Sneeze, Cough and Fever: RSV Season Is Coming

RSV infections are particularly common among the very young and the elderly.

By Jennifer Turney MSN, RN, CNS, CPN, contributor

Nasal congestion, fever and cough will soon become the most common complaint infiltrating doctor’s offices, clinics and emergency departments this winter. The culprit is often respiratory syncytial virus, commonly known as RSV. 

RSV is a seasonal ribonucleic acid (RNA) virus that occurs in temperate climates. Although people of any age can develop a RSV infection, severe infection is most common in the very young and the elderly (CDC, 2014a). It is the most common respiratory virus found in infants and young children and is thought to virtually infect all infants by the time they reach the age of two years old (CDC, 2014a &c).

High risk groups include: premature infants, children younger than 2 years of age with underlying conditions such as congenital heart or chronic lung disease, children with compromised immune systems due to a medical condition or medical treatment, adults with compromised immune systems and adults 65 years and older (CDC, 2014a). 

RSV is most commonly spread by physical contact. According to the CDC (2014b), the virus can live up to five hours on countertops and for several hours on used tissues. RSV is transmitted directly via large droplets during close contact with people who are infected, or indirectly via RSV-contaminated hands and surfaces. Daycare settings and play areas provide a multitude of sources to facilitate transmission of infection. The surfaces of toys, high chairs, and infant seats may be contaminated with RSV (CDC, 2014b). 

Most individuals infected with RSV are contagious for 3 to 8 days. Infants and individuals with weakened immune systems can be contagious for up to 4 weeks (CDC, 2014b). 

RSV continues to cause the majority of visits to healthcare facilities, and most children that become infected with RSV will primarily complain of cold-like symptoms. However, other children may become seriously ill and require hospitalization. RSV may cause mild, cold-like symptoms (nasal congestion, mild fever, and cough) in adults and healthy older children, but can cause bronchiolitis and pneumonia in children less than one year of age (CDC, 2014a). When infants and children are exposed to RSV for the first time, 25% to 40% of them have signs or symptoms of bronchiolitis or pneumonia (CDC, 2014a). 

Minor symptoms such as nasal congestion, mild fever, and cold-like complaints are often easily managed at home and recovery occurs within 1-2 weeks (CDC, 2014a).  Children or adults with symptoms such as nasal flaring, tachypnea, labored breathing, severe wheezing, uncontrolled fever, and cyanosis should seek medical care and may require hospitalization (CDC, 2014d). 

Most children hospitalized for RSV are less than 6 months of age and about 0.5 % to 2 % of children will require hospitalization (CDC, 2014a). Treatment for RSV is primarily supportive with emphasis on keeping the child hydrated and keeping oxygen saturations within normal range (CDC, 2014d).  Since antibiotics are not effective for viral diseases, antibiotic therapy is not indicated for RSV (AAP, 2014). 

Development of an RSV vaccine is a high research priority, but a vaccine is not yet available (CDC, 2014b & Turner et al., 2014). Synagis® (Palivizumab) is a monoclonal antibody that helps prevent serious lower respiratory tract disease caused by RSV in children at high risk for RSV disease and works by slowly increasing antibody levels (Turner et al., 2014). Synagis ® is approved for use in high risk infants under two years of age that have lung problems related to chronic bronchopulmonary dysplasia (BPD) or prematurity (AAP, 2014 & Turner et al. 2014).

One factor that is beneficial to help control and prevent RSV is that the virus is unstable in the environment and is usually easily inactivated with soap and water and disinfectants (CDC, 2014b). Instructing healthcare workers, parents, family members, and friends to follow simple guidelines for frequent and thorough handwashing can help prevent the spread of RSV infection (CDC, 2014b). Also, instruct parents to not share cups, eating utensils or food with a child or person with cold-like symptoms, and avoid cigarette smoke (CDC, 2014b). 

Inform parents with high-risk young infants that they should avoid crowds during outbreaks of RSV (CDC, 2014b). Ultimately, frequent handwashing, wiping down surfaces and avoiding crowds will minimize the risk of spreading RSV.

Learn more about RSV by taking Respiratory Syncytial Virus on RN.com

American Academy of Pediatrics [AAP] (2014). Clinical practice guideline: the diagnosis, management and prevention of bronchiolitis. Pediatrics, 134(5). e1474-e1502. Retrieved from: http://pediatrics.aappublications.org/content/early/2014/10/21/peds.2014-2742.full.pdf+html
Centers for Disease Control & Prevention [CDC] (2014a). Respiratory Syncytial Virus: Infection and Incidence. Retrieved from: http://www.cdc.gov/rsv/about/infection.html
Centers for Disease Control & Prevention [CDC] (2014b). Respiratory Syncytial Virus: Transmission and Prevention. Retrieved from: http://www.cdc.gov/rsv/about/transmission.html
Centers for Disease Control & Prevention [CDC] (2014c). Respiratory Syncytial Virus: Trends and Surveillance. Retrieved from: http://www.cdc.gov/rsv/research/us-surveillance.html
Centers for Disease Control & Prevention [CDC] (2014d). Respiratory Syncytial Virus: Symptoms and Care. Retrieved from: http://www.cdc.gov/rsv/about/symptoms.html
Turner, T.L, Kopp, B.T., Paul, G. Landgrave, L.C. Hayes Jr., D. & Thompson, R. (2014) Respiratory syncytial virus: current and emerging treatment options. ClinicoEcomonics and Outcomes Research. 6. 217-225. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008286/

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