Respiratory Syncytial Virus (RSV)
Medical Editor: Frederick Hecht, MD, FAAP, FACMG
What is the respiratory syncytial virus (RSV)?
The respiratory syncytial virus (RSV) is a virus that
causes mild respiratory infections such as colds and coughs in adults but in young children can produce severe pulmonary diseases including bronchiolitis and pneumonia.
RSV is an RNA virus. It is unstable in the environment and survives only a few hours on environmental surfaces. The virus is readily inactivated with soap and water and disinfectants.
When does RSV infection occur and who gets it?
Infection with RSV is seasonal. In temperate climates, RSV infections usually occur during the late fall, winter, or early spring months. There are annual community outbreaks of RSV infection that often last 4 to 6 months.
More than half of all infants are exposed to RSV by their first birthday. Many have few or no symptoms. However, some infants with RSV become very ill. RSV is the most common cause of bronchiolitis and pneumonia among infants and children under the age of one.
After childhood, RSV causes repeated infections throughout life. These infections are usually associated with cold-like symptoms. However, severe lower respiratory tract disease may occur at any age, especially among the elderly or among those with compromised cardiac, pulmonary, or immune systems.
Is RSV contagious and how is it spread?
RSV disease is very highly contagious. It is spread from respiratory secretions through close contact with infected
persons or contact with contaminated surfaces or objects. Infection can occur
when infectious material contacts mucous membranes of the eyes, mouth, or nose,
and possibly through the inhalation of droplets generated by a sneeze or cough.
What are the symptoms of RSV infection?
Characteristically, the symptoms in infants are fever, prominent runny nose, and congestion, coupled with wheezing. The duration of these symptoms is 1 to 2 weeks. During their first RSV infection, between 25% and 40% of infants and young children also have signs and symptoms of bronchiolitis or pneumonia. The majority of children hospitalized for RSV infection are under 6 months of
age.
After childhood, RSV causes repeated infections with moderate-to-severe cold-like symptoms although severe lower respiratory
tract disease may occur with RSV at any age.
How is RSV infection diagnosed?
The diagnosis of RSV infection can be made by a number of different laboratory tests including isolation of the virus, detection of viral antigens, detection of viral RNA, demonstration of a rise in serum antibodies, or a combination of these approaches. Most clinical laboratories today use blood tests based on antigen detection to diagnose RSV infection.
How is an RSV infection treated?
For children with mild RSV disease, no specific treatment is necessary other than
the treatment of symptoms (such as acetaminophen to reduce fever).
Children with
severe disease may require oxygen therapy and sometimes mechanical ventilation.
Ribavirin aerosol may be used in the treatment of some patients with severe
disease. Some investigators have used a combination of immune globulin
intravenous (IGIV) with high titers of neutralizing RSV antibody (RSV-IGIV) and
ribavirin to treat patients with compromised immune systems.
How can RSV infection be prevented?
Frequent handwashing and not sharing items such as cups, glasses, and utensils with persons who have RSV illness should decrease the spread of virus to others.
Excluding children with colds or other respiratory illnesses (without fever) who are well enough to attend child care or school settings will probably NOT decrease the transmission of RSV, since it is often spread in the early
stages of illness.
In a hospital setting, RSV transmission can and should be
prevented by strict attention to contact precautions, such as handwashing and wearing gowns and gloves.
Is there an RSV vaccine?
There is no RSV vaccine yet, although development of one is a high research priority.
Effective immunity against RSV requires a continuous solid level of antibodies against the virus. There is particular concern for RSV in premature babies because of their lack of maturity and lack of protective antibodies. And there is similar concern about RSV in people of all ages with immunodeficiency.
Last Editorial Review: 1/21/2004
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