RSV Facts and Prevention
Author: Dr. Anna Kaplan
Respiratory syncytial virus (RSV) is a virus that, as its name suggests, attacks the respiratory tract. This is a very contagious virus that gets everywhere. Essentially all children have caught it by the age of 2. It is unusual in that being sick with it does not give you significant immunity. Most adults catch it a second time.
It is more important to know about RSV if you have small children. Whereas in older children and adults RSV behaves more like a common cold, little children can get very sick with symptoms in the lower respiratory tract. While they often still have nasal mucous, they will also have a fever and symptoms from irritation and swelling in airways. RSV irritates the trachea or windpipe, bronchi, and bronchioles, which are progressively smaller airways. This causes cough, difficulty breathing, and wheezing. RSV can cause pneumonia, which means the parts of the lungs are filled with infectious fluid.
Although most children, even the youngest ones, will recover within one to two weeks, there are children who will become very sick with RSV. Often the sickest children have other medical problems. They need to be hospitalized because there is treatment that can help.
Some important facts about RSV:
- RSV infections occur mainly in winter and spring, sometimes late fall, and almost never summer. There are usually local epidemics that last about five months.
- RSV is very contagious. It can spread through a family, a classroom or school, or a pediatric ward very quickly.
- Infants and young children with RSV often develop what is called bronchiolitis - this is the form of the illness with wheezing, coughing, and difficulty breathing.
- Doctors can make the diagnosis of RSV in a young child with typical symptoms during the right time of year, especially if there is an outbreak underway in your community.
- Definitive diagnosis can be made from nasal mucous obtained by suction or swab.
- A chest x-ray can tell the doctor if your child has pneumonia, but not what caused it.
- RSV, as a virus, cannot be treated with regular antibiotics
- Secondary bacterial infections can occur, such as ear infections or sinus infections. Those can be treated with antibiotics.
When is hospitalization necessary, and what can they do in the hospital?
- If your child is having trouble breathing, he or she needs to be in the hospital. You may see rapid shallow breaths, wheezing, noisy breathing, or struggling for breath.
- Your child may not be able to eat or drink because of the trouble breathing. If your child cannot eat or drink and is not wetting his or her diapers, hospitalization will probably be necessary.
- If your baby has any other health problems, like congenital heart disease, or was born prematurely, or is being treated for cancer, hospitalization will almost certainly be needed.
- They will give your child oxygen as well as medicine somewhat like asthma treatment to open his or her airways.
- Fluid and calories can be given by vein. Suctioning of the mucous in the nose and trachea will be done.
- An antiviral agent can be given by mist to very sick children. Humidity is also helpful.
There is a preventative treatment that should be given to children at very high risk of catching RSV and becoming very ill if they have it. The American Academy of Pediatrics has guidelines indicating who is at the most risk. The medicine used is called palivizumab, and it is very expensive and not without risk. That is why it is reserved for those whose risk from RSV is much worse than any risk from the medication. It is an injection given once a month for 3 to 5 months, depending on the patient. If you believe your child is in any of these groups or is otherwise at risk, you should discuss it with your doctor. Here is an abbreviated summary of some of the conditions.
Children may need palivizumab if:
- they have chronic lung disease of prematurity, and if they are under 24 months old and needing treatment for the lung disease.
- they were born before 32 weeks, especially if it is RSV season during their first 12 months of life.
- born between 32 and 35 weeks, depending on other factors, such as their age and likelihood of exposure.
- they have congenital abnormalities of their nervous system, muscles, or airways.
- they have congenital heart disease.
Infants with cancer or with an illness damaging their immune system may also need prophylaxis.
What else can you do?
You cannot really prevent most children from catching RSV. Most children have it and recover from it. Many adults have it again, usually in a less severe form unless they have other medical problems.
You can try and keep your infant away from RSV, so that your child may catch it when he or she is a bit older.
You can be aware of RSV and what to look for. Wash your hands thoroughly around sick children, and remind your children to do the same.
If you have a child at risk, try and keep him or her out of daycare or other situations where there are large groups of children.
Keep tobacco smoke away from anyone suspected of having RSV.
If you have any other questions about your baby's risk from RSV, talk to your doctor about it.
