10 questions & answers about respiratory syncytial virus (RSV)
1. What is RSV and how is it spread?
Respiratory syncytial virus (RSV) is a virus that causes respiratory infection. Older children and adults under 65 years of age usually do not have any serious symptoms. RSV infection usually begins with symptoms of the common cold. Almost all children have had RSV at least once during the first two years of life. Most of the time, the illness is mild. However, in infants under six months of age, people over 65 years of age, and people with weakened immune systems, RSV can cause serious illness.
RSV is spread from person to person through droplets released into the air when someone who is sick coughs, sneezes, or breathes. This virus can also be spread through close contact, such as kissing or shaking hands with someone who is sick and has the virus on their hands. The virus can also be spread through droplets that land on surfaces or objects that you touch and then touch your nose, mouth, or eyes, where you can become infected with the virus. RSV can survive for several hours on various surfaces, especially hard surfaces such as toys and doorknobs. It takes three to five days from the time a child is infected with RSV for symptoms to appear.
In newborns and infants the virus is usually spread by older siblings who go to daycare or school. A child who has had RSV once does not develop full and lasting immunity. Therefore, the same child can get sick with RSV again, but usually with milder symptoms. Most cases of RSV occur annually during the winter season, especially in February and March.
2. What are the common symptoms of RSV infection?
The RSV virus usually causes symptoms of the common cold. However, infants under six months of age often develop more severe respiratory symptoms four to six days after the initial symptoms of the disease. It may then take several weeks for full recovery.
An RSV infection usually begins with the following symptoms:
- Runny nose and congestion, often with sticky, gelatinous mucus.
- Fever.
- Refusal to feed.
- Weakness, fatigue.
- In very young infants, irritability, decreased activity, and/or episodes of apnea may be the only symptoms of the infection.
A severe cough
The cough usually appears after a few days. It can be very bothersome and last for several weeks.
3. How can I help my child at home?
- Nasal decongestion
Saline nasal drops can help decongest the nose and make breathing much easier by breaking up mucus and making it less sticky. Saline drops can be given several times a day and it is especially important to give them before the child eats or sleeps. For children over one year old, you can also use decongestant nasal drops or nasal sprays. These types of drops and sprays should not be used for more than ten days.
- Fluid intake
It is important for the child to get enough fluids. Breastfeed or feed your child more often than usual if he or she cannot tolerate eating enough at each meal.
- Position that favors the child’s breathing
Raise the bed mattress, for example, by placing extra pillows, under the point where the child rests his head when sleeping. This reduces swelling of the nasal mucosa.
- Antipyretics when necessary
Give an antipyretic if your child is very affected by the fever, if for example he is so tired that he cannot bear to eat or drink.
- Do not smoke near the child
Avoid smoking near children or in the environment in which children live. Cigarette smoke in the child’s environment significantly increases the risk of respiratory problems in combination with respiratory infections.
4. What are the serious symptoms of RSV infection?
While in most cases the symptoms are mild, RSV can cause worsening of underlying diseases or serious complications, which can be life-threatening. Respiratory complications of RSV infection include bronchiolitis (inflammation of the small airways of the lungs) and pneumonia (infection of the lungs).
In these cases, the child presents with:
- labored breathing with shallow and rapid breaths.
- retractions, i.e. the skin is sucked in during breathing movements. In young children, this is mainly observed under the ribs, just above the stomach or even between the ribs and on the neck.
- during breathing, the abdomen moves up and down noticeably more than the chest.
- breathing becomes noisy and may be heard as a gurgling or whistling sound.
Apnoea
RSV infection can also cause breathing to stop. This mainly occurs in infants under two months of age or infants of other ages who were born prematurely.
5. When and where should we seek care?
Contact your doctor immediately or seek help in an emergency department if you suspect that your child has an RSV infection and any of the following apply:
- is an infant under 3 months old and has a fever.
- has difficulty breathing.
- has difficulty breastfeeding, drinking, or eating.
6. When is hospitalization necessary and why?
Children who have severe respiratory symptoms require hospitalization. When the virus attacks the bronchioles (small airways in the lungs), gas exchange in the alveoli is impeded, oxygenation of the blood passing through the lungs is impaired, and oxygen saturation in the blood decreases. Then there is difficulty breathing, fatigue, a generally affected condition and an inability to take in fluids and food.
Therefore, treatment in the hospital includes
- Oxygen administration
- Inhaled medications that facilitate breathing
- Fluid administration, usually intravenously (serum).
Children who have severe respiratory problems for which the above therapeutic measures are not sufficient require hospitalization in an intensive care unit/or intensive care unit.
7. Which children are most at risk of becoming seriously ill?
Most people infected with RSV have mild symptoms of a common cold. However, some children may become seriously ill and require hospital treatment.
The risk of serious illness increases in:
- Infants younger than six months of age.
- Children younger than one year of age who were born prematurely.
- Children younger than two years of age with chronic lung disease.
- Children younger than two years of age with heart disease.
- Children younger than two years of age with neurological disease.
- Children with immunodeficiency.
It is especially important to protect children who are at risk of becoming seriously ill.
8. How can we as parents reduce the chance of a child getting sick from RSV?
- Wash your hands before coming into contact with the child. Use hand sanitizer if soap and water are not available.
- Avoid contact with people who are sick, even if they have symptoms of a common cold.
- Avoid crowded indoor spaces. Choose outdoor activities.
- Breastfeed if you can. Breastfeeding reduces the risk of respiratory infections.
- Do not smoke around your child.
9. Are there other ways to protect against RSV infection?
Infants and young children who are at increased risk for severe RSV infection can receive monoclonal antibodies against RSV (passive immunization). It is administered by injection: either a single dose of long-acting monoclonal antibodies (Nirsevimab) before the start of their first RSV season or a once-monthly dose (again monoclonal antibodies but not long-acting, Palivizumab) during their first RSV season. These agents can be administered to children up to 2 years of age if they continue to be at significant risk of severe RSV disease during their second RSV season. However, their administration does not help during active RSV infection.
The European Medicines Agency has approved two vaccines with the indication of active immunization for the prevention of RSV-associated lower respiratory tract infections in adults ≥60 years of age. One of these two vaccines has an additional indication for the immunization of pregnant women (at 24-36 weeks of gestation) to prevent RSV-associated lower respiratory tract infections in infants from birth to 6 months of age.
10 . Can RSV cause long-term respiratory problems?
Children who are younger than one year of age and have had a severe RSV infection are at increased risk of developing breathing problems that resemble asthma symptoms and are commonly associated with colds in preschoolers. RSV has been associated with the diagnosis of asthma in older children who are predisposed to asthma. However, there is no scientific evidence to suggest that RSV is a causative factor for asthma.
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