What is RSV?
RSV is a virus, and is short for Respiratory Syncitial Virus. It causes a viral infection of the lungs, leading to the inflammation of the smallest lung airways. This is called bronchiolitis. RSV is commonly the cause of bronchiolitis in young children.
It affects both infants and older adults, namely RSV is an important cause of pneumonia in older adults. There is increased risk of RSV infection in older adults who are in regular contact with small children. Awareness of RSV in older adults is almost absent, which also includes adult physicians who rarely attempt to diagnose the disease. Every year about 3-6% of all older adults are infected with RSV. Course of disease is most severe on older adults with severe underlying disease such as heart failure or COPD. If these patients with severe underlying disease are hospitalized about 8% may even die. RSV infection can be diagnosed by PCR on respiratory swabs. There is no treatment or vaccination for RSV infection in older adults. Currently, there are several vaccines in clinical development with the purpose to prevent severe RSV infection in older adults.
However, primarily babies between 3-6 months of age are at risk due to their undeveloped lungs, which is why in the sections below the information will be targeted for babies.
What should I know about RSV?
- The RS virus is highly contagious.
- Babies, small children and elderly people are most at risk.
- RSV can cause upper respiratory infections (such as colds) and lower respiratory tract infections (such as bronchiolitis and pneumonia).
- You can be infected with RSV several times during your lifetime. After each RSV infection, your body becomes more immune to the virus, but you are never completely immune.
What are the symptoms of RSV?
The first symptoms a baby have are the same as a common cold and recover with ease.
However, if the condition worsens, the symptoms may include:
- Wheezing, rapid breathing, gasping for breath
- Bluish color around the mouth and fingernails
- Chest in-drawing with each breath and/or widening nostrils
Who is at an increased risk for RSV?
In their first year of life babies are at an increased risk of a severe RSV infection compared to older children or adults, because their bodies have not yet produced enough antibodies.
Research shows that 10% of all children visits a doctor because of an RSV infection. 1% of all children are hospitalised, of which 10% end up in ICU.
Healthy term babies are least at risk for severe RSV infection. Certain groups however, are at significant higher risk:
- premature babies (< 37 weeks gestation)
- infants with chronic lung diseases, such as broncho-pulmonary dysplasia or cystic
- infants with Down Syndrome
Furthermore, there are certain risk factors that – to a greater or lesser degree – play a role:
- month of birth (August-February);
- presence of older siblings;
- exposure of the baby to cigarette smoke;
- bottle feeding instead of breast feeding; eczema
- genetic predisposition to asthma, eczema of hay fever
- babies born right before or during RSV season
- older siblings that spend time at highly contagious places such as schools and child care centres, are often a source of infection for the new-born
Is there a treatment for RSV?
There is no specific treatment for children with RSV infection. Antibiotics do not treat RSV. Mild to moderate infections resolve without treatment and can be managed at home. However, close monitoring is important, especially in at-risk children (see Risk factors). Nasal suction may be useful in removing the mucus, especially before feeding the baby and nebulized hypertonic saline can be useful.
Currently, there is no treatment or vaccination against RSV. Only for infants considered at higher risk (extremely pre-term and/or with heart/lung conditions) there is a very costly therapy called Palivizumab, that has to be given monthly by injection during the RSV season lasting from October to March in temperate countries. In 2022 the EMA approved the promising remedy against RSV, it is called Nirsevimab. Nirsevimab requires one injection and works for three months.
Infants and children with a severe RSV infection may be admitted to a hospital.
Treatment may include:
- Oxygen supplementation
- Fluids through a nasogastric tube or a vein (by IV)
- Respiratory support with noninvasive/invasive positive pressure
What are the long-term consequences?
Even after the RSV infection itself has gone, a serious infection can cause health problems for a long period of time and have a significant impact on the quality of life of the child and its family. Severe RSV cases are associated with a greater risk of recurrent wheezing in pre-schoolers, and with asthma and impaired respiratory function in school-aged children.
What can I do to minimize the risk of severe RSV disease?
A RSV infection cannot be prevented.
Every child is infected before they reach the age of two. It is easy to catch the virus in places like waiting rooms or child-care centers. The virus easily spreads from one person to another, usually via airborne droplets containing the virus, produced when the person who is infected sneezes or coughs. RSV can survive on hard surfaces for many hours.
However, you can take preventive measures to reduce the chance of RSV infection in the first 3 to 6 months of a baby’s life by:
- Keep the baby away from people with a cold;
- Only touching the baby with washed hands;
- Not smoking near the baby;
- If possible, choose breast feeding over bottle feeding.