Respiratory Syncytial Virus (RSV) Infection

There is no treatment for an RSV infection.

• Respiratory syncytial virus (RSV) is a common viral infection that can cause colds, bronchiolitis, and pneumonia.
• Most children will get RSV infection by the time they are 2 years old.
• RSV is highly contagious and easily spreads from person to person.
• The respiratory syncytial virus can also survive on hard objects or surfaces such as countertops, doorknobs, or tables, which become contaminated by an infected person coughing, sneezing, or even breathing on them. When someone touches a contaminated object or surface and then touches his or her eyes, mouth, or nose without washing his or her hands, the infection can spread. RSV also spreads from infants to adults if an adult kisses an infected child on the face.
• Signs and symptoms of RSV include runny or stuffy nose, decreased appetite, cough, sneezing, fever, wheezing, sore throat, and earache.
• There is no specific treatment for RSV. In mild to moderate infections, home care is usually all that is needed.
• Home remedies to help relieve symptoms of RSV include drinking plenty of fluids, using a humidifier, saline nasal drops, rest, and over-the-counter pain relievers.
• The prognosis for RSV is good. Most people fully recover within 2-8 days.
• Complications of RSV infection include pneumonia, bronchiolitis, croup, and ear infections.
• Respiratory syncytial virus can be prevented with the usual proper hand washing hygiene followed to prevent the common cold.

RSV is a common cause of respiratory tract infections in infants and young children. Most children will get RSV infection by their second birthday because it's so prevalent and easily spread. In otherwise healthy children, the virus will usually cause a cold.

In the United States, RSV often occurs in outbreaks during the late fall, winter, and early spring.

A virus that invades the respiratory tract (airway) causes RSV infections.

Risk factors for contracting respiratory syncytial virus include:

• infants and children who are in daycare or frequent public places such as parks,
• having older siblings who become infected and spread the virus to younger siblings,
• sharing food contaminated with the virus,
• touching objects that are contaminated and not washing hands before touching your face,
• older adults living in nursing homes or other group settings,
• smoking or exposure to secondhand smoke,
• patients with Down syndrome, and
• living at an altitude greater than 8,200 feet.

Risk factors for getting a severe infection with RSV include:

• premature infants born before 35 weeks,
• infants 8-10 weeks and younger,
• children under 2 years of age born with heart or lung disease,
• babies and young children with weakened immune systems due to illness or medical treatment,
• infants and children with underlying lung disease or congenital heart disease,
• patients with asthma, and
• older adults with chronic lung disease or functional disability.

Respiratory syncytial virus is highly contagious and is spread from person to person. When someone with the virus coughs, sneezes, or even talks, the virus present in their saliva droplets or mucus spreads.

An individual can catch RSV by close contact with an infected person, and because the virus can live on hard surfaces or objects (such as doorknobs, countertops, or tabletops), an infection can happen when someone touches an object contaminated by an infected person and then touches his or her mouth, nose, or eyes without first washing his or her hands. Transmission of RSV can also happen if an adult kisses an infected child on the face.

New research has also found RSV may be transmitted from a pregnant mother to the fetus. The virus appears to be able to spread from the respiratory tract of the mother across the placenta into the lungs and bronchioles of the fetus. RSV may be present in the lungs after birth and could be responsible for some cases of asthma.

People with RSV are usually contagious for 3-8 days.

An incubation period refers to how long it takes from when someone is first exposed to RSV until symptoms appear. The incubation period for RSV is 2-8 days, but the illness usually begins 4-6 days after exposure to the virus.

Signs and symptoms of RSV include a respiratory illness with cold-like symptoms such as:

• runny or stuffy nose,
• decreased appetite,
• cough,
• sneezing,
• low-grade fever,
• wheezing,
• sore throat, and
• earache.

Infants may have different or additional symptoms, including:

• irritability,
• decreased activity,
• sleepiness,
• breathing difficulties (apnea), and
• poor feeding.

It is also possible for a child to have RSV without a fever, as well.

For most otherwise healthy children who have symptoms of an upper respiratory tract infection (cough, runny or stuffy nose), home care is usually sufficient as RSV infection is typically not life-threatening. If your child has any risk factors for a more severe infection, or if symptoms worsen, see a doctor.

Contact your child's pediatrician if your child shows any of the following symptoms:

• Difficulty breathing
• Fever above 101 F
• Coughing up yellow, green, or gray phlegm (mucus)
• Has cold symptoms that become severe
• Lacks appetite
• Dehydration (lack of tears when crying, dry mouth, little or no urine in the diaper for six hours, cool, dry skin)

Go to a hospital emergency department or call 911 if your baby is lethargic, has trouble breathing, is breathing very rapidly, or has a blue tint to the lips or fingernails.

Medical professionals who can diagnose and treat RSV disease include primary care providers such as a child's pediatrician, a family practitioner or general practitioner, infectious disease doctors, or an emergency medicine specialist.

A history and physical to evaluate symptoms may be all that is done when respiratory syncytial virus is suspected.

If a patient has symptoms of a common cold, there is usually no testing that needs to be done. In people with a higher risk for severe infection, a viral detection test may be ordered to make a diagnosis. This is a lab test that analyzes nasal drainage and can help determine if RSV is present to take steps to prevent the spread of the virus. If RSV symptoms worsen or if complications such as pneumonia or bronchiolitis are suspected, tests may be performed, including:

• chest X-ray to check for pneumonia,
• blood tests, and
• oximetry (measurement of blood oxygen levels via a device placed on the patient's finger).

There is no specific treatment for respiratory syncytial virus (RSV) disease. In mild to moderate infections, home care is usually all that is needed and medications are not usually prescribed.

Because RSV is a virus, antibiotics are not usually needed. However, if a secondary bacterial infection (such as pneumonia) develops, antibiotics may be prescribed.

In severe cases, infants or children who develop RSV bronchiolitis may need to be hospitalized. Treatment may include supplemental oxygen, suctioning of mucus, and IV fluids to prevent dehydration. Elderly adults with compromised immune systems may require similar treatment. Newly revised recommendations do not endorse the use of ribavirin breathing treatments to help limit wheezing.

In premature infants and infants with chronic lung disease, preventive treatment of a neutralizing antibody to RSV called palivizumab (Synagis) may be given to reduce the risk of severe illness. Palivizumab does not treat RSV but helps prevent infection by this virus.

Home remedies that help relieve the symptoms of RSV include the following:

• Drink plenty of fluids (in infants, make sure they are breastfeeding or bottle feeding)
• Use a humidifier to keep air moist.
• Saline nasal drops help keep nasal passages lubricated.
• Elevate the head the bed to help nasal secretions drain.
• Use over-the-counter pain reliever medications such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin). Ibuprofen should not be used by children less than 6 months of age. Do not give children or teenagers aspirin as it could cause Reye syndrome.
• Make children get plenty of rest.
• Keep children away from secondhand smoke.

There is currently no vaccine to prevent RSV.

Respiratory syncytial virus can be prevented with the usual proper hygiene that is followed to prevent the common cold. If one has symptoms of RSV or a cold, it's possible to help prevent its spread to others by doing the following:

• Wash hands frequently (wash with soap and water for 20 seconds).
• Cover the mouth when coughing or sneezing.
• Do not share food, dishes, or utensils with others.
• Parents of children at high risk for severe infection with RSV should take precautions to protect their children from the virus.
  • Do not interact with children at high risk if you have a cold.
  • Refrain from kissing children at high risk while you have symptoms.
  • Limit the time high-risk children spend at daycare or other public settings during RSV season.

Premature infants and infants with chronic lung disease who are at high risk of severe infection from RSV may be given a preventive treatment of a neutralizing antibody to RSV called palivizumab (Synagis) to reduce the risk of severe illness.

The prognosis for respiratory syncytial virus (RSV) is good. Nearly all children are infected with RSV by the time they are 2 years old, and most of the time symptoms will resolve within 2-8 days. Even in children with severe infection who need to be hospitalized, the hospital stay is usually brief and full recovery occurs within 1-2 weeks. RSV infection may reoccur later in life but is generally mild and often hard to distinguish from a cold.

RSV can cause worsening symptoms in children with chronic breathing conditions, and children with congenital heart disease may have more severe symptoms. Complications of RSV include pneumonia, bronchiolitis, croup, and ear infections. In rare and severe cases, RSV may result in lung failure.

Centers for Disease Control and Prevention, Respiratory Syncytial Virus (RSV)

American Academy of Pediatrics, Respiratory Syncytial Virus (RSV)