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Respiratory Syncytial Virus (RSV)

What is respiratory syncytial virus (RSV)?

RSV is the most common cause of inflammation of the small airways in the lungs (bronchiolitis) and pneumonia in babies. It is an illness that often occurs in yearly outbreaks in communities, school classrooms, and day care centers. In the U.S., RSV is more common in winter and early spring months.

What causes RSV?

RSV is spread from respiratory secretions through close contact with infected people or contact with contaminated surfaces or objects. Infection can occur when infectious material contacts mucous membranes of the eyes, mouth, or nose, and possibly through the inhalation of droplets generated by a sneeze or cough. The time from exposure to symptoms (incubation period ) is about 2 to 5 days.

Who is affected by RSV?

RSV can affect a person of any age. Most babies have been infected at least once by the time they are 2 years old. Babies can also be re-infected with the virus. Recurrence throughout life is common. RSV infection in older children and adults may seem like an episode of severe asthma. Babies born prematurely or with heart, lung, or immune system diseases are at increased risk of more severe illness.

Why is RSV a concern?

In babies at increased risk, infection with the virus can lead to severe respiratory illness and pneumonia, and may become life-threatening. RSV in infancy may be related to development of asthma later in childhood. Adults with RSV infection may have severe asthma.

What are the symptoms of RSV?

The early phase of RSV in infants and young children is often mild, somewhat like a cold. In children younger than 3, the disease may progress into the lower airways and cause coughing and wheezing. In some, the infection progresses to a severe respiratory disease requiring hospitalization to help the child breathe.

The following are the most common symptoms of RSV:

  • Runny nose

  • Fever

  • Cough

  • Apnea (periods without breathing)

  • Trouble eating, drinking, or swallowing

  • Wheezing

  • Flaring of the nostrils or straining of the chest or stomach while breathing

  • Breathing faster than usual, or trouble breathing

  • Turning blue around the lips and fingertips 

The symptoms of RSV may look like other conditions or medical problems. Always see your baby's healthcare provider for a diagnosis.

How is RSV diagnosed?

Diagnosis is sometimes hard because the symptoms of RSV can look like other infections. Illness in other family members, other babies in the hospital nursery, or the time of year may provide clues. In addition to a complete medical history and physical exam of your child, a test (nasal swab or nasal wash) of the baby's respiratory secretions may show the presence of a virus.

What is the treatment for RSV?

There are no medicines used to treat the virus itself. Care of a baby with RSV involves treating the effects of the virus on the respiratory system. Because a virus causes the illness, antibiotics are not useful, unless there is also a bacterial infection. Treatment may include:

  • Supplemental oxygen

  • Breathing treatments

  • Suctioning of mucus

  • IV (intravenous) fluids to prevent dehydration

  • Tube feedings (if the baby has trouble sucking)

Children with very serious breathing problems are put on ventilators (a machine that helps with breathing).

How can RSV be prevented?

The American Academy of Pediatrics (AAP) recommends that babies at high risk for RSV receive a medicine called palivizumab. Ask your child's healthcare provider if your child is at high risk for RSV. If so, ask about monthly injections during RSV season to help prevent RSV.

To reduce the risk for RSV and other viral infections, the AAP recommends all infants, especially preterm infants:

  • Be breastfed

  • Avoid exposure to smoke

  • Avoid high-volume child care settings during their first winter season

  • Avoid contact with sick people

Other members of the household need to get a flu shot and clean hands with alcohol-based hand cleaners before and after touching babies with RSV.

Medical Reviewers:

  • Freeborn, Donna, PhD, CNM, FNP
  • Lentnek, Arnold, MD