Respiratory syncytial virus infections
Respiratory syncytial virus (RSV) is a highly contagious virus that primarily causes infections of the respiratory system, such as the common cold, bronchitis, bronchiolitis, pneumonia, and croup. While RSV can affect individuals at any age, it poses the greatest risk to infants, young children, and the elderly, leading to severe respiratory issues and, in some cases, death. The virus spreads through respiratory droplets and can survive on surfaces for extended periods, making it easy to transmit. Symptoms often vary by age; young children may experience serious conditions like bronchiolitis, while older children and adults typically exhibit milder cold-like symptoms.
Annual outbreaks of RSV typically occur from late fall to early spring, and recent years have seen increased hospitalizations due to the virus, particularly among children. Prevention strategies include practicing good hygiene, such as frequent hand washing, avoiding face touching, and not sharing personal items. For high-risk infants, a monoclonal antibody treatment can help reduce the severity of RSV infections. Overall, while most individuals recover from RSV without serious complications, the virus can lead to significant health challenges, especially for vulnerable populations.
Respiratory syncytial virus infections
Definition
Respiratory syncytial virus (RSV) is a common cause of many types of infections of the human respiratory system (lungs and breathing passages), including the common cold, bronchitis, bronchiolitis, pneumonia, and croup. Although these infections can happen at any age, they occur most commonly and are usually most severe in infants, young children, and the elderly. In severe cases, RSV infections can cause death.
Causes
RSV is spread through infected fluids of the mouth and nose. The contagious virus most often enters the body from touching the mouth, nose, or eyes. It can also be spread by inhaling droplets from a sneeze or cough.
RSV can survive on surfaces and objects for hours and is easily passed from person to person. Virus shedding (contagiousness) usually lasts for three to eight days, but may last up to four weeks.
Risk Factors
Infants and young children, especially those under two years of age, and older adults are at higher risk for RSV. Risk factors include exposure to a person infected with the virus or an object contaminated with the virus; premature birth; problems with the heart, lungs, or immune system; present or recent treatment with chemotherapy; having had an organ or bone marrow transplant; and having problems associated with muscle weakness.
RSV infections occur most often in annual epidemics that last from late fall to early spring. In most cases, the infection is not severe; almost all children contract the virus by two years of age, and for most it simply presents as a cold. However, one should not discount the dangers posed by the virus. According to the Centers for Disease Control and Prevention (CDC), in the United States alone, an estimated 58,000–80,000 children under the age of five are hospitalized due to RSV infection each year, as are an estimated 60,000–120,000 adults sixty-five years and older. An estimated 6,000–10,000 of cases in adults sixty-five years and older result in death.
In 2022, the United States reported a particularly strong surge of RSV cases and severity among children, with many hospitals reporting that their pediatric units were at capacity as a result of the virus. Medical experts connected the spike at least in part to the social distancing measures adopted during the COVID-19 pandemic that began in 2020, which prevented many children from developing a natural immunity to RSV that usually occurs through repeated exposure.
Symptoms
The symptoms of RSV infection vary and usually differ with age and previous exposure to RSV. Young children, the elderly, and people with chronic diseases are more likely to have severe symptoms. In children younger than age three, RSV can cause illnesses such as bronchiolitis and pneumonia. Symptoms may include stuffy or runny nose, high fever, severe cough, wheezing, shortness of breath, very fast rate of breathing, bluish color of the lips or fingernails, lethargy or irritability, lack of appetite, and discharge from the eyes.
In children older than three and in healthy adults, RSV typically causes an upper respiratory infection or cold. Symptoms commonly include a runny or stuffy nose, sore throat, mild cough, headache, low-grade fever, and discharge from the eyes.
Screening and Diagnosis
A doctor will ask about symptoms and medical history and will perform a physical exam. A variety of tests are available to diagnose RSV. Chest x-rays may be used to check for telltale signs of bronchiolitis, while blood tests may be conducted to check white blood cell counts or to determine if any antigens are present. Other lab tests called antigen detection assays are commonly done using secretions from the nose.
Treatment and Therapy
Mild infections such as colds do not need special treatment. The goal of any treatment is to ease symptoms so that the patient feels more comfortable while the body fights the virus. For symptom relief, one should drink increased amounts of liquids, especially water and fruit juice, to help keep nasal fluid thin and easy to clear; use a cool-mist vaporizer to humidify the air, which may help reduce coughing and soothe irritated breathing passages; use saline (salt water) nose drops to loosen mucus in the nose; and use nonaspirin antipyretic medication, such as acetaminophen, as needed to reduce fever.
People of all ages can develop severe infections from RSV, but it is most common in the young and the elderly. Such infections include pneumonia and bronchiolitis and may require treatment in a hospital. Hospital treatment for RSV is aimed at opening up breathing passages and may include humidified air, supplemental oxygen, treatments to improve breathing, and, in certain cases, mechanical ventilation (a breathing machine).
Prevention and Outcomes
Basic healthful practices are the best form of protection from RSV for most people. These include washing one’s hands often, especially after touching someone who may have a cold or other RSV infection; avoiding touching one’s face or rubbing one’s eyes; avoiding sharing items such as cups, glasses, silverware, or towels with people who may have a cold or other RSV infection; and avoiding smoke exposure. A monoclonal antibody drug (palivizumab) directed against RSV that is injected monthly can significantly decrease the risk of severe infection in high-risk infants, such as those born prematurely or those who have chronic lung disease.
Bibliography
Baumgaertner, Emily. “'This Is Our March 2020': Children's Hospitals Are Overwhelmed by RSV.” The New York Times, 3 Nov. 2022, www.nytimes.com/2022/11/01/science/rsv-children-hospitals.html. Accessed 10 Nov. 2022.
Caron, Christina. “RSV? She Hadn't Heard of It. Then Her Child Was Hospitalized.” The New York Times, 10 Jan. 2018, www.nytimes.com/2018/01/10/health/rsv-symptoms-prevention.html. Accessed 8 Feb. 2018.
Caserta, Mary, and Andrea Jones. "RSV: When it's More Than Just a Cold." HealthyChildren.org, American Academy of Pediatricians, 25 Oct. 2024, www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/RSV-When-Its-More-Than-Just-a-Cold.aspx. Accessed 6 Jan. 2025.
Choy, Gary. “A Review of Respiratory Syncytial Virus Infection in Infants and Children.” Home Care Provider, vol. 3, no. 6, 1998, pp. 306–11, doi:10.1016/S1084-628X(98)90008-9. Accessed 21 Feb. 2018.
Collins, Peter L., and James E. Crowe Jr. “Respiratory Syncytial Virus and Metapneumovirus.” Fields Virology, David M. Knipe and Peter M. Howley, editors in chief, 5th ed., vol. 2, Lippincott Williams & Wilkins, 2007, pp. 1601–46.
“Respiratory Syncytial Virus.” Red Book: 2015 Report of the Committee on Infectious Diseases, by David W. Kimberlin, edited by Michael T. Brady et al., 30th ed., American Academy of Pediatrics, 2015, pp. 667–76.
“Respiratory Syncytial Virus Infection (RSV).” Centers for Disease Control and Prevention, US Dept. of Health and Human Services, www.cdc.gov/rsv/index.html. Accessed 6 Jan. 2025.
“Respiratory Syncytial Virus (RSV).” Mayo Clinic, 4 Oct. 2023, www.mayoclinic.org/diseases-conditions/respiratory-syncytial-virus/symptoms-causes/syc-20353098. Accessed 6 Jan. 2025.
“Respiratory Syncytial Virus (RSV).” National Foundation for Infectious Diseases, www.nfid.org/infectious-disease/rsv/. Accessed 6 Jan. 2025.