Respiratory syncytial virus (RSV): Symptoms, Treatment and Prevention

Overview

What is Respiratory syncytial virus ?

Respiratory syncytial virus is a respiratory disorder that affects the nasal passages, throat, lungs, and respiratory tract. RSV affects humans of all ages, including children and adults. In children under one year old, respiratory syncytial virus (RSV) is the main cause of bronchiolitis and pneumonia in the United States.¹Overview| Researched based study from Nlm.nih.gov

RSV follows seasonal patterns with higher cases seen during autumn and winters.

Prevalence

Prevalence of RSV

RSV usually strikes children around their second birthday.

• The transmission of the virus is highly significant among young children, particularly in home sitting or school environments. This occurs due to the close proximity of children and the chances for them to share goods with a contagious fellow student.

• RSV is respiratory for approximately 58,000 hospitalizations annually in children under the age of 5 in the United States ³Prevalence| Researched based study from Nlm.nih.gov . Approximately 177,000 adults are hospitalized annually due to respiratory syncytial virus (RSV), with 14,000 fatalities occurring among individuals aged 65 and above.

• Globally, RSV impacts approximately 64 million individuals and results in 160,000 fatalities each year.

Causes

Which medical conditions are brought on by RSV infection?

RSV has become a common cause for:

Bronchiolitis

• Airways of lungs become infected.

Pneumonia

• Infection of the lungs.

Croup

• Infection affecting the voice box and windpipe.

Apnea

• Difficulty in breathing.

Ear infection

• It can be painful with some ear discharge.

Exacerbation of pre existing illnesses

• RSV can increase the risk of lung or heart diseases like asthma and heart block.

Infection

How does it occur?

• RSV is a single-stranded RNA Paramyxovirus with a coat. Most of the time, RSV only affects the respiratory tract, and there is bronchial congestion.
• RSV makes copies of itself and attaches itself to the bronchiolar epithelium, killing the cell.
• There is an extra production of mucus which causes swelling. So, the small tubes become obstructed. This causes hyperinflation and atelectasis (collapse of lung). It leads to inflammation and tissue damage.

Risk factors

Risk factors of RSV

Certain factors increase the risk of acquiring RSV. They are:

Lack of awareness

• Parents and other adults who don’t know enough about preventive steps put babies at a higher risk.

Day-care attendance

• Another risk factor is the number of people who come into touch with the child, either at home or elsewhere.

Passive smoke exposure

• Being around tobacco smoke is one of the most likely external causes of lung infections in babies.

Babies born at full term who have lung disease

• RSV illness in full-term babies is more likely if they already have a lung problem.

Immunosuppressed individuals

• Severe RSV sickness is a known problem that can sometimes kill people who have had bone marrow or organ transplants.

Transplantation of the lungs

• In lung transplant patients, RSV virus is linked to a high rate of illness and death. ²Risk factors| Researched based study from Resmedjournal.com

Other risk factors include:

• School going kids
• Male gender
• Birth in the six months before the RSV season
• Crowded spaces of living
• Multiple births
• Adults more than 65 years of age
• Getting babies out of the newborn ICU in the winter
• Infants who suffer from BPD (bronchopulmonary dysplasia), CHD (congenital heart disease), or are immune-compromised, like kids with HIV, are more likely to get a more serious form of RSV disease.
• Low birth weight
• Family history of asthma
• Abnormalities of lung airways
• Body mass <5kgs

Symptoms

Symptoms of RSV

After exposure to the virus, symptoms may appear as soon as one day or up to 10 days later, although they often appear within 5 days. Symptoms often stay for one to two weeks.

Most individuals get mild to severe illnesses that go away on their own. Symptoms resembling those of a common cold may be present and can include the following:

• Runny nose
• Sore throat
• Cough
• Sneezing
• Fever
• Generalized aches
• Headache
• Ear pain
• Loss of appetite

Preterm infants infected with respiratory syncytial virus (RSV) may exhibit symptoms such as:

• Feeding difficulties
• Apnea: Apnea is prevalent in approximately 20% of hospitalizations among infants who test positive for respiratory syncytial virus (RSV), particularly among pre-term and young neonates.
• Irritability
• Lethargy

Infants typically exhibit symptoms such as:

• Persistent clear nasal discharge
• Coughing
• Sneezing
• Fever
• Difficulty in breathing
• Wheezing
• Pharyngitis
• Respiratory distress

Symptoms and signs of severe respiratory infections, such as bronchiolitis, pneumonia, and croup, may include:

• Severe physical discomfort or illness
• Symptoms of wheezing or difficulty breathing may manifest as rapid, shallow, or irregular breathing patterns
• Blue discoloration or paleness of the skin
• Experiencing significant fatigue or irritability
• Experiencing reduced food and beverage intake compared to their typical consumption
• Persistent or high fevers
• Exacerbating cough or productive cough

It is advisable to seek medical attention if symptoms persist, worsen, or if there are indications of severe respiratory infections.

Criteria for hospitalization:

The criteria were drawn from European research on the treatment of RSV-infected children.

• Hospitalization is necessary for infants with suspected respiratory syncytial virus (RSV) infection when they experience severe respiratory distress, such as apnea, cyanosis, polypnea (respiratory rate of 60 breaths per minute), or transcutaneous oxygen saturation below 92-94% while breathing air.

• Additional reasons for hospitalization include infants aged over 6 weeks (or 3 months for those born prematurely) due to the potential occurrence of difficulty in breathing, challenges with feeding, presence of underlying conditions like bronchopulmonary dysplasia (BPD) or cardiomyopathy, and/or unfavorable living conditions.

Transmission

Spread of RSV

RSV can be transmitted through various means:

• Infected person emits respiratory droplets through coughing or sneezing.
• Direct contact with the virus can occur through activities such as kissing the face of a child infected with respiratory syncytial virus (RSV).
• The mucosa of the nose and eyes seem to be similarly susceptible entry points for viruses.
• When an individual comes into contact with a contaminated surface, such as a doorknob, and then touches their face without washing their hands.
• RSV has the ability to remain viable on solid surfaces, such as tables and cot rails, for longer periods of time. It usually has a shorter lifespan on fragile surfaces such as tissues and hands.

Is RSV contagious?

• RSV is a highly contagious respiratory virus transmitted through close contact via respiratory droplets
• RSV-infected individuals are contagious for a duration of 3 to 8 days, with the ability to transmit the virus a day or two prior to the onset of symptoms. But, certain infants and individuals with compromised immune systems have the potential to transmit the virus for up to four weeks, even after the disappearance of visible symptoms.
• RSV season typically starts in autumn and reaches its highest point during the winter in the majority of regions in the United States and other similar climatic zones.
• Due to its prolonged viability on surfaces, it is important to maintain regular hand hygiene and disinfect frequently-touched surfaces in order to stop the transmission of this virus.

Diagnosis

Diagnosis of RSV

RSV infections usually receive a diagnosis based on clinical symptoms as examined by your healthcare professionals.

Most of the children suffering from cold, cough and breathing difficulties can be diagnosed by the doctor itself, but the confirmation of RSV can be only done using PCR test.

Laboratory diagnosis

• It can be done using viral isolation by rapid diagnostic tests like RT-PCR. The virus is isolated and the sensitivity of viral load is assessed.

• The virus can also be detected using a PCR test on a nasal or throat swab.

Shell vial culture

• This assay gives the diagnosis within the next 48 hours.

Immunofluorescent assay

• It is a rapid direct antigen detection test that is done for hospitalized infants.

Enzyme immunoassay (EIA) method and Optical immunoassay (OIA)

• These are the most frequently done rapid detection tests in infants.

RT-PCR

• RT-PCR for the diagnosis of RSV infections has greater rates of sensitivity and specificity than any other diagnostic acid. It determines the strain group of RSV.

Treatment

Treatment of RSV

No drug exists to treat RSV, like other colds. But there are many options to make your child feel better at home, including:

Relieve congestion

• Administer small amounts of nasal saline solution into each nostril and then put a suction tube to extract the nasal discharge. This will help in clearing out the nasal passages.

Utilize steam

• To increase moisture levels in the chair in the bedroom, you must use a mist humidifier, and provide steamy baths. Water vapor helps to reduce congestion.

Honey

• For children, aged one year or even older, honey is considered as a potential remedy for reducing symptoms of cough. Honey has the same efficacy as the over-the-counter cough medication.

Reduce pain

• You can administer acetaminophen to infants older than 2 months or ibuprofen to infants older than 6 months, as necessary to relieve fever or discomfort. These medications can relieve muscle aches, headaches, and sore throats. A warm washcloth can be applied to the affected ear to alleviate ear pain.

Maintain hydration

• Breast milk or formula are optimal sources of hydration for infants due to their nutritional composition.
• For older adults, drinking plenty of water along with use of ORS solution is the optimal choice to maintain hydration.

Oxygen supplementation

• It is necessary for individuals with oxygen saturation levels below 90%. It is also recommended for those who are unable to maintain their saturation levels above 90%.

Mechanical ventilation

• It is indicated for individuals experiencing respiratory failure and/or severe apnea.

Bronchodilators

• Inhaled bronchodilators, such as albuterol and epinephrine, have been found to be effective in the treatment of respiratory syncytial virus (RSV).

Ribavirin

• Ribavirin is the sole FDA-approved medication for the treatment of respiratory syncytial virus (RSV).

• It has antiviral properties that stops the replication of DNA and RNA viruses. However, this medication has adverse effects such as headaches, nausea, rash, and chest pain.

• This aerosolized agent is administered for a duration of 8-24 hours over a period of 3-5 days. Pregnancy is a contraindication of ribavarin.

Heliox

• Heliox is a combination of helium and oxygen that is inhaled, and has been investigated in clinical trials. It gives enhanced ventilation and reduced respiratory effort.

Palivizumab

• It is a monoclonal antibody. Parents of preterm infants with underlying lung conditions should consult their healthcare provider regarding the potential use of Palivizumab (Synagis) to reduce the risk of severe infection. Monthly intramuscular injections are administered during the RSV season.⁴Treatment| Researched based study from Nlm.nih.gov

• The American Academy of Pediatrics (AAP) recommends administering this monoclonal antibody medication to high-risk infants and young children who are likely to benefit from immuno -prophylaxis due to their age of delivery and some underlying medical conditions.

Prevention

Prevention of RSV

Below are few tips for the prevention of RSV:

• Frequently cleanse your hands using soap and warm water for a minimum duration of 20 seconds prior to rinsing. In the absence of soap and water, alcohol-based hand sanitizer can be used as an alternative.

• It is advisable to refrain from touching one’s face, specifically the hands, nose, and mouth.

• It is recommended to use a tissue or the inside of your elbow to cover coughs and sneezes.

• It is recommended to practice hand hygiene by washing your hands after coughing or sneezing. Dispose off the used tissue in the dustbin.

• Disinfect frequently touched surfaces, which are commonly accessed and handled by multiple individuals. Examples of commonly touched surfaces include doorknobs, countertops, and toys.

• Minimize contact with individuals who are infected with RSV or any other contagious disease.

• Minimize duration of exposure in densely populated or communal environments, such as childcare facilities, supermarkets, or indoor shopping centers.

• If possible, remain at home if you or your child are experiencing illness.

• Perform a COVID-19 test at home. The isolation protocols for infants/children who test positive for COVID differ from the preventive and treatment measures given for RSV.

• If you have a very young child who was born at 29 weeks or earlier or a child or adult with congenital lung disease, try to keep them away from family members who have respiratory viruses or symptoms.

• Maintaining social distancing is important to reduce the transmission of many infectious diseases.

• It is advisable to ventilate indoor spaces or maintain open windows to allow air circulation.

• It is advisable to wear a mask in indoor environments or in situations where there is a high density of people.

• Get yourself a flu vaccination.

Is there an RSV vaccine available for prevention and protection?

• Currently, there is no available vaccine for the prevention of RSV infection. However, ongoing efforts by scientists are focused on the development of a vaccine. The CDC has identified a medication palivizumab, also known as Synagis, to premature infants and young children who have specific heart and lung conditions. This medication is typically given as a monthly injection throughout the respiratory syncytial virus (RSV) season.⁵Prevention| Researched based study from Cdc.gov

Takeaway

Takeaway

Each year, millions of kids are affected by the RSV illness. The primary treatment involves supportive care, which includes nutrition, hydration, clearing of nasal secretions, and, if necessary, administration of oxygen.

To prevent the transmission of RSV, it is important to practice effective handwashing techniques and follow contact isolation measures.

Palivizumab should be administered to individuals who have risk factors and meet the inclusion criteria in order to prevent RSV infections. Hence, it is noticed that prevention is the optimal way to stop the occurrence and severity of RSV infection.