Childhood Respiratory Diseases Rsv

Respiratory syncytial virus (RSV) is a common virus that causes inflammation of the lungs and breathing passages. RSV is a major cause of respiratory illness in children under three years of age and a common cause of infant bronchiolitis, inflammation of the small airways in the lungs.

About 250,000 infants with respiratory syncytial virus are hospitalized annually in the United States. One to two percent of infant RSV cases requiring hospitalization prove fatal.

RSV Transmission

Respiratory syncytial virus is spread through contact with infected nasal fluids and saliva. This virus enters the body when the eyes and nose are touched. Kissing, hugging and holding hands can all promote the transmission of RSV.

RSV occurs across the globe, usually appearing in epidemics because the virus has a high contagion rate. In the northern hemisphere, respiratory syncytial virus epidemics tend to occur between the late fall and early spring. An RSV epidemic can last as long as five months.

In general, RSV tends to affect children between two to six months old, with a peak incidence rate between two and three months of age. The disease is often passed to infants by older siblings who contracted the virus at school. When respiratory syncytial virus infects preschools and daycare centers, a 100 percent infection rate is common.

Clearly, RSV is a particularly contagious virus. During an epidemic, approximately 50 percent of children exposed to infected individuals will catch respiratory syncytial virus. This staggering number is due, in part, to the fact that the virus can survive in the environment for several hours outside of a host body.

By age two, almost all children will have been infected with respiratory syncytial virus at least once. While the body builds up a resistance to RSV infections, complete immunity is not possible.

Symptoms of RSV

In children older than age three and in adults, respiratory syncytial virus usually causes symptoms similar to the common cold. Symptoms can include:

  • low fever
  • mild cough
  • mild headache
  • runny nose
  • sore throat
  • stuffy nose.

Children younger than age three often exhibit symptoms similar to those listed above. However, in some cases, RSV causes lower respiratory infections in infants, including bronchiolitis and pneumonia. Infants with severe respiratory infections and bronchiolitis may develop more severe symptoms, such as:

  • cyanosis (bluish skin)
  • difficulty breathing
  • fever over 101 F
  • nasal flaring
  • rapid breathing
  • severe cough
  • thick brown, green or yellow mucus
  • wheezing.

Babies with severe RSV experience abnormal chest muscle movements when breathing: The chest muscles retract between the ribs due to labored breathing. Infants breathing in this manner or exhibiting symptoms of severe respiratory syncytial virus should receive immediate medical assistance. Don’t attempt to treat such symptoms at home.

Risk Factors for Severe Respiratory Syncytial Virus

With such a high contagion rate, almost everyone catches RSV at some point. Children in daycare or school are particularly likely to contract RSV. The virus also travels quickly in hospital settings.

Premature babies have a high risk of developing bronchiolitis or other respiratory syncytial virus complications. The same is true for infants with heart, lung or immune disorders.

The risk of bronchiolitis in infants due to RSV is very high: One in nine infants will develop bronchiolitis in the first year of life. Children exposed to tobacco smoke or living in crowded conditions have a higher than normal risk of developing bronchiolitis or severe cases of respiratory syncytial virus.

Home Treatment for RSV

Doctors typically recommend treating mild cases of respiratory syncytial virus at home. Because RSV is a virus, antibiotics are of no use. As a result, home treatment focuses on symptom relief and keeping the child comfortable.

Home treatment options revolve around:

  • applying small amounts of petroleum jelly just under the nostrils to soothe irritation
  • keeping the child well-hydrated to keep nasal secretions thin and easy to clear
  • using a cool mist vaporizer to relieve coughing and soothe the nasal passages
  • using a rubber aspirator to clear the infant’s nasal passages (Ask your doctor how to use one properly.)
  • using saline drops to loosen hard nasal mucus.

Mild fever may be treated with acetaminophen (e.g., Tylenol®). Never use aspirin to treat a child’s fever: Aspirin can cause Reye’s syndrome, a serious health complication that affects children’s brains and livers.

If RSV symptoms worsen, breathing becomes difficult or if nasal mucus thickens and turns yellow, green or brown, contact your doctor immediately.

Severe Respiratory Syncytial Treatment

Severe cases of RSV, which can result in pneumonia or bronchiolitis, may require hospitalization. The standard treatment for severe respiratory syncytial virus includes having the child breath humidified oxygen, take medication to open inflamed air passages and receive intravenous hydration.

The bronchodilator albuterol, which is also used to treat asthma, may also be used to open airways and relieve wheezing. In especially severe cases of respiratory syncytial virus pneumonia, the antiviral medication ribavirin may be administered. However, some doctors question ribavirin’s effectiveness in combating RSV.

RSV, Bronchiolitis and Asthma

Bronchiolitis and pneumonia symptoms affect 25 percent to 40 percent of infants infected with respiratory syncytial virus. Childhood bronchiolitis has been associated with a higher risk of asthma in later life.

The connection between RSV-caused bronchiolitis and asthma is unclear. Medical experts don’t know whether bronchiolitis itself increases the risk of asthma or whether an existing predisposition toward asthma increases the risk of bronchiolitis.

RSV Prevention

Regular and thorough hand washing is the best protection against respiratory syncytial virus. Older children should be encouraged to use proper hand washing hygiene and should stay away from younger siblings if they have mild RSV symptoms.

While no vaccine against RSV exists, children at high risk of respiratory syncytial virus may be prescribed palivizumab. Palivizumab, a medication that provides temporary protection against respiratory syncytial virus, is often prescribed to premature infants and young children with heart and lung disorders.

Palivizumab is administered by intramuscular injection once a month through the autumn months. It provides some degree of protection during the RSV season of fall to spring.

Note that palivizumab is not long-acting: Children requiring protection against respiratory syncytial virus must receive plaivizumab on a regular basis for it to be effective.

Resources

Centers for Disease Control and Prevention (updated January 21, 2005). Respiratory Syncytial Virus. Retrieved September 18, 2007 from the CDC Web site: http://www.cdc.gov/ncidod/dvrd/revb/respiratory/rsvfeat.htm.

Mayo Clinic (updated October 4, 2006). Respiratory Syncytial Virus. Retrieved September 18, 2007 from the Mayo Clinic Web site: http://www.mayoclinic.com/health/respiratory-syncytial-virus/DS00414.