Respiratory Syncytial Virus

  • Respiratory syncytial virus (RSV)

    Respiratory syncytial virus (RSV) is a viral organism that can cause upper and lower respiratory tract infections. It most commonly causes bronchiolitis (inflammation of the lower airways) and pneumonia in children and infants under the age of 1.

    Children's approach to RSV: prevention

    A study of children age 7 and younger coming to Children's Emergency Department with acute respiratory illnesses found that those infected with RSV had more than twice as many emergency department visits and six times more hospitalizations than those with seasonal flu.

    Children's encourages parents to focus on the prevention of RSV by recommending: handwashing, alcohol-based hand-sanitizers and simply staying home when sick. Learn more about the flu-whether seasonal flu, RSV or H1N1.

    If your child is at Children's being treated for RSV, our healthcare workers will wear special isolation apparel such as gowns and gloves when they enter your child's room.

    Children's Hospital Boston
    300 Longwood Avenue
    Boston MA 02115

     fax: 617-730-0373

  • In the United States, RSV is more common during the winter and spring months. For most children and infants, RSV is a virus that can be managed on an outpatient basis. However, about 0.5 to 2 percent of children and infants who develop RSV may require hospitalization. The disease usually runs its course in one to two weeks. Children who are at risk for developing more severe cases or RSV include the following:

    • children/infants younger than 1 year, particularly those between 6 weeks and 6 months
    • premature infants
    • children/infants with breathing or heart problems
    • children/infants with weakened immune systems
    • children/infants with weakened immune systems

    How is RSV transmitted?

    RSV transmission occurs by coming in contact with infectious material either from another individual or inanimate object. The secretions from the eye, mouth, or nose (and possibly from a sneeze) contain the virus. The virus can also survive for many hours on inanimate objects such as doorknobs, hard surfaces and toys. It can also live on human hands for up to 30 minutes.

    If my child has RSV, how long will he or she be contagious?

    After being exposed to the virus, symptoms may not appear for four to six days. An individual with RSV is usually contagious for three to eight days, although this may be longer in younger children.

    Symptoms of RSV

    The following are the most common symptoms of RSV infections. However, each child may experience symptoms differently. Symptoms may include:

    • lethargy and inactivity
    • irritability
    • poor feeding
    • episodes of apnea (more common in infants; an event where an infant may not take a breath for longer than 10 seconds)
    • nasal discharge that is usually clear
    • fever
    • wheezing (a high-pitched sound usually heard on inspiration, breathing in)
    • rapid breathing
    • cough
    • retractions (pulling in) of the chest wall
    • nasal flaring
    • rattling in the chest that may be felt over an infant's back or chest
  • How is RSV diagnosed?

    Children's doctors will begin by reviewing your child's complete medical history and then conduct a physical examination. Other diagnostic tests for RSV may include:

    • culture of your child's nasal drainage
    • chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film
    • pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood
  • RSV has been underappreciated. There's been disproportionate attention given to influenza, even though our data show morbidity to be very high from RSV. Based on our data, much more should be done in terms of prevention.

    Florence Bourgeois, MD, MPH of Children's Division of Emergency Medicine and the Children's Hospital Informatics Program.

    There is no cure for RSV, so if your child is infected treatment is supportive (aimed at treating the symptoms present). The care of your child or infant involves treating the effects of the virus on the respiratory system. Because a virus causes the infection, antibiotics are not useful.

    Treatment for RSV may include:

    • keeping your child well hydrated by encouraging fluids by mouth (if necessary an intravenous (IV)
       line may be started to give your child fluids and essential electrolytes)
    • bronchodilator medications administered in an aerosol mist by a mask or through an inhaler (to open
       your child's airways)
    • supplemental oxygen through a mask, nasal prongs, or an oxygen tent
    • anti-viral aerosol medication (generally used only with very high-risk children)
    • mechanical ventilation or a "respirator" (to assist with breathing for a period of time)

    Preventive medications and RSV

    Two medications are recommended for babies and children at high risk for RSV to protect them against the serious complications of the illness. This includes children with weakened immune systems, organ recipients, and premature infants. These are usually given monthly during the RSV "season" from late fall through spring.

    These medications are not vaccines, and do not prevent the virus. However, they do lessen the severity of the illness and may help shorten the hospital stay.

  • With H1N1 starting to recede and seasonal flu debuting, researchers in Children's Division of Emergency Medicine report a huge toll from another virus that's been hugely overlooked; respiratory syncytial virus, or RSV. Florence Bourgeois, MD, MPH, and colleagues studied children age 7 and younger who came to the Emergency Department (ED) with acute respiratory illnesses from 2001 to 2006. Among their finding, published in last month's Pediatrics:

    • Children infected with RSV had more than twice as many ED visits and six time more hospitalizations that those with seasonal flu.
    • Parents of children with RSV missed almost three times more workdays than parents of children with seasonal flu.
    • Parents of children under age 2 were nearly five times more likely to miss work when their child had RSV versus seasonal flu.
    • RSV-related illnesses were twice as likely as seasonal flu to lead to additional clinic visits and antibiotic treatment.

    Though this study used data from the pre-H1N1 era, the flu-prevention measures preached here and everywhere — handwashing, alcohol-based hand sanitizers, staying home when sick — still apply. RSV strikes virtually all young children and is a common cause of bronchiolitis and pneumonia. It's a particular threat in premature infants, children with weakened immune systems and the elderly.

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