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Respiratory Syncytial Virus | Overview

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.

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, 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.

What are the symptoms of RSV?

These are the most common symptoms of RSV infections. However, each child may experience symptoms differently.

  • 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 we approach RSV

A study of children age 7 and younger coming to our 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.

We encourage 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 here being treated for RSV, our healthcare workers will wear special isolation apparel such as gowns and gloves when they enter your child's room.

Respiratory Syncytial Virus | Diagnosis & Treatments

How is RSV diagnosed?

Our 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 under appreciated. 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 Division of Emergency Medicine and the Children's Hospital Informatics Program

How we treat RSV

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

Respiratory Syncytial Virus | Programs & Services