Respiratory | Respiratory syncytial virus (RSV)

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection especially in young children.

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Overview

Respiratory syncytial virus (RSV) is a common cause of respiratory tract infection especially in young children. RSV is a member of the Paramyxoviridae family of viruses. There are two types of RSV, types A and B, and there are many strains. RSV has an RNA genome that encodes 10 viral proteins. The virus has a lipid envelope that contains viral glycoproteins that are involved in entry of the virus into cells and fusion of the viral envelope with cell membranes. Much of the pathology caused by RSV is related to damage to the lining of the small airways of the respiratory tract.

 

RSV infections often resemble the common cold with mild symptoms such as a runny nose, coughing and low-grade fever. However, symptoms indicative of more severe RSV infections may include difficult or rapid breathing, wheezing, irritability and restlessness and poor appetite.

RSV is readily spread from contact with respiratory secretions from infected individuals or contaminated surfaces and objects. It is also the major viral cause of hospital-acquired infection. The virus is seasonal, with a higher prevalence in the cooler months of the year. 

The disease is highly prevalent, with half of all children becoming infected during their first year of life, and virtually all by the age of two. 

The incubation period of RSV infection ranges from two to eight days, with most children recovering from illness in about eight to 15 days. Children at greatest risk of severe RSV infections include:

  • Premature infants
  • Term infants younger than 6 weeks old
  • Children with medical conditions such as:
  •     Chronic lung disease
  •     Serious heart conditions
  •     Problems with their immune system

In the U.S., RSV is estimated to be responsible for 73,400 to 126,300 hospitalizations annually for bronchiolitis and pneumonia among children younger than 1 year. It is one of the most common viral causes of death in children younger than 5 years, particularly in children younger than 1 year.

Immunocompromised adults (for example, cancer and bone marrow transplant patients) as well as elderly patients in long-term care facilities are also prone to RSV infection. 

There is no vaccine available for RSV. Healthcare and childcare providers can help prevent the spread of RSV by practicing good hygiene and keeping surfaces clean including:

  • Washing hands frequently
  • Avoiding contact with people who have cold-like illnesses
  • Not sharing personal items such as:
  •     Pacifiers
  •     Utensils
  •     Toothbrushes
  •     Bed and bath linens
  • Cleaning toys and play areas frequently
  • Keeping young children away from cigarette smoke
  • Isolating hospitalized RSV-infected children

Clinicians are not able to accurately diagnose RSV infection based on symptoms alone. There are many viruses that cause respiratory infection and create similar symptoms.

There are a number of methods available for laboratories to detect RSV in respiratory specimens from patients. 

Molecular methods such as reverse transcription polymerase chain reaction-based tests are the most accurate methods to detect RSV but are expensive and can only be done in laboratories that can afford expensive equipment and employ highly trained technologists. Rapid antigen diagnostic tests, such as lateral flow tests, can be performed at the site of patient care such as the physicians’ office or emergency department. These tests offer the possibility of identifying an infected patient early in the course of the disease and during the patient’s visit to the healthcare facility. Early diagnosis at the point of care can have a positive impact on clinical management decisions.

Management of an RSV infection is generally focused on symptomatic therapy. When an RSV infection becomes more serious and progresses to bronchiolitis, patient management goals are to relieve respiratory distress, alleviate airway obstruction and improve oxygen levels. It is important to normalize body temperature and maintain proper hydration. Treatment with the antiviral ribavirin is reserved for seriously ill patients and has limited efficacy.