Respiratory syncytial virus (RSV)
RSV; bronchiolitis; pneumonia; respiratory; syncytial; virus; viral; wheeze;
Contents
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia in young children under the age of 12 months. RSV infections are very common. About 50% of children first get the infection before they are 12 months old, and almost all children will have had an RSV infection by the time they are two years old.
During their first RSV infection, between 25% and 40% of young children will develop bronchiolitis or pneumonia, but less than 2% will need to be admitted to hospital. Most of those who need admission will be under 6 months old. The children at greatest risk are babies who were born very prematurely, or those with other health problems.
RSV illness
Incubation period
- Symptoms start developing about 5 days after catching the infection (though it can be as early as 2 days, or as late as 10 days).
Symptoms
- The illness usually begins with a fever, runny nose and cough. The illness usually is like a very bad cold, often with a sore throat and bronchitis.
- On average people recover in about 10 days.
RSV in infants
After 1 to 3 days, some young children will get wheeziness, rapid breathing, flaring of the nostrils and signs that breathing is hard work (for example, the ribs move in and out more than usual). This is bronchiolitis.
- The infection causes the linings of the airways to swell, narrowing the airways, causing wheezing and making breathing hard.
- A baby may be coughing so much and having such difficulty breathing that it is hard for him to drink. There is a risk of dehydration if children do not get enough drinks. (See our topic 'Bronchiolitis' for more information.)
Infants who develop bronchiolitis due to RSV are more likely to go on to have asthma later. It is not known if the infection causes asthma or whether children who are going to develop asthma later are more likely to get bronchiolitis when they get sick with RSV.
RSV in children
- RSV can trigger asthma in children.
- Many children with RSV infections develop ear infections.
- Some children will develop pneumonia, an infection in the lungs. They have narrowing of the smallest airways of the lungs and increased mucus production. They become short of breath and have a cough, but are less wheezy than children with bronchiolitis. (See our topic 'Pneumonia'.)
RSV in older children and adults
People can be re-infected with RSV several times during their life.
- It will usually cause moderate to severe cold-like symptoms.
- However, it can cause pneumonia at any age, especially among elderly people or others who are already unwell, such as people with heart, chest or immune system problems.
- Adults and older children with RSV can spread the infection to babies and young children.
- RSV is spread from droplets of mucus coughed or sneezed up, or mucus from a runny nose.
- Spread happens when there is close contact with a person who is infected, or when the droplets land on surfaces and are carried by another persons hands to their eyes, mouth or nose.
- In South Australia, RSV infections usually occur each year in winter and early spring, but the timing and severity of the infections can vary from year to year.
Infectious period
- The person who has been infected is probably infectious from a day or so before becoming unwell to about the time that they start becoming well again (about 10 days).
- There are several ways that it can be shown that a child's illness is due to RSV, including blood tests and looking for the virus in mucus from the nose and throat.
Treatment of bronchiolitis
- Often the illness is mild, and does not need any special treatment. It is important that a baby is encouraged to have her normal amount to drink (breast or formula feeds), but smaller feeds more often may be easier to manage if she is short of breath.
- Vaporisers, humidifiers, or using other ways to put steam into the air, have not been shown to be helpful for babies with bronchiolitis.
- If a baby is very distressed, and having trouble feeding, she may need to be admitted to hospital where she can be closely observed, given oxygen and sometimes extra fluid through a drip (intravenous therapy).
- Bronchiolitis 'looks like' and 'sounds like' asthma, but the treatments that work for older children with asthma often do not help with bronchiolitis, although they may be tried in hospital to see if they help.
- Have a look at the topic 'Bronchiolitis' for more information.
Treatment of RSV and related problems
- There is no specific treatment for RSV infections - antibiotics do not work with viral infections.
- Treatments for symptoms may help the child feel more comfortable (see our topics 'Fever', 'Colds', 'Bronchitis' and 'Ear infections').
- Children who are unwell may not feel like eating as much as usual for several days, and this is not a problem, but they need to be encouraged to continue to drink.
- Sometimes a bacterial infection in the ears, sinuses or chest can develop on top of the RSV infection, and antibiotics may then be useful.
When to see the doctor
- Seek urgent help if your child has difficulty breathing, is breathing fast or is unable to feed normally because of coughing and wheezing.
- See a doctor if the child does not start to get well after a one or two days, or starts to become more unwell.
Protecting others from RSV
- There is no vaccine yet for RSV.
- The infection is most likely to spread in the early days, when it may appear that the child just has a cold (before wheezing starts). Children or adults who are unwell with the early signs of a cold should avoid close contact with babies and young children.
- Do not send children with the early signs of a cold to child care, pre-school or school, as they may spread the infection to other children.
- Children or adults who may have RSV should not visit frail elderly people or those who are already unwell.
- Washing hands and cleaning surfaces can help to reduce the spread of the infection. The virus survives for a few hours on surfaces. It will be killed by soap and water, and other disinfectants.
- Staff at child care centres and pre-schools should ensure that children do not share cups, spoons or other utensils, or toys that they put into their mouths. Toys should be washed after they have been played with.
References
Centers for Disease Control and Prevention (CDC) 'Respiratory Syncytial Virus'. http://www.cdc.gov/ncidod/dvrd/revb/respiratory/rsvfeat.htm
Chen, S. 'Respiratory syncytial virus/bronchiolitis', in Mosby's Pediatric Clinical Advisor. Garfunckel, L.C., Kaczorowski, J., Christy, C. (Eds), Mosby 2002.
Department of Health (SA) 'Respiratory syncitial virus (RSV) infection'
http://www.dh.sa.gov.au/pehs/ygw/respiratoryryncytial-pehs-sahealth-2009.pdf
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.