The 5 W's of RSV
WHO does RSV affect?
Respiratory syncytial virus (“RSV”) is one of the most common causes of cold in babies and toddlers—in fact, almost all children have likely had a case of RSV by the time they are 2 years old. Since reinfection with RSV is common, however, it truly can affect people at any age. Patients at highest risk of infection are infants in childcare settings. Patients at risk of more severe infection are infants <6 months of age, premature infants, infants exposed to second hand smoke, and patients of any age group (including adults!) with Down syndrome, immunocompromised, persistent asthma, or other cardiac or pulmonary disease.
WHAT does RSV look like?
For most patients RSV infection means typical upper respiratory symptoms such as congestion, runny nose, sneezing, and cough, +/- decrease in energy/appetite and fever. This type of infection generally lasts about a week. For some patients, however, it progresses to more serious lower respiratory tract symptoms, and is referred to as “RSV bronchiolitis.” Persistent fast breathing, wheezing, and increased work of breathing (e.g. chest wall muscle retractions, belly breathing, nasal flaring, and grunting) all are indicative of bronchiolitis. When RSV causes bronchiolitis, symptoms generally last longer, with the more severe breathing issues peaking about 3-5 days into illness, but the cough perhaps lingering for several weeks after the start of symptoms.
WHERE do I go for help?
Mild RSV infection does not require a visit to a clinician, but any concern for bronchiolitis should prompt an in-office visit so a clinician can perform a thorough exam. Preferably this is your friendly clinician at Annapolis Pediatrics, but if breathing concerns strike during off hours this means a trip to urgent care or the emergency room. The clinician will determine if any testing such as oxygen saturations, chest x-rays, or viral confirmatory testing is necessary. The clinician will also determine if any higher level of care is warranted, such as if the patient requires oxygen, or if any treatment options are available for home use. Because RSV is a viral infection, there is no curative treatment, but nasal suctioning, humidifiers, antipyretics and aggressive hydration are helpful. Medications like antibiotics and steroids are NOT helpful, unless there is a secondary bacterial ear infection or the viral illness is also provoking an asthma attack. Though RSV bronchiolitis can be very scary, only about 3% of children with RSV will require a hospital stay and usually will return home after 2-3 days.
WHEN does RSV occur?
Though historically thought to be a fall and winter illness, unseasonal RSV outbreaks have sporadically occurred since the start of the COVID pandemic, so RSV now seems to be able to strike at any time. It spreads like any other common-cold virus via direct person-to-person contact, unclean hands, or unclean objects/surfaces. The incubation period is about 2-8 days, and people infected with RSV are usually contagious for at least 3-8 days. As stated above reinfection is common, and can even occur in the same season.
WHY is there no vaccine to prevent RSV?
Great question, and things are always in development, but for now there is no vaccine available for prevention of RSV for use in humans. There is, however, a monoclonal antibody treatment called palivizumab (also known by the brand name Synagis) that can help reduce the risk of severe RSV infection in some high-risk infants—your pediatrician will let you know if your baby is a candidate. For now the best measures of prevention for most people are good hand hygiene, limiting exposures to large crowds or others that may be ill, getting all other routine vaccinations, and feeding babies breastmilk when possible.
RSV: When It's More Than Just a Cold
Respiratory Syncytial Virus Infection: Clinical features and diagnosis
Respiratory Syncytial Virus Infection: Prevention in infants and children