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Respiratory Syncytial Virus (RSV)

Respiratory Syncytial Virus (RSV) is a major cause of respiratory tract illness across all ages.  The virus is generally present between October and April.  In adults and older children, RSV causes nothing more than common cold symptoms.  In infants, however, RSV can spread to the lower respiratory tract and cause bronchiolitis (infection of the lower airways) and pneumonia.  While only a fraction of infants with RSV will develop lower respiratory tract disease, the symptoms may be severe enough to cause trouble breathing, poor feeding, and dehydration.  The younger the infant is, the higher the likelihood that bronchiolitis will develop, and the more severe the symptoms can be.  It is unusual to see bronchiolitis above two years of age.

In all children, RSV starts out with common cold symptoms, including congestion, cough, and a possible fever.  Infants that develop bronchiolitis will begin to wheeze after a few days of congestion.  The signs and symptoms you may see include labored and fast breathing, worsening cough, and poor feeding.  The wheezing episode is at its worst by 2-3 days and generally subsides by 4-5 days, although wheezing may be prolonged in very young infants.

Your child can be tested for RSV with a nasal washing that can be run at a laboratory station.  The test detects the presence of RSV proteins within one hour.  However, we can usually diagnose RSV clinically and we rarely send a child for testing.

Like any virus that causes a common cold, there is no medicine that will cure RSV.  Antibiotics are not effective because RSV is a viral illness.  If your child has nothing more than common cold symptoms, you should treat your child accordingly.  If your child is wheezing, you should watch your child's breathing and fluid intake carefully.  We occasionally will try a nebulized Albuterol treatment in the office, and we may also send your child home with a nebulizer.  Albuterol is a bronchodilator (opens airways up) that is used in children who have asthma.  However, Albuterol has been shown to help RSV bronchiolitis only about 20% of the time.  Steroids, which are used regularly in severe wheezing caused by asthma, have no effect with RSV bronchiolitis.

Children who were born prematurely with immature lungs, have chronic lung disease, or chronic heart disease are at particular risk for severe RSV bronchiolitis.  Some infants born prematurely, and some infants with chronic lung or heart ailments, are eligible to receive a monthly injection of an RSV antibody preparation called Synagis.  Synagis does not prevent RSV, but it will make the course of the illness considerably less severe.  We usually identify our children who are eligible for Synagis before the start of the RSV season, but you may contact us if you have questions about your child's eligibility.

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