What Is RSV?

A highly contagious viral illness in infants and young children

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Respiratory syncytial virus (RSV) is a common, highly contagious illness that often causes mild upper respiratory symptoms, similar to a cold. However, in infants, older adults, and patients with weakened immune systems or certain underlying health problems, RSV can cause serious lower respiratory illnesses.

There is no cure for RSV; rather, treatment involves managing the symptoms (e.g., drinking fluids and lowering fever), as well as monitoring closely for breathing problems, which may warrant hospitalization.

RSV infection occurs most commonly from December through March. The vast majority of children have been infected with RSV at least once by the age of 2.

RSV Symptoms

Though RSV can present with many symptoms of the common cold, this infection can have serious complications, especially for very young children. Even if you are not sure if you're right about the symptoms being exhibited, it is best to get them evaluated.

Respiratory Syncytial Virus Symptoms
Verywell / Gary Ferster

In Infants and Young Children

In infants and young children, the symptoms of RSV are usually limited to the upper respiratory tract (e.g., nose, throat, and sinuses), and they tend to develop in stages.

For example, a baby or child may develop a clear runny nose and decreased appetite followed by a mild cough a couple of days later. This may then be soon followed by sneezing and a fever.

Of note, very young infants may become irritable or exhibit decreased activity as their only symptom.

Severe symptoms of RSV may develop one to three days after cold symptoms have begun. They indicate that the illness has spread to the lower respiratory tract—specifically, the tiny airways that connect to the child's lungs (a condition called bronchiolitis) and/or to the lungs themselves (pneumonia).

Severe Symptoms

Symptoms of a severe RSV illness in infants and young children may include:

  • High fever
  • Fast breathing rate
  • Wheezing
  • Coughing persistently
  • Problems feeding due to fast breathing rate or severe nasal congestion
  • Apnea (a pause in breathing for more than 15 or 20 seconds)

While any infant or young child is considered at risk for RSV, some particular groups are considered high risk for developing severe RSV symptoms. These groups include: 

  • Premature babies
  • Infants younger than 6 months old
  • Children younger than 2 years old with chronic lung or heart disease
  • Children with weakened immune systems
  • Children with neuromuscular disease, congenital heart disease or lung malformations, or chronic lung disease

When to Seek Immediate Medical Attention

Call 911 immediately if any of these symptoms or signs occur:

  • Nasal flaring (wide flaring of the nostrils with each breath)
  • Difficulty breathing (e.g., fast breathing, labored breathing) or not breathing at all
  • Retractions (the skin around the ribcage is sucked in with each breath)
  • Grunting
  • Extreme drowsiness
  • Cyanosis (appearance of blue lips, fingernails, or skin)
  • Severe coughing spells
  • Pale skin
  • Anxious, agitated demeanor

In Older Children and Adults

Like infants and young children, healthy adults and older children with RSV usually develop a mild upper respiratory tract illness with cold symptoms, such as:

  • Nasal congestion
  • Sore throat
  • Cough
  • Headache
  • Fatigue
  • Fever

Severe Symptoms

Severe symptoms of RSV in older children and adults include:

  • Significant coughing
  • Wheezing
  • Chest tightness
  • Problems breathing

These symptoms indicate that the illness has progressed to a lower respiratory tract infection, such as pneumonia or bronchitis.

Adults who are particularly at risk for developing a severe RSV illness include:

Causes

RSV is a contagious virus that is spread through contact and droplet transmission. This means that anyone who comes in contact with the nasal or oral secretions of someone infected with RSV can become infected themselves.

For example, you may become infected if someone with RSV sneezes or coughs, and the virus particles go into your eyes, nose, or mouth.

Touching a toy (or another object like a crib rail or doorknob) that a child sick with RSV has touched can also lead to transmission of RSV.

Direct contact, such as kissing a child with RSV, can spread the virus as well.

Diagnosis

The diagnosis of RSV is made by a medical history and physical examination. These will also help guide a doctor in recommending a treatment plan and determining whether or not hospitalization is necessary.

For infants and children, a doctor will likely inquire about worrisome symptoms like a high fever or decreased activity, eating, or urination at home. They will also ask about underlying health problems like a history of heart or lung disease or prematurity. If a baby or child has RSV, certain health conditions (e.g., congenital heart disease or neuromuscular disease) are associated with an increased risk of progressing to a lower respiratory tract infection like bronchiolitis.

They will also check for the presence of nasal flaring, an increased breathing rate, and/or low oxygen saturation.

Laboratory Testing

If a patient has a severe respiratory illness, or they have a respiratory illness and are considered high risk for developing severe illness if they have RSV, a laboratory test may be performed to see if the virus is present.

For infants and children, the rapid antigen test is often used. This test involves taking a swab of nasal secretions from the child's nose. Results are usually back within thirty minutes to an hour.

For older children and adults, for whom the rapid antigen test is not as sensitive for detecting the RSV antigen, a test called the polymerase chain reaction (PCR) is used. This test also involves taking a swab of nasal secretions. A benefit to the PCR test is that it looks for a spectrum of respiratory viruses, not just RSV.

Imaging tests, like a chest X-ray, are reserved for severe cases of breathing problems, like those that warrant a potential intensive care unit (ICU) admission.

Treatment

There is no medication to cure RSV. For most children and adults, RSV infection causes only cold symptoms, so the treatment is no different than that used to treat any other cold at home.

However, in some people, especially babies, the breathing difficulties that result from RSV require hospitalization.

Home Care

Treatment for RSV is supportive, meaning it is intended to manage symptoms until the virus runs its course. In addition to supportive care (e.g., fever reduction and drinking ample fluids), it's important to closely monitor for worsening symptoms and to contact your doctor with any concerns.

Fever Reduction

Be sure to also ask your doctor about the specifics of when and how to treat fever. Remember to never give aspirin to any child under the age of 18 to avoid the risk of developing a serious illness called Reye's syndrome.

Hospital Care

In the hospital, besides close monitoring, supportive treatments may include oxygen therapy, nasogastric (through the nose) or intravenous (through the vein) fluid administration, and in severe cases, mechanical ventilation (a breathing machine).

Prevention

There is no vaccine against RSV, although researchers are hard at work trying to develop one. At this time, the best way to prevent RSV infection is to use good hand hygiene.

Here are some helpful strategies to prevent against RSV infection:

  • Wash hands thoroughly and frequently with soap and water.
  • Avoid close contact with others (especially if they are sick) and shaking hands.
  • Do not share food utensils or cups.
  • Avoid touching your face (until you have washed your hands).
  • If possible, avoid high-risk settings (e.g., recreation centers, shopping centers).
  • Regularly clean and disinfect household and work surfaces that are frequently touched (e.g., doorknobs or light switches).
  • Everyone in a household, including infants 6 months and older, should get a flu shot every year as soon as they are available.

If you are a parent or guardian, these additional tips can help keep your little one protected:

  • Make sure anyone who touches your child washes their hands first.
  • Keep your child away from crowds and large groups, no matter the setting.
  • Keep your child away from tobacco smoke and secondhand smoke.
  • Whenever possible and reasonable, especially if your baby is at high risk for RSV infection, limit their participation in childcare settings during flu season.

It's also important to be mindful of others. If you are sick with cold symptoms, be sure to cover your mouth when you cough or sneeze with a tissue to minimize the spread of your illness. Also, stay away from those who are at high risk for a severe RSV illness.

Synagis (Palivizumab)

Synagis is an intramuscular (injected into the muscle) monoclonal antibody that helps prevent severe lower respiratory tract illnesses in premature babies and children at high risk of RSV. It's typically given once a month during RSV season for a maximum of five months.

This therapy is only indicated for children who are less than 24 months old; older children and adults are not candidates.

Synagis is not a vaccine and it cannot cure or treat a child who is already diagnosed with RSV. If your child is at very high risk for RSV infection, your pediatrician may discuss this option with you.

A Word From Verywell

The bottom line here is that while RSV is a common illness that usually causes run-of-the-mill, cold symptoms, it can be very serious in certain individuals, especially infants, older adults, and those with a weakened immune system or certain underlying health conditions.

In the end, educating yourself about this illness can help you be on the alert if you or a loved one contracts it. Let's hope too that with more research, scientists can develop a safe and effective RSV vaccine.

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Article Sources
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