Respiratory Syncytial Virus is an incredibly common virus that hits both the very young and the very old disproportionately.
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.
The illness may coexist with pneumonia or influenza. It’s not clear exactly how RSV interacts with these other illnesses, but protection against them may make RSV infection less likely; a 2015 study by epidemiologists found an 18% reduction in RSV hospitalizations in the United States when patients had received a pneumococcal vaccine.
Other factors that may play a role in more serious cases of RSV include cyanotic heart disease, in which the blood does not receive enough oxygen; chronic lung disease; and being born before 29 weeks gestation, when the lungs are not fully developed. Despite these risk factors, 70% of infants hospitalized for RSV were full-term at birth without any prior health issues.
Treatment for sick infants consists mainly of administering oxygen in cases where oxygen saturation is below 90%; there is no treatment to lessen the disease’s severity or duration. Prevention is the goal when it comes to RSV, and certain infants may benefit from prophylactic treatment. Babies born at less than 29 weeks gestation may benefit from injections of palivizumab (Synagis), a monoclonal antibody therapy, during their first winter of life. Similarly, infants born at less than 32 weeks gestation who have chronic lung disease and who needed supplemental oxygen after birth may receive the treatment, as may children with acyanotic congenital heart disease.
RSV can leave children with lasting health effects. Many babies with RSV will continue wheezing when they develop other viral infections up until they are about 7 years old. However, certain babies with severe bronchiolitis are at greater risk of developing asthma later in childhood or in young adulthood, as well as experiencing a reduction in peak airway flow should they become cigarette smokers. It’s also possible that severe RSV in infancy is a risk factor for the later development of chronic obstructive pulmonary disease (COPD).
In adults, severe RSV infection is mainly a problem in immunocompromised and elderly individuals, particularly if the elderly patients also have cardiopulmonary disease. Anywhere from 6% to 10% of adults with RSV are hospitalized during the winter. As with children, the mainstay of treatment is supportive care. Although there currently is no vaccine to prevent RSV, more than 40 vaccines are being developed, with more than 15 already under clinical study.
Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.