What is RSV?

If you have ever had a runny nose, sore throat or mild fever then chances are, you may have been suffering from Respiratory Syncytial Virus (RSV)^[1]. This complex sounding virus affects the majority of people at some point or another in their lives. Around 75,000 to 125,000 children are hospitalized with RSV each year. RSV can affect people of all ages but mostly occurs in infants less than 2 years old. Globally, RSV affects an estimated 64 million people and causes 160,000 deaths each year. RSV is the second largest cause of death in children under one year of age (second only to malaria). So, what is RSV? There are two different strains of the virus: A and B and both can cause an infection of the lungs and respiratory tract. Each year, epidemics of RSV occur during the winter and early spring, although the timing of these may vary from region to region. There is currently no known vaccine for RSV and people do not form long-lasting immunity to the virus. Therefore, they may encounter RSV more than once over the course of their lifetime.

How does the virus spread?

RSV is spread via droplet infection from secretions from the mouth or nose. The virus can survive for at least 30 minutes on hands^[2] and for several hours on infected surfaces. Symptoms of RSV infection usually appear around four to six days after being infected by the virus.

How does RSV affect people?

RSV can affect any part of the respiratory tract causing intense inflammation. The respiratory tract is made up of a trachea that splits into two bronchi, which in turn further subdivide into smaller bronchioles. These in turn end in tiny air sacs of the lungs called alveoli, where gas exchange takes place into the bloodstream. The alveoli are responsible for maximizing the surface area available for oxygen to enter and carbon dioxide to leave the body. Any lung infection such as RSV will cause a reduction in airflow in and out of the lungs. Sometimes, an RSV infection can lead to the development of other serious lower respiratory tract infections such as bronchiolitis, pneumonia^[3], and sometimes even respiratory failure in children.

What to do if you have an infection?

Treatment for RSV is with self-care and symptom relieving medications. If you are experiencing RSV symptoms, such as chest pain^[4], make sure you drink plenty of fluids to prevent dehydration. Taking pain relievers will help relieve fever and headache symptoms^[5], but avoid aspirin use in children. This is because it can lead to a rare but serious illness called Reye’s syndrome which can damage the brain and liver.

Is RSV serious?

For patients suffering from heart and lung disease, premature babies or older adults, RSV can cause more serious problems such as pneumonia and severe breathing problems. RSV can also be problematic for anyone who is immunocompromised as they have a very weak immune system. RSV-related infections in children younger than 5 years of age account for more than 2 million visits to the provider or to the emergency department each year. It’s a leading cause of hospitalization for infants younger than 1 year of age.

RSV symptoms

RSV symptoms^[6] may be mild or severe, depending upon the person affected. RSV symptoms in otherwise healthy adults and children may be missed as they are like that of the common cold. Initial symptoms may include a congested or runny nose, a dry cough^[7], low or high-grade fever, sore throat and a mild headache. Other RSV symptoms may include:

• Abnormally fast breathing (tachypnea)
• Caving in of the chest in between the ribs and under the ribs (chest wall retractions)
• Spreading-out of the nostrils with every breath (nasal flaring)
• Wheezing or shortness of breath^[8]. Wheezing is a high-pitched whistling sound as the patient breathes out
• Difficult drinking
• Lethargy or irritability
• Bluish color around the mouth, lips and fingernails (cyanosis)
• Apnea (breathing cessation) is a common symptom of RSV bronchiolitis among very young infants, especially those born prematurely. Severe apnea or sleep apnea in children can cause sudden infant death syndrome (SIDS).
• Sinus or ear infections are also associated more with RSV than other infections.

It is important to note that some of these initial symptoms are common in a wide range of medical conditions. It is important to seek medical advice from your provider if you have any concerns at all about your health.

Severe cases of RSV

If the virus has spread to the lower respiratory tract, this may lead to pneumonia or bronchiolitis^[9]. Bronchiolitis causes inflammation of the bronchioles. Pneumonia is an infection that may be caused by a number of bacteria and viruses^[10] including RSV. Symptoms of bronchiolitis Bronchiolitis starts out with symptoms similar to those of a common cold but then progresses to coughing, wheezing and sometimes difficulty breathing. These symptoms can last for anything from several days to a month. Symptoms of pneumonia The symptoms of pneumonia can develop suddenly over 24–48 hours, or they may appear more slowly over several days. Pneumonia needs to be treated separately as it is a bacterial infection. A patient may present with any of the following symptoms:

• Fever: Particularly over 100°F.
• Severe cough: This may be dry, or produce thick yellow, green, brown or blood-stained mucus^[11] (phlegm).
• Wheezing: A high-pitched noise that's usually heard on breathing out (exhaling)
• Rapid and shallow breathing or difficulty breathing even when resting: The patient may prefer to sit up rather than lie down.
• Bluish color of the skin due to lack of oxygen: This is termed cyanosis, which indicates a lack of oxygen in the blood.

Seek immediate medical attention if your child or anyone at risk of severe RSV infection has difficulty breathing, a high fever, or a blue color to the skin^[12]—particularly on the lips and in the nail beds.

Groups at higher risk for developing pneumonia

Babies and very young children, elderly people, those who smoke and people who have other health conditions such as asthma^[13] or cystic fibrosis are at a greater risk of developing pneumonia. Asthma causes constriction of the bronchi and bronchioles and cystic fibrosis is a hereditary disease which causes the lungs to clog up with thick sticky mucus. Additionally, people with heart, liver or kidney conditions or a weakened immune system are also at higher risk. Their immune system may be compromised as a result of a recent illness, such as flu, HIV or AIDS, chemotherapy, or if on immune-suppressing transplant medicine.

RSV in children

Infants are most severely affected by RSV. Each year in the United States, an estimated 57,000 children younger than 5 years old^[14] are hospitalized due to RSV infection. Those at greatest risk for developing a severe illness from RSV include:

• Premature infants and very young infants, especially those 6 months and younger.
• Children younger than 2 years old with chronic lung or heart disease.
• Children with weakened immune systems or neuromuscular disorders. This includes those who have difficulty swallowing or clearing mucus secretions.

Signs and symptoms

Early symptoms of RSV in children are the same as for others:

• A runny nose
• Decrease in appetite
• A cough which may develop into wheezing
• Short, shallow and rapid breathing
• Unusual tiredness and a decrease in activity
• Irritability

Most children and adults recover in 1–2 weeks, although some might experience repeated wheezing. Severe or life-threatening infection requiring a hospital stay may occur in premature babies or infants and adults who have chronic heart or lung problems. Those who are hospitalized may require oxygen, incubation, and/or support with breathing by mechanical ventilation. Do seek advice promptly from your medical practitioner, if you are concerned about these or any other symptoms that your child may be experiencing.