical Conditions

RSV is one of the leading causes of intensive care unit (ICU) hospitalization among older adults and children under 5 years old. In fact, each year, it is estimated there are 60,000-120k cases of RSV infection in the United States, resulting in approximately 10,000 deaths. While most people recover completely, some develop serious complications such as pneumonia, bronchiolitis, and even death.

In addition to being contagious, RSV can cause serious illness in adults over 50. These individuals are at increased risk because their immune system becomes less effective with age. A weaker immune system makes them more susceptible to developing severe lower respiratory tract illnesses caused by RSV, which could lead to respiratory tract disease and even respiratory failure.

Adults who are at the highest risk for severe RSV infection include:

• Older adults, especially those 65 years and older
• Adults with chronic lung disease or chronic heart disease
• Immunocompromised adults or have weakened immune systems
• Adults with asthma, respiratory disease, or chronic obstructive pulmonary disease (COPD)
• Congestive heart failure or other cardiac disease
• Congenital Heart Disease
• Adults that have had severe bronchiolitis in the past
• Adults that have had viral pneumonia or bacterial pneumonia in the past

Resource

RSV in Older Adults and Adults with Chronic Medical Conditions. https://www.cdc.gov/rsv/high-risk/older-adults.html