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Respiratory Syncytial Virus Infection—What it Means for You

Do you have a pediatric or geriatric patient with nasal congestion, fever, cough, rapid breathing, chest retractions, and wheezing? Suspect Respiratory Syncytial Virus (RSV) as the culprit. RSV, which was first identified more than 60 years ago, is an incredibly common virus in the Pneumoviridae family that hits both the very young and the very old disproportionately. It consists of two major viral groups: A and B, with A being more common.
Just about every child gets infected with RSV, according to research by Edward E. Walsh, MD, a professor of infectious disease at the University of Rochester Medical Center in Rochester, NY. Dr. Walsh says 50% to 70% of newborn babies are infected with RSV during their first winter of life, and those who aren’t almost certainly get it by the age of two, after which further infections are common although less severe.
Twenty percent of all babies with RSV are seen at pediatricians’ offices or emergency rooms, and 1% to 2% of all babies are hospitalized (about 100,000 per year). Deaths from RSV are rare in the United States—about 50 to 100 each year—but in developing nations the death rate is anywhere from 66,000 to 199,000 each year, and the infections account for 3 million hospitalizations for children younger than five years old.
The virus, which tends to hit colder areas of the United States hardest in the winter, tends to persist for 16 to 22 weeks in the communities in which it circulates, overlapping with the 6- to 8-week influenza epidemics. In warmer areas, RSV may proliferate during rainy periods. Nasal secretions are the primary mode of contagion; as the virus can linger for hours on hands and surfaces, touching contaminated spots is a reliable way to contract it. Thus, children frequently introduce RSV into the home, infecting both parents and younger siblings.
RSV typically incubates for 4 to 6 days, after which nasal congestion, mucus discharge, and fever develop, followed by rapid breathing, coughing, and respiratory distress manifesting as chest retractions and wheezing. This is due to bronchiolitis, or inflammation of the smallest airway passages in the lungs. Preterm infants may even stop breathing periodically.

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