What is Respiratory Syncytial Virus Infection in Children?
The human respiratory syncytial virus, often referred to as RSV, is a common virus that mainly affects children across the globe and is becoming increasingly known to affect adults too, mainly the elderly. The typical result of an RSV infection is something similar to a common cold or upper respiratory infection. However, it can be serious in young kids, where it often leads to bronchiolitis. Bronchiolitis is an illness where the smaller airways in the lungs become blocked. In rare circumstances, RSV may even lead to pneumonia, breathing difficulties, halted breathing (apnea), or even death.
The primary treatment for most RSV infections is simply supportive care, which means easing symptoms while the body fights off the virus. However, there’s a special type of immunization available for young children at risk of severe disease, such as premature babies or those with past heart, lung, or neuromuscular diseases. There is only one antiviral medication specifically approved for RSV, but its use is limited due to concerns about how effective it is, possible side effects, and its cost. Therefore, it’s usually only recommended for patients at high risk of severe disease, and the decision to use it is made on an individual basis.
What Causes Respiratory Syncytial Virus Infection in Children?
RSV, or respiratory syncytial virus, is a type of virus that is structured like a wrapped ball containing proteins, with some proteins helping the virus attach to and fuse with host cells. This virus is part of the Paramyxoviridae family and belongs to the Pneumovirus group. It was first discovered in chimpanzees in 1955 and was soon after found to also cause infections in humans.
RLEVANT Yet, there are other similar viruses in the same group as human RSV that affect animals but do not infect humans, and we won’t talk more about these in this article. While all RSV viruses are the same type, they are divided into two strains, “A” and “B”. These strains differ mainly in the structure of some of their membrane proteins, particularly the one that helps the virus attach to cells.
Risk Factors and Frequency for Respiratory Syncytial Virus Infection in Children
RSV, or Respiratory Syncytial Virus, is a common virus that affects many people, especially children. Its capability to reinfect is due to the short-lived immunity after the first infection. By the age of two, 90% of children are likely to have been infected with RSV. Adults can also contract this virus multiple times.
Most people with RSV experience a respiratory illness that affects the upper part of their respiratory systems. However, a smaller group of people, particularly children under one year, may develop a more serious illness affecting the lower parts of their respiratory systems, such as bronchiolitis. In fact, 40% of primary RSV infections in children under one year result in bronchiolitis.
- Globally, RSV is linked to around 33 million lower respiratory tract illnesses.
- RSV leads to approximately three million hospital visits.
- It causes up to 199,000 deaths in children, mostly in countries with fewer resources.
RSV occurrences vary by season and geographic location. Areas with temperate climates see a spike in RSV cases in the winter and spring, while tropical and equatorial areas see less pronounced spikes and cases distributed more evenly throughout the year.
The impact of RSV is more significant in certain groups of people, including premature infants, people with pre-existing heart, lung, neurological or immune disorders, and the elderly. These individuals often experience much higher levels of harm and fatality from RSV infections.
Signs and Symptoms of Respiratory Syncytial Virus Infection in Children
RSV, or respiratory syncytial virus, usually begins as an illness affecting the upper part of the respiratory system. Depending on where the disease is located and how severe it is, the symptoms can vary. If the virus is just in the upper respiratory tract, you could see symptoms like a runny nose, nasal congestion, cough, sneezing, and sometimes even fever and muscle aches. In some people, particularly those under the age of 2 or those who are at risk for severe disease, RSV can progress to the lower respiratory tract. This can result in more severe symptoms.
- Runny nose
- Nasal congestion
- Cough
- Sneezing
- Fever (sometimes)
- Muscle aches (sometimes)
- Rhonchorous breath sounds
- Rapid breathing
- Use of extra muscles to breathe
- Wheezes
- Extended breathing out
In severe cases, RSV can present with additional symptoms like hypoxia (low oxygen levels), lethargy (extreme tiredness), apnea (pauses in breathing), and acute respiratory failure.
Testing for Respiratory Syncytial Virus Infection in Children
Getting a diagnosis for Respiratory Syncytial Virus (RSV) and following bronchiolitis is usually based on the symptoms you may be experiencing and doesn’t typically involve any specific tests or scans. Doctors don’t usually recommend testing for RSV unless the results could change the treatment approach.
However, there are times when specific testing may help distinguish RSV from other health conditions. There are two key tests used for this purpose: rapid antigen testing and polymerase-chain-reaction-based (or PCR) testing. Rapid antigen testing is done quickly, inexpensive, and it can be easily performed using a sample from your nose. The downside is, it’s only about 80% accurate, especially during an RSV outbreak.
On the other hand, PCR testing is becoming more popular because it’s highly accurate, can give results quickly, and can detect a range of different organisms. The downside of PCR testing is that it tends to be more expensive and requires specialized equipment to perform.
Imaging, like a chest x-ray, can sometimes show symptoms similar to RSV such as bronchiolitis. These might include signs of hyperinflation, patchy atelectasis (a condition where the air sacs in the lungs collapse or fill with fluid), and peribronchial thickening (thickening of the tubes that carry air in and out of your lungs). However, these indicators can be hard to differentiate from bacterial pneumonia, and should always be evaluated within the context of your overall health and symptoms.
Treatment Options for Respiratory Syncytial Virus Infection in Children
The treatment for RSV, or Respiratory Syncytial Virus, generally falls into three categories: supportive care, the use of immune-boosting medication, and antiviral medication. RSV is a common illness that often doesn’t require specific medical treatments. However, scientists continue to research potential vaccines and treatments.
The primary approach to treating patients with RSV is supportive care. This can include using a nasal suction device and lubricants to alleviate nasal congestion, using medicine to manage a fever, and assisting with hydration, either by mouth, through a nasal feeding tube, or directly into a vein. Oxygen may also be provided for patients struggling to breathe. For severe cases, the patient may require a ventilator, a machine that helps with breathing, to support their respiratory system. Hospital stays are suggested for patients who are experiencing, or are at risk for severe illness, need additional fluid intake, or require help with their breathing.
A medication called palivizumab is available that can provide passive immune protection against RSV. Palivizumab works by targeting a protein on the RSV virus, preventing it from binding to and infecting host cells. However, this medication is expensive and needs to be given monthly throughout the RSV season, which has led to some debate about its cost-effectiveness. It’s generally reserved for children less than a year old who were born very prematurely, have chronic lung disease, heart disease, or neuromuscular disorders.
An antiviral drug called ribavirin is approved for use against RSV in the United States. This medication works against several types of RNA viruses, including RSV. However, its use is controversial due to its cost, potential risks to healthcare workers exposed to it, and doubts about its effectiveness. Therefore, the routine use of ribavirin is discouraged, but it can be considered on a case-by-case basis.
Two other medications, palivizumab and nirsevimab, can help prevent RSV. These are both monoclonal antibodies, a type of medication designed to target specific cells or proteins. Palivizumab is given monthly during the RSV season, while nirsevimab is given as a single dose. Both of them are less expensive and may be more effective than ribavirin.
Other treatments for RSV’s effect on the lungs, a condition called bronchiolitis, have been tried. These include medications such as albuterol, racemic epinephrine, steroids, hypertonic saline, antibiotics, and chest physiotherapy. However, these treatments have not consistently shown to be effective and are not generally recommended.
What else can Respiratory Syncytial Virus Infection in Children be?
- Asthma
- Bronchiolitis
- Influenza
- Croup
- Bronchitis
- Pneumonia
What to expect with Respiratory Syncytial Virus Infection in Children
Kids who are admitted to the hospital due to an RSV infection usually get better without any lasting health issues. They typically stay in the hospital for about 3 to 4 days. Infants who are at high risk may need to stay in the hospital longer and are more likely to require mechanical breathing help or need to be cared for in the intensive care unit.
People who have been infected with RSV are able to spread the virus to others for 3 to 8 days. However, some babies and people with a weakened immune system can still spread the virus even after their symptoms have ended, sometimes for as long as 4 weeks.