Respiratory Syncytial Virus (RSV) 

Evidence 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3461981/ 

Lea S. Eiland 

Respiratory Syncytial Virus (RSV) is a common virus that infects children and adults; however, children younger than two years of age tend to develop more serious respiratory symptoms. RSV is responsible for thousands of Emergency Department and GP visits, hospitalizations and can result in death. Treatment is primarily supportive care, and the illness resolves without complications in most children and adults. RSV prophylaxis with palivizumab is an option for high-risk infants and children.  Palizumibab can decrease hospital admission and length of stay. Immunocompromised patients are a special population in whom palivizumab may be used for treatment. Recent vaccine trials have shown that an RSV vaccine given to pregnant women are 80% effective in preventing severe disease within 90 days of birth.  The vaccine boosts the mother’s response to previous wild virus infections and the antibodies cross the placenta and protect the infant.  We hope that vaccines will decrease the mortality and economic burden of this disease. 

The preterm infant with RSV may present with poor feeding, apnoea, irritability, or lethargy. Apnoea is associated with up to 20% of hospitalizations in RSV-positive infants.  These infants were mostly born pre-term and are under 6 months of age. Infants present with constant clear rhinorrhea, cough, sneezing, fever, shortness of breath, wheezing, pharyngitis or respiratory distress. Cough and wheezing occur in 50% of infected children. 

Breast feeding has been shown to provide some protection against hospitalisation and severe disease 

Acknowledgements: 

https://www1.racgp.org.au/newsgp/clinical/possible-rsv-vaccine-is-very-exciting 

https://publications.aap.org/pediatrics/149/20Abstracts%%202022/280/185980/Impact-of-Breastfeeding-on-the-Incidence-and?

Education 

Respiratory syncytial (sin-city-al) virus (RSV) is the most common cause of respiratory and breathing infections in children. It is a virus that causes infection of the lungs and breathing passages and is one of the most frequent causes of the common cold. 

RSV is a leading cause of hospitalisation in young children. On average, the virus is responsible for almost 12,000 annual admissions to hospital by Australian children under 12 months of age. Infants with severe RSV may be admitted to ICU for additional oxygen, tube feeding, intravenous fluids, and ventilation. 

Severe RSV in infancy is linked to increased risk of recurrent wheezing and asthma, allergies, decreased lung function, and other long-term health issues. 

Those at greatest risk for severe illness from RSV include:  

• Premature infants 
• Infants, especially those 6 months and younger 
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease 
• Children with weakened immune systems 
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions.

In infants, the symptoms of RSV are similar to many other respiratory viruses and include a runny nose, coughing, sneezing, wheezing, loss of appetite, lethargy, and irritability.  

RSV can cause bronchiolitis or pneumonia so medical care is important for infants who display symptoms of severe RSV, including a high fever, shortness of breath and a greater effort required to breathe.  

Signs that a baby may have bronchiolitis or pneumonia include:  

• Rapid breathing (more than 40 breaths per minute) 
• Laboured breathing – tugging under and between the ribs and/or lower neck 
• Up and down head movements (bobbing) and/or grunting while breathing 
• Flared nostrils 
• Wheezing 
• Blue tint or changes to skin colour around the mouth and eyes

Call an ambulance or go to your nearest hospital emergency department if your child is turning blue, having trouble breathing, or is breathing very quickly. 

RSV is too serious and unpredictable to delay medical care. Babies and young children can deteriorate very quickly. If you suspect severe RSV or an associated lung infection, see a healthcare professional urgently. 

How is RSV spread? 

Children with RSV are usually infectious (able to pass the virus onto others) for at least eight days from the start of their symptoms. RSV is very contagious via droplet transmission and can live on surfaces for several hours, and on unwashed hands for 30–60 minutes. RSV spreads quickly and easily among children through coughing and sneezing and sharing cups and other objects that have been in contact with the infected child's mouth, nose, or eyes.  

It can be difficult to stop the spread of RSV; however, practising good hygiene will help avoid passing any virus onto others. 

Empowerment 

 If you have contact with an infant or young child, especially those who were born prematurely, have chronic lung or heart disease or a weakened immune system, you should take extra care to keep the infant healthy by doing the following: 

Wash your hands often 

Wash your hands often with soap and water for at least 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer. Washing your hands will help protect you from germs. 

Keep your hands off your face 

Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way. 

Avoid close contact with sick people 

Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms. 

Cover your coughs and sneezes 

Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward. 

Clean and disinfect surfaces 

Clean and disinfect surfaces and objects that people frequently touch, such as toys, doorknobs, and mobile devices. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects. 

Stay home when you are sick 

If possible, stay home from work, school, and public areas when you are sick. This will help protect others from catching your illness. 

There is a vaccine on the close horizon that will reduce the impact of RSV infection vaccine on infants and the at risk elderly. And there is a medicine that can help protect some babies at high risk for severe RSV disease. Healthcare providers usually give this medicine (called palivizumab) to very premature infants and young children with certain heart and lung conditions as a series of monthly shots during RSV season. If you are concerned about your child’s risk for severe RSV infection, talk to your child’s healthcare provider. 

Useful Links 

https://www.ifa.org.au/rsvandme/campaign 

https://www.rch.org.au/kidsinfo/fact_sheets/respiratory_syncytial_virus_rsv/ 

https://www.pregnancybirthbaby.org.au/colds-and-flu-in-babies-and-children#rsv