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Respiratory Syncytial Virus Infection

Causes and incidence

Antibody titers seem to indicate that few children under age 4 escape contracting some form of RSY, even if it's mild. In fact, RSV is the only viral disease that has its maximum impact during the first few months of life (incidence of RSV bronchiolitis peaks at age 2 months).

This virus creates annual epidemics that occur during the late winter and early spring in temperate climates and during the rainy season in the tropics. The organism is transmitted from person to person by respiratory secretions and has an incubation period of 4 to 5 days.

Re-infection is common, producing milder symptoms than the primary infection. School-age children, adolescents, and young adults with mild re-infections are probably the source of infection for infants and young children.

Signs and symptoms

The following are the most common symptoms of RSV. However, each baby may experience symptoms differently. Symptoms may include:

• runny nose
• apnea
• listlessness
• fever
• poor feeding
• wheezing
• retractions (pulling in) of the chest wall
• rapid breathing
• cough

The symptoms of RSV may resemble other conditions or medical problems. Always consult your baby's physician for a diagnosis.

Diagnosis

Rapid tests for this virus can be performed at many hospitals on fluid obtained from the nose. Listening to the chest with a stethoscope ( auscultation ) may reveal wheezes or other abnormal lung sounds.

Tests used in the diagnosis of RSV include:

• a chest X-ray (may show pneumonia or bronchiolitis)
• arterial blood gas analysis (demonstrates decreased oxygen saturation)

Treatment

Prevention

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

Treatments can be given to protect infants who are at highest risk for severe illnesses if they are infected with RSV, such as those who were born prematurely or those with chronic heart and lung disease. These treatments provide temporary immunity against RSV. One treatment, palivizumab, is given as monthly intramuscular injections during the autumn months and provides protection throughout the typical RSV season. Unlike a vaccine, its protection is short-lived and has to be repeated in following years, until the child is no longer at severe risk from RSV infection.