Respiratory Syncytial Virus

Signs and Symptoms:
Respiratory syncytial virus (RSV) is a major cause of respiratory illness in young children. RSV infection produces a variety of signs and symptoms involving different areas of the respiratory tract, from the nose to the lungs.

In adults and children above age three, RSV usually causes symptoms of a simple upper respiratory tract illness or "common cold." These symptoms include a stuffy or runny nose, sore throat, mild headache, mild cough, low-grade fever, and a general feeling of being "ill."

In children younger than age three, RSV most often causes a lower respiratory tract illness like bronchiolitis or pneumonia and may lead to respiratory failure. In this case, symptoms may include high fever, severe cough, wheezing, abnormally rapid breathing, difficulty breathing, and a bluish color of the lips or fingernails. In infants with severe RSV infection, there may be abnormal retractions of the muscles between the ribs, as the child struggles to draw breath into infected breathing passages.

Description:
RSV is a virus that causes infection of the lungs and breathing passages. It can infect the same person several times during a lifetime, causing more severe illnesses (like pneumonia) in infancy, but only a "common cold" in adulthood. After each RSV infection, the body forms some immunity to the virus, but that immunity is never complete. Re-infections occur, but they usually are less severe than earlier RSV attacks. RSV passes from person to person through infected nasal and oral fluids. It can enter the body when eyes or nose are touched.

RSV infections occur all over the world, most often in epidemics that can last up to five months, from late fall through early spring. Since 1990, epidemics have typically begun sometime between late October and mid-December, and peaked during January and February. Each year during these epidemic periods, about 90,000 infants and young children are hospitalized with RSV infections - and about 4,500 die.

The highest rates of RSV illness occur in infants two to six months old, with a peak at age two to three months. RSV infection is often carried home by a school-aged child and passed onto a younger one, especially an infant. When RSV infects a day-care center, it is not unusual to see 100% of the children come down with an RSV infection. RSV commonly spreads through hospitals, too, infecting both patients and staff.

Prevention:
Synagis is an intravenous vaccine that doctors use to protect infants who are considered to be at-risk for RSV. This new preventive treatment takes several hours to administer.

Since RSV spreads in fluids from the nose and throat of an infected person, it is best to wash your hands after touching anyone who has either a "cold" or a known RSV infection. Also, it is wise not to touch your nose or eyes after contact with someone with RSV since the virus could enter your body through either of these two areas. And whenever a school-aged child comes down with a "cold," keep the child away from an infant brother or sister until the symptoms pass.

Incubation:
Incubation period is four to six days.

Duration:
RSV infection usually lasts seven to 14 days, but some cases may last up to three weeks. Children who are hospitalized with lower respiratory tract illness usually spend five to seven days in the hospital.

Contagiousness:
RSV is contagious and can attack up to 50% of infants during an RSV epidemic. Yearly epidemics occur in the late fall, winter, and early spring - almost never in the summer. Children in day-care centers are at greater risk. Infants are at special risk if they have an older brother or sister in school.

Someone who has an RSV infection, even if it's "just a cold," can pass infectious RSV particles through oral and nasal fluids. Contagiousness is highest during the first two to four days of the illness, but RSV particles may continue to be spread for up to two weeks after the stuffy nose begins.

Home Treatment:
In treating RSV infection, the goal is to make children more comfortable while their own bodies fight the virus.

Using a cool-mist vaporizer to humidify the air may help soothe irritated breathing passages and relieve coughing. Give plenty of fluids such as water, fruit juice, and weak tea - these help keep nasal secretions watery and easy to clear.

If necessary to loosen mucus in the nose, you can use salt water (saline) nose drops. If the nostrils are irritated, rub a little petroleum jelly under them.

Treat fever using a nonaspirin fever medicine like acetaminophen. Aspirin should NOT be used in children with viral illnesses since the use of aspirin in such cases has been associated with the development of Reye's syndrome.

In children who are too young to blow their own noses, use a nasal aspirator to remove sticky nasal fluids if the child is uncomfortable. Call your doctor if nasal discharge turns from clear to yellow, green, or gray.

Professional Treatment:
RSV infection is not treated with antibiotics, since these drugs do not work against viruses. An antiviral medicine called ribavirin may sometimes be given to very ill children who are hospitalized for severe pneumonia caused by RSV.

Younger children, especially infants, who have severe RSV pneumonia or bronchiolitis may need to be treated in a hospital. There they can receive specialized respiratory therapy, including humidified oxygen and medicines to open up their breathing passages.

When to Call Your Pediatrician:
Call your doctor if your child has any of the following: fever over 101 degrees F (38.3 degrees C); thick nasal discharge that is yellow, green, or gray; cough that lasts more than four days; cough that produces yellow, green, or gray mucus; chest pain; difficulty breathing; very rapid breathing; bluish or gray color of the lips, skin or fingernails; or is less alert than usual. Of course, call if you have any questions or concerns.

In infants, in addition to symptoms already mentioned, call your doctor if your child is unusually irritable or inactive, or if he refuses to breast-feed or bottle-feed.

Also, ask your child's doctor if your child would benefit from the RSV vaccine, Synagis.