Nicole S. Kearney, MD FAAP, works for Jackson Pediatric Center. She agreed to explain some questions regarding Respiratory Syncytial Virus.

Question: Could you explain what RSV is and how it affects the body?

Answer: RSV, or Respiratory Syncytial Virus, is a virus that causes acute respiratory tract illness (common cold and other respiratory signs and symptoms) in persons of all ages. It is the most common cause of bronchiolitis. Seasonal outbreaks occur worldwide, however in the U.S. epidemics generally begin in November, peak in January or February and decline and then end in May.

Q. Are there age limits to this virus? Is there a common age?

A. It is very common in early childhood, particularly in children under 5 years of age, however, it can affect healthy older patients as well. Nearly every child has been infected by 2 years of age.

Q. What causes this?

A. It is spread through contact with large droplets that form when a child talks, coughs or sneezes. The droplets land on, or are rubbed into, the eyes, nose or mouth. Also, it can be acquired by contact with the respiratory secretions from objects contaminated by children who are infected by the virus. The contagious period is typically 3-8 days but may last up to 3-4 weeks in young infants. Before signs or symptoms appear, the infected person starts to shed the virus that may infect others.

Q. What are the signs and symptoms?

A. Signs and symptoms vary depending upon the patient’s age, health condition and whether the infection is primary or secondary. Infants and young children with primary infections usually present with lower respiratory tract infections (bronchiolitis, wheezing from narrowed airways in the lungs, pneumonia or respiratory failure) whereas older children and adults typically have upper respiratory tract symptoms (runny nose, congestion, cough). Symptoms in general are characterized by cough, wheeze, respiratory distress and hypoxia (decreased oxygen level). Most symptoms are mild and self-limited.

Q. What tests are used to diagnose or rule out RSV?

A. RSV is diagnosed by a rapid assay via analysis of respiratory secretions. A nasal wash usually provides the best yield, but a nasal swab may be adequate if a nasal wash is not possible. This can be performed with results in less than 30 minutes.

Q. Can anything be done to prevent or reduce the risks of contracting RSV?

A. Prevention includes hand washing to minimize transmission, minimizing passive exposure to cigarette smoke, and avoiding contact with individuals with respiratory tract infections.

Q. How is this treated?

A. Treatment is mostly supportive including nasal suctioning with saline, maintaining hydration, supplemental oxygen if needed, and respiratory support in more severe cases. Bronchodilators (albuterol or epinephrine) are not recommended in the treatment of RSV bronchiolitis per the American Academy of Pediatrics 2014 clinical practice guidelines. However, in individuals with severe disease or respiratory failure a one time trial may be warranted.

Q. What is the person’s prognosis after diagnosis?

A. Long-lasting immunity does not occur; reinfection is common (individuals can be infected more than once in the same RSV season), usually with diminished severity of symptoms either in the same season or in different years. It is usually a self-limited process that results in no apparent long-term sequel, however, RSV infection is correlated with recurrent wheezing in some patients.

Typical illness with bronchiolitis begins with upper respiratory tract symptoms (runny nose, congestion, cough) followed by lower respiratory tract signs and symptoms (wheezing, pneumonia) on days 2 to 3, which peak on days 5 to 7, and then gradually resolve.

Cough from RSV often lasts as long as three weeks.

If provided supportive measures at home, knowing when to seek immediate medical care is important. Indications include apnea, cyanosis, poor feeding, fever, increased respiratory rate and/or work of breathing (retractions, nasal flaring, grunting).

Antibiotics should not be used routinely in the treatment of bronchiolitis, which is virtually always caused by viruses. They are only warranted when there is a coexisting bacterial infection.

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