Respiratory Syncytial Virus

Joseph Halphen PA-C, Lake After Hours Central

Like the flu or common-cold virus, Respiratory syncytial virus (RSV) is a seasonal virus. The start of the season varies from one part of the country to the next, but it usually starts in the fall and continues into the spring. In different parts of the country, the length of the RSV season may vary. In Louisiana the season is typically form October to around mid-March.

RSV causes infection of the lungs and breathing passages and is a major cause of respiratory illness in young children. RSV can present in adults as well but it is more commonly seen in young children usually before the age of two. The symptoms in most infants are similar to those of a bad cold, they include fever, prominent runny nose and nasal congestion. The duration of these symptoms is one to two weeks. During the first RSV infection, between 25%-40% of infants and young children also have signs and symptoms of bronchiolitis or pneumonia. Bronchiolitis is a clinical state of infants (by definition) during which inflammation of the terminal airways restricts airflow and may produce wheezing. The majority of children hospitalized for RSV infection are under six months of age, especially in premature babies and infants with underlying health conditions. In the US, it accounts for approximately 18% of ER visits and 20% of admissions to the hospital due to acute respiratory infections in children under five years of age. The need for supplemental oxygen, IV fluids, and pulmonary inhalation therapy are the most common indicators for hospitalization. If wheezing causes an infant's respiratory rate to increase substantially, they may have a difficult time taking in adequate fluids and become dehydrated.

The diagnosis of RSV is made by taking a thorough medical history, doing a physical exam and performing a rapid RSV test. The rapid RSV tests are available at all Lake After Hours locations. It is important to differentiate between RSV, Influenza and other illness which can affect the upper respiratory system (e.g. bacterial pneumonia). One study found that 17% of children suspected of having an RSV infection actually had Influenza A.  Usually only one sample from the patient is required to run both the RSV and influenza tests. By testing for both viruses, your provider will be able to determine if the child has an RSV or influenza infection. It is important to obtain the correct diagnosis so that the proper form of treatment will be administered, which may help prevent the child from being prescribed inappropriate medications such as antibiotics or antivirals which are not necessary to treat RSV.

For children with mild RSV, no specific treatment is necessary other than the treatment of symptoms such as Tylenol (acetaminophen) to reduce fever. Children with more severe disease may require oxygen and sometimes (rarely) mechanical ventilation. Immunoprophylaxis with palivizumab is available for high-risk groups. The majority of the time RSV is uneventful and supportive treatment is all that is necessary.  Frequent hand washing and not sharing items such as cups, glasses, and utensils with children who have RSV illness should decrease the spread of virus to others.