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Respiratory Syncytial Virus

Introduction
Signs and symptoms
Causes
Risk Factors
Screening and diagnosis
Treatment
Prevention

In adults and older, healthy children, the symptoms of respiratory syncytial virus are mild and typically mimic the common cold. Self-care measures are usually all that's needed to relieve any discomfort.

Infection with respiratory syncytial virus can be severe in some cases, especially in premature babies and infants with underlying health conditions. RSV can also become serious in older adults and adults with heart and lung diseases.

Signs and symptoms of respiratory syncytial virus infection typically appear about four to six days after exposure to the virus. In adults and children older than 3, RSV usually causes mild cold-like signs and symptoms. These include:

• Congested or runny nose
• Dry cough
• Low-grade fever
• Sore throat
• Mild headache
• A general feeling of unease and discomfort (malaise)

In children younger than 3 years of age, respiratory syncytial virus can lead to a lower respiratory tract illness such as pneumonia or bronchiolitis - an inflammation of the small air passages entering the lungs. Signs and symptoms may include:

• High fever
• Severe cough
• Wheezing - a high-pitched noise that's usually heard on breathing out (exhaling)
• Rapid breathing or difficulty breathing, which may make the child prefer to sit up rather than lie down
• Bluish color of the skin due to lack of oxygen (cyanosis)

Infants are most severely affected by RSV. They may markedly draw in their chest muscles and the skin between their ribs, indicating that they are having trouble breathing, and their breathing may be short, shallow and rapid. They may cough. Or they may not show any signs of a respiratory tract infection, but will eat poorly and be unusually lethargic and irritable.

Most children and adults recover from the illness in eight to 15 days. But in young babies, infants born prematurely, or infants or adults who have chronic heart or lung problems, the virus may cause a more severe - occasionally life-threatening - infection that requires hospitalization.

Respiratory syncytial virus enters your body though your eyes, nose or mouth. It spreads easily when infectious respiratory secretions - such as those from coughing or sneezing - are inhaled or passed to others through direct contact, such as shaking hands. The virus can also live for hours on objects such as countertops and toys. Touch your mouth, nose or eyes after touching a contaminated object, and you're likely to acquire the virus.

An infected person is most contagious in the first few days after infection, but RSV may spread for up to a few weeks after the start of infection.

By age 2, most children will have been infected with respiratory syncytial virus. Children who attend child care centers or who have siblings who attend school are at a higher risk of exposure. So are infants who are exposed to high levels of air pollution or cigarette smoke. Susceptibility is also greater during the peak RSV season, which typically begins in the fall and ends in the spring.

People at increased risk of severe - sometimes life-threatening - infections include:

• Infants younger than 6 months of age
• Younger children, especially under 1 year of age, who were born prematurely or who have an underlying condition, such as congenital heart or lung disease
• Children with weakened immune systems, such as those undergoing chemotherapy or transplantation
• Older adults
• Adults with congestive heart failure or chronic obstructive pulmonary disease

During the exam, he or she may listen to the lungs with a stethoscope to check for wheezing or other abnormal sounds.

Your doctor may also use:

• Painless skin monitoring to check whether the level of oxygen available in the bloodstream is lower than usual
• Blood tests to check white cell counts or to look for the presence of viruses, bacteria or other organisms
• Chest X-rays to check for pneumonia

In addition, your doctor may collect respiratory secretions from your nose to test for the virus in a lab.

Antibiotics, which doctors prescribe to treat bacterial infections, are of no use against respiratory syncytial virus because it's a viral infection. However, your doctor may prescribe antibiotics if there's a bacterial complication, such as middle ear infection or bacterial pneumonia.

Otherwise, he or she may recommend an over-the-counter medication such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others), depending on your age. These medications reduce fever but won't cure the infection or make it go away sooner.

Treating severe cases
In cases of severe infection, hospitalization may be necessary to provide intravenous (IV) fluids and humidified oxygen. Hospitalized infants and children may also be hooked up to mechanical ventilation - a breathing machine - to ease breathing.

In some severe cases, a nebulized bronchodilator such as albuterol (Proventil, Ventolin) may be used to relieve wheezing. This medication opens air passages in the lungs. Nebulized means it's administered as a fine mist that you breathe in. Occasionally, a nebulized form of ribavirin (Rebetol), an antiviral agent, may be used. Your doctor may also recommend an injection of epinephrine or a form of epinephrine that can be inhaled through a nebulizer (racemic epinephrine) to relieve symptoms of RSV infection.

No vaccine exists for respiratory syncytial virus. But common-sense precautions can help prevent the spread of this infection:

• Wash your hands frequently. Do so particularly before touching your baby, and teach your children the importance of hand washing.
• Avoid exposure. Limit your infant's contact with people who have fevers or colds. This is especially important in premature babies and all infants in the first 2 months of life.
• Keep things clean. Make sure countertops are clean in the kitchen and bathrooms, especially when someone in your family has a cold. Discard used tissues right away.
• Don't share drinking glasses with others. Use your own glass or disposable cups when you or someone else is sick. Label each person's cup.
• Don't smoke. Infants who are exposed to tobacco smoke have a higher risk of contracting RSV and potentially more severe symptoms. If you do smoke, never do so inside the house or car.
• Wash toys regularly. Do this especially when your child or a playmate is sick.

Protective medication
In addition, the medication palivizumab (Synagis) can help protect children under age 2 who are at high risk of serious complications when they get RSV, such as those born prematurely or with congenital heart or lung disease.

Synagis works by providing the necessary antibodies to protect against respiratory syncytial virus. It requires a monthly injection into the muscle tissue of the thigh during the peak RSV season, beginning in the fall and continuing for about five months (usually November through April). Injections are repeated every year until the child is no longer at high risk. The medication doesn't interfere with childhood vaccines.

Use of this treatment decreases the frequency and length of hospitalization for respiratory syncytial virus infections. But the high cost of the medication limits its use to those at highest risk of complications from RSV infections. The medication isn't helpful in treating respiratory syncytial virus infection once it has developed. Talk to your doctor if you think your child may qualify for this treatment.

Scientists are working to find a vaccine against the respiratory syncytial virus not only in infants but also in older adults and high-risk adults.