Infectious Diseases

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Respiratory Syncytial Virus (RSV)

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What is RSV?

Respiratory Syncytial Virus or (RSV) is a respiratory illness caused by a virus. Anyone can be infected but RSV most often causes serious illness in infants, young children, elderly, and those with a weakened immune system.

How is it spread?

Transmission usually is spread by direct or close contact with contaminated secretions, which may involve droplets or fomites. RSV can persist on environmental surfaces for many hours.

What are the symptoms?

RSV causes acute respiratory illness in people of all ages. Illness begins most frequently with fever, runny nose, cough, and sometimes wheezing. RSV can cause repeated infections throughout life, usually associated with moderate-to-severe cold-like symptoms; however, severe lower respiratory tract disease may occur at any age, especially among the elderly or among those with compromised cardiac, pulmonary, or immune systems.

How soon do symptoms of RSV appear?

2-8 days after exposure with 4-6 days being most common.

How is RSV diagnosed?

RSV can be diagnosed by having a nasopharyngeal or throat swab done. Most clinic laboratories use antigen detection assays to diagnose infection.

What is the treatment for RSV?

Primary treatment is supportive and should include hydration and careful clinical assessment of respiratory status. Ribavirin is a costly aerosolized medication that is reserved mainly for certain high risk children. A decision about ribavirin administration should be made on the basis of the particular clinical circumstances and experience of the physician.

How do I protect myself and others?

You can help stop the spread of RSV by washing your hands after coughing or sneezing, before preparing foods and before eating. If you do cough or sneeze, cover your nose and mouth with a tissue. At this time, there is not a vaccine for RSV. RSV medication is available to decrease risk of RSV hospitalization in high-risk children and infants.

 
Two vaccines are available. Palivizuma and RSV-IGIV are recommended for infants younger than 2 years of age and have chronic lung disease. Premature infants may benefit from RSV prophylaxis even if they do not have chronic lung disease.

 
In infants and young children, RSV is the most common cause of bronchiolitis and pneumonia. Lethargy, irritability, and poor feeding, sometimes accompanied by apneic (periods of not breathing) episodes are the major symptoms. Almost every child will be infected at least once by 2 years of age, and reinfection is common.

Transmission occurs through direct or close contact with contaminated secretions. RSV can persist on environmental surfaces for many hours and on hands for 30 minutes or more.

Children may be contagious prior to onset of symptoms and for up to 8 days after symptoms appear.

Children may attend childcare facilities if not suffering from fever and are well enough to participate in daily activities.

People infected with RSV are usually contagious for 3 to 8 days. However, some infants and people with weakened immune systems can be contagious for as long as 4 weeks. RSV is often introduced into the home by school-aged children who are infected with RSV and have a mild upper respiratory tract infection, such as a cold. RSV can be rapidly transmitted to other members of the family, often infecting about 50% of other household members.

RSV can be spread when droplets containing the virus are sneezed or coughed into the air by an infected person. Such droplets can linger briefly in the air, and if someone inhales the particles or the particles contact their nose, mouth, or eye, they can become infected.

Infection can also result from direct and indirect contact with nasal or oral secretions from infected persons. Direct contact with the virus can occur, for example, by kissing the face of a child with RSV. Indirect contact can occur if the virus gets on an environmental surface, such as a doorknob, that is then touched by other people. Direct and indirect transmissions of virus usually occur when people touch an infectious secretion and then rub their eyes or nose. RSV can survive on hard surfaces such as tables and crib rails for many hours. RSV typically lives on soft surfaces such as tissues and hands for shorter amounts of time.

Frequent handwashing and wiping of hard surfaces with soap and water or disinfectant may help stop infection and spread of RSV. Also, persons with RSV illness should not share cups or eating utensils with others.

Ideally, persons with cold-like symptoms should not interact with high-risk children. If this is not possible, these persons should cover their mouth and nose when coughing or sneezing and then wash their hands before providing any care. They should also refrain from kissing high-risk children while they have cold-like symptoms. When possible, limiting the time that high-risk children spend in child-care centers or other potentially contagious settings may help prevent infection and spread of the virus during the RSV season.

  • Specifically, people who have cold-like symptoms should:
  • Cover their coughs and sneezes.
  • Wash their hands frequently and correctly (with soap and water for 15–20 seconds).
  • Avoid sharing their cups and eating utensils with others.
  • Refrain from kissing others.

In addition, cleaning contaminated surfaces (such as doorknobs) may help stop the spread of RSV.

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