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Respiratory Syncytial Virus (RSV) Infection

Topic Overview

What is respiratory syncytial virus (RSV)?

The respiratory syncytial virus (RSV) causes an illness that usually
resembles a moderate to severe cold and is very contagious. RSV most
often resolves on its own and does not cause major health concerns.
This infection can become a problem when it is severe or leads to
complications. Babies (especially those born prematurely), people with
immune system problems, and older adults have an increased risk of
developing complications from RSV infection.

Outbreaks of RSV infection generally occur at regular and predictable
times each year, although they vary in severity. The number of
infections usually peaks in the late fall, winter, and early spring in
the United States and Europe. In tropical climates, epidemics occur
during the rainy season.

Who is affected by RSV?

Infection with RSV affects people of all ages, but most often occurs
during infancy or early childhood. Approximately 60% of all babies
under 1 year of age become infected with RSV; by 2 years of age, over
90% of children have been infected.1 Most otherwise healthy babies and
children gradually recover between 10 and 14 days after symptoms
begin. The virus is more likely to be severe and cause complications
in babies born prematurely who are less than 6 months of age and in
children with other health problems. Only about 1% of children age 2
and younger who are infected with RSV require hospitalization.2

Adults usually have milder RSV symptoms than children. However,
symptoms may be severe in adults over age 65 who have other health
problems, such as a history of heart or lung disease. These adults
also are at increased risk for developing complications from RSV
infection.

What causes infection with RSV?

RSV infection is caused by a virus that attacks the respiratory
tract—the mouth, nose, eyes, throat, and lungs. Infection
spreads from person to person through everyday contact. When someone
who is infected with RSV breathes, coughs, or sneezes, tiny droplets
containing the virus are released into the air. If you breathe in
these droplets, they enter your respiratory tract and you can become
infected. Other common ways the virus spreads is through sharing food
or drink with an infected person, or getting the droplets on your
hands and then touching your eyes, nose, or mouth.

There are two types of RSV, as well as multiple subtypes (strains).
Therefore, the body does not develop complete immunity to the virus,
and infection can occur repeatedly throughout life, sometimes even
during the same season.

What are the symptoms of RSV infection?

RSV infections cause symptoms like those of a common cold: a stuffy or
runny nose, sore throat, wheezing and coughing, low-grade fever, and
earache. Babies may have additional symptoms that include
listlessness, lack of appetite, irritability (fretfulness), disrupted
sleep, and a decreased interest in things going on around them.
Rarely, some babies may also have apnea, a condition where breathing
stops for about 15 to 20 seconds.

Symptoms gradually resolve sometime between 10 and 14 days. Your age,
general health, and severity of the infection affect recovery time.

How is RSV different from a common cold?

Although RSV causes the same symptoms as the common cold, RSV symptoms
can be more severe. Some people also develop complications from RSV,
such as bronchiolitis or pneumonia, which result in a longer recovery
time. These complications may also require treatment.

What complications can develop from RSV infection?

In babies, RSV infection can spread to the bronchial tubes and lungs
(lower respiratory system) and cause bronchiolitis and pneumonia.

In older adults, RSV infection can cause pneumonia.

How can I help prevent my child from becoming infected with RSV?

Almost all children become infected with RSV before age 2. The virus
spreads easily and is extremely difficult to completely avoid. Washing
your hands and your child's hands frequently may help, as well as
avoiding congested public areas, such as stores, during peak times
when RSV typically spreads. However, if your child is otherwise
healthy, preventing the infection from becoming severe is of most
concern. This involves using home treatment methods, such as making
sure your child gets plenty of rest.

Babies born prematurely or children with other health problems have an
increased risk of complications from RSV. Periodic injections with
antibodies, such as respiratory syncytial virus immune globulin
intravenous (RSV-IGIV) or palivizumab, during the peak season of RSV
help prevent infection in some children. Even if this medication does
not completely prevent RSV, it may result in a less severe infection.

How is RSV infection diagnosed?

The diagnosis of RSV is mainly determined by the symptoms and a known
community outbreak of the disease. Tests are not normally needed.
However, your health professional may want to do testing if the risk
for complications is high. Various types of viral testing are used to
diagnose RSV, although a viral detection test from a sample of nasal
drainage is most common.

What is the treatment for RSV infection?

If an otherwise healthy baby develops cold symptoms, they usually will
gradually resolve on their own within a week or two, regardless of
whether they are caused by a cold or RSV. For mild RSV infection,
measures to help relieve symptoms usually are all that is needed. Some
babies with RSV infection may require hospitalization.

Learning about RSV infection:

* What is RSV?
* What causes RSV infection?
* What are the symptoms?
* Which babies and children are at risk?
* How is RSV diagnosed?
* How is RSV treated?
* Who is affected?

Being diagnosed:

* When should I take my child to see a health professional?
* What exams and tests are used?
* What kinds of questions will a health professional ask?
* What will a health professional look for during a physical exam?
* What is nasal draining, and how is it related to testing?

Getting treatment:

* How do I know when to call a doctor for cold symptoms that might
be RSV?
* What can I do at home to treat RSV?
* What kinds of treatments are used when hospitalized?
* Are medications used as prevention?
* Are medications used as treatment?
* Are corticosteroids ever used?

Ongoing concerns:

* How can I prevent RSV?
* Who is at greatest risk for developing complications?
* What kinds of complications can develop in an adult?

Cause

RSV infection is caused by the respiratory syncytial virus. There are
two main types of RSV and many subtypes (strains). For this reason,
you cannot develop full immunity to the virus and may have many RSV
infections throughout life.

People with RSV infection may spread the virus through their saliva or
mucus (secretions) when they cough, sneeze, or talk. You can catch the
virus by coming into contact with that saliva or mucus. This commonly
occurs by:

* Touching an object or surface contaminated with the virus and
then touching your nose, eyes, or mouth without first washing your
hands. This is the most common way RSV is spread. The virus can
survive for more than 6 hours on countertops and other hard surfaces,
such as doorknobs, and for 30 minutes on hands, clothing, or tissue.
* Close contact. You may become infected when you breathe in or
absorb (through your eyes or mouth) RSV contained in droplets of
saliva or mucus in the air.

The virus spreads easily in congested settings, such as child care
facilities, preschools, churches, and nursing homes. Children
attending school often spread the virus to their parents and siblings.

You are most likely to spread the virus within the first several days
after symptoms of RSV infection begin, although you will remain
contagious for up to 8 days. Babies and young children may spread the
virus for 3 to 4 weeks.3

Symptoms

When a respiratory syncytial virus (RSV) infection affects the mouth,
nose, and throat (upper respiratory system), symptoms are usually mild
and resemble those of the common cold. They include:

* Cough.
* Stuffy or runny nose.
* Mild sore throat.
* Earache.
* Fever, usually at the beginning of the illness. A high fever
does not mean the illness is more severe.

Babies may have additional symptoms, including:

* A decreased interest in their surroundings.
* Listlessness and sleepiness.
* Fretfulness (irritability) and not sleeping well.
* Poor feeding.
* Apnea, where breathing stops for about 15 to 20 seconds. This
usually occurs only in babies who were born prematurely and who also
have a history of apnea.

It is difficult to distinguish between a common cold and RSV
infection. Unless you or your child has an increased risk of
developing complications from RSV, it usually is not important to
determine which virus causes symptoms.

RSV infections can affect the lower respiratory system, resulting in
bronchiolitis and/or pneumonia. Symptoms of these illnesses include:

* Difficulty breathing, which may include breathing more rapidly
than normal.
* Wheezing.
* Worsened coughing. A child may choke or vomit from intense
coughing that may be dry or loose (producing mucus).
* Lethargy, increased tiredness, decreased interest in
surroundings, or loss of interest in food.


What Happens

In healthy children, respiratory syncytial virus (RSV) infections tend
to be mild and resemble a cold. Children who have only upper
respiratory system symptoms, such as cough or a runny nose, usually
recover in about 10 to 14 days.

A child's first RSV infection usually is the worst. Some babies and
children have an increased risk of developing complications from an
RSV infection because their immune system is unable to fight off the
virus. In addition, babies have narrow breathing tubes that can clog
easily, making breathing difficult. The most common complications for
young children are bronchiolitis and pneumonia, which are lower
respiratory tract infections.

Adults over age 65 have an increased risk of developing complications
following infection with RSV. Pneumonia is a particular risk,
especially if other health problems exist, such as chronic obstructive
pulmonary disease (COPD) or heart failure.

It may take older adults longer to recover from RSV infection and
complications than other age groups.

What Increases Your Risk

Respiratory syncytial virus (RSV) is a common virus that infects
approximately 90% of children by the age of 2 and almost all children
by age 3. The first RSV infection, which normally occurs between birth
and 2 years of age, is usually the most severe. The virus spreads
easily and is extremely difficult to completely avoid. Babies and
young children who are in day care centers or frequently in public
places are most likely to become infected, especially during the peak
season when the virus spreads. Older brothers and sisters in school
often become infected with the virus and spread it to other household
members, including babies and preschoolers. Sharing food, touching
objects that are contaminated with the virus, and not washing hands
can lead to RSV infection.

With RSV infections, there is an increased risk of developing
complications, especially in certain babies and young children and
adults over age 65. Older adults living in nursing homes or other
group environments also have an increased risk of becoming infected
with RSV.

You always have a risk of developing RSV because there are two
different types and many subtypes (strains) of the virus, meaning you
can never develop complete immunity.

When to Call a Doctor

Call 911 or other emergency services immediately if your child is
having difficulty breathing, indicated by:

* Breathing very fast (more than 60 times per minute).
* Making a grunting noise.
* Inability to speak, cry, or make sounds, sometimes with
drooling.
* Flaring nostrils or lifting the shoulders when inhaling.
* Skin that is gray, mottled, or blue (look for skin color changes
in the fingernail beds, lips, or earlobes).
* Wheezing that lasts over 1 hour in a baby younger than 3 months
old who also appears sick.
* Breathing stops for longer than 15 to 20 seconds.

Note:

If breathing has stopped, call 911 or other emergency services.

* Begin rescue breathing. Go to the topic Dealing With Emergencies
to see Rescue Breathing.
* If choking is present, go to the topic Choking Rescue Procedure to
see the Heimlich maneuver for children older than 1 year of age or
back blows for babies less than 1 year of age. Do not perform the
Heimlich maneuver if the child is coughing or able to speak.

See your health professional immediately if your baby or child has
moderate difficulty breathing, indicated by:

* Breathing 40 to 60 times per minute.
* Tiring quickly during feeding. The child either stops eating or
****s in air to catch a breath. The child loses interest in eating
because of the effort involved.
* Using the stomach muscles when breathing.
* Unusual color. The child's face, hands, and feet are pale to
slightly gray, or lacelike purple and pale (mottled), but the tongue,
gums, and lips remain pink.

See your health professional if your child shows signs of a lower
respiratory infection, such as:

* Rapid breathing.
* Difficulty breathing. Children may use muscles in the neck,
chest, and stomach when taking in air. This causes the skin to retract
between the ribs with each breath, making the ribs more defined than
usual, a condition known as retractions. The severity of retractions
increases (the ribs become more defined) as the degree of difficulty
in breathing increases.
* Wheezing.
* Excessive tiredness.
* Little interest in food or surroundings.
* Possible ear infection (otitis media). See the topic Ear
Infections for more information.
* Is less than 3 months old and has a fever greater than 100.4°F
(38°C).

Call a health professional if your child has:

* Slightly faster-than-normal breathing that gets worse. Most
healthy children breathe less than 40 times per minute.
* Cold symptoms become severe or other problems develop, such as signs
of an ear infection.

Watchful Waiting

For an otherwise healthy child who has symptoms of an upper
respiratory infection, such as a cough or runny nose, home treatment
usually is all that is needed. However, it is important to watch for
signs and symptoms of complications, such as dehydration. For more
information, see the Check Your Symptoms section of the topic
Respiratory Problems, Age 11 and Younger.

Watchful waiting may not be appropriate when your child with an upper
respiratory infection has an increased risk for complications. Watch
your child closely if symptoms of an upper respiratory infection
develop. See a health professional right away if symptoms get worse or
new symptoms develop.
Who to See

Respiratory syncytial virus (RSV) infection can be diagnosed and
treated by a health professional such as a:

* Family physician.
* Pediatrician.
* Nurse practitioner.
* Physician's assistant.

Exams and Tests

In otherwise healthy people, it is not usually necessary to
distinguish respiratory syncytial virus (RSV) from a common cold. A
health professional may suspect RSV infection as the cause of symptoms
when there is evidence of a recent community outbreak. A diagnosis of
RSV generally is not confirmed with lab tests. However, a medical
history and physical exam may be done to evaluate symptoms.

A health professional may want to confirm a diagnosis of RSV for
symptomatic children and adults over age 65 at an increased risk for a
severe infection or developing complications. For these people, a
viral detection test usually is used to diagnose RSV. This test
involves laboratory ****ysis of nasal drainage, obtained with a cotton
swab or nasal wash. Testing may also be recommended for people who are
hospitalized when:

* There is a high risk of complications.
* The person lives in a nursing home or group living facility.
* The cause of symptoms has not already been determined.

The results of viral detection tests help determine if precautions are
needed to prevent the spread of infection. For children who have a
risk of developing severe infections or complications of RSV
infections, the results of these tests may help guide treatment, such
as the need for medications.

If you do not get better or must be hospitalized, more tests may be
needed.

Treatment Overview

General treatment

Respiratory syncytial virus (RSV) infections are usually mild and seem
like a common cold. In most cases RSV infections go away on their own
in about 10 to 14 days. Home treatment to ease symptoms and prevent
complications is usually all that is needed.

Treatment for severe infection or complications

Children who develop lower respiratory infections, especially
bronchiolitis, may need medications, such as bronchodilators, in
addition to home treatment. Although antibiotics are not used to treat
RSV or any other viral infection, they are used when bacterial
infections, such as pneumonia, develop as a complication.

When complications develop in otherwise healthy children,
corticosteroid medications sometimes are used. However, more study is
needed before corticosteroids are routinely recommended for this
purpose.4

A child who is having difficulty breathing or is dehydrated may need
to be cared for in a hospital. The child may need respiratory and
other medical treatments. Very rarely, some children receive the
antiviral medication ribavirin while they are in the hospital.

* Pregnant women should avoid contact with a child who is
receiving ribavirin.
* If your child is in the hospital for RSV, there are extra measures
you can take to make his or her stay comfortable.

Prevention

Respiratory syncytial virus (RSV) infection is easy to catch (highly
contagious). It is common for children to develop viral infections
such as RSV because they are often exposed to infected people and have
not built up immunity. There is no sure way to prevent many
respiratory illnesses in babies and children.

The following may help reduce your child's risk of respiratory
problems:

* Wash your hands frequently and teach your children to do the
same. Also, make sure people who care for your child wash their hands
and understand the importance of this habit in preventing the spread
of infection.
* See that your child gets all of his or her vaccines, especially
the diphtheria, pertussis (whooping cough), and tetanus (DTaP), and
Haemophilus influenzae type b (Hib). See the topic Immunizations in
Related Information.
* Breast-feed your baby for at least the first 6 months after
birth, if possible. Studies indicate that breast-fed babies may have
fewer serious RSV infections than those who are fed formula. Breast
milk seems to offer some protection against RSV infection, but more
study is needed.5 Breast milk does not prevent RSV infection.
* Separate a child diagnosed with RSV from others in the home as
much as possible.
* If you smoke, quit. If you cannot quit, do not smoke in the house or
car. Secondhand smoke irritates the mucous membranes in your child's
nose, sinuses, and lungs, making him or her more susceptible to
infections.

Outbreaks of RSV often occur between late fall and early spring. To
keep from catching the virus during this time, limit your exposure to
RSV. This is most critical for babies and children who are at risk for
serious RSV infections, and parents should make sure that they avoid:

* Sharing items such as cups, glasses, and utensils with others.
* People with upper respiratory infections, such as colds.
* Child care centers, malls, movie theaters, and other congested
places where many people are in an enclosed area.
* Visiting children who are in the hospital.

Some babies who are born prematurely or who have other risk factors
have an increased risk for developing serious complications if they
become infected with RSV. These babies may be given medications, such
as RSV-IGIV or palivizumab, to prevent RSV infection.

If your child is otherwise healthy, home treatment to prevent RSV
infection from becoming severe, such as ensuring your child gets
plenty of rest, is usually all that is needed.

Home Treatment

When to use home treatment

Most mild to moderate respiratory syncytial virus (RSV) infections in
otherwise healthy people are like the common cold and can be treated
at home. If your child is older than 1 year of age and is not at risk
for complications from RSV infection, try home treatment. However, RSV
infections in people with an increased risk of complications need
close monitoring.

People who have impaired immune systems, need to see a health
professional for cold-like symptoms because of the increased risk for
developing complications. Babies and children with health problems and
other risk factors, as well as older adults, should also see a health
professional at the first sign of RSV.

How to help your child with RSV infection

* Watch for signs of dehydration. Make sure to replace fluids lost
through rapid breathing, fever, diarrhea, or vomiting. Encourage more
frequent breast- or bottle-feeding. Avoid giving your baby sports
drinks, soft drinks, undiluted fruit juice, or water; these beverages
may contain too much sugar, contain too few calories, or lack the
proper balance of essential minerals (electrolytes).
* Make your child more comfortable by helping relieve his or her
symptoms and encouraging rest.
* Make sure you understand if and when antibiotics are needed.
Antibiotics are not usually given for RSV infections. However, if your
child develops complications, such as an ear infection (otitis media),
your health professional may prescribe an antibiotic. Do not stop
giving antibiotic medication when your child starts to feel better.
The entire prescription must be taken to completely kill the bacteria.
If you do not give your child all the medication, the bacterial
infection may return.
* Take care of yourself. Caring for a sick child can be very tiring
physically and emotionally. You can best help your child when you are
rested and feeling well.

Medications

Most respiratory syncytial viral (RSV) infections do not require
prescription medications. However, medications may be recommended for
certain people to help:

* Prevent RSV infection.
* Treat RSV infection and its complications.

Medication Choices

Medication to prevent or lessen the severity of RSV infection include.

* RSV-IGIV (RespiGam).
* Monoclonal antibody, such as palivizumab (Synagis).

Medications to treat RSV infection include:

* Bronchodilators.

Medications to help treat complications of RSV infection include:

* Corticosteroids.
* Antibiotics.

What to Think About

* High doses of vitamin A to treat symptoms of RSV have not proven
effective and in fact may be harmful. For these reasons, this
treatment is not recommended.
* Ribavirin (Virazole) is an antiviral medication that sometimes
is used to treat babies and children with RSV infections who have a
high risk of developing complications. However, this is not a standard
treatment because it is not always effective. The risk of side effects
may not justify its use for many children.
* Studies show that bronchodilators are effective only about a
third of the time for babies. Many experts recommend that
bronchodilators be tried initially for babies who are having
difficulty breathing. If the baby is able to breathe easier, the
medication can be continued.6
* A vaccine for RSV is not currently available. Studies are ongoing.

Other Places to Get Help

Organization

U.S. Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333
Phone: (404) 639-3311 (CDC Operator)
Phone: 1-800-311-3435 (public inquiries)
Fax: (404) 332-4564
E-mail: netinfo@cdc.gov
Web Address: http://www.cdc.gov


The Centers for Disease Control and Prevention (CDC) is an agency of
the U.S. Department of Health and Human Services, working with state
and local health officials and the public in the fight against
communicable diseases and cancer. The agency provides information to
the public about disease prevention and treatment.
National Jewish Medical and Research Center
1400 Jackson Street
Denver, CO 80206
Phone: 1-800-222-LUNG (1-800-222-5864)
Phone: (303) 388-4461 (outside the United States)
E-mail: lungline@njc.org
Web Address: http://www.njc.org or http://www.NationalJewish.org


The National Jewish Medical and Research Center is devoted to
treatment, research, and education in chronic respiratory diseases. It
also publishes a newsletter and pamphlets; maintains the LUNG LINE, a
free call-in information service for consumers; and has a patient
referral center (inpatient and outpatient services).
American Lung Association
61 Broadway, 6th Floor
New York, NY 10006
Phone: (212) 315-8700
Phone: 1-800-LUNG-USA (1-800-586-4872)
E-mail: info@lungusa.org
Web Address: http://www.lungusa.org/

The American Lung Association, along with its medical branch, the
American Thoracic Society, provides programs of education, community
service, and advocacy. Some of the topics available include asthma,
tobacco control, emphysema, asbestos, carbon monoxide, radon, and
ozone.

http://my.webmd.com/content/healthwise/89/22111