Young Ju, Ph.D.

Respiratory Syncytial Virus (RSV) is a common seasonal respiratory virus that causes cold-like symptoms usually during fall, winter, and spring. However, just as we are getting out of the COVID-19 pandemic, RSV infection cases are rapidly increasing and becoming unseasonal.  Combined with increased travel for tournaments and holiday events and decreased social distancing and masking, it is important to be aware of the risks of RSV infection and what you can do to prevent it.

Respiratory Syncytial Virus

Human RSV, discovered in 1956, is a widespread human pathogen.  Immunity does not last long after an RSV infection, and reinfection occurs frequently.

During the COVID-19 pandemic, one unexpected benefit from social distancing and wearing face masks was prevention of the spread of all kinds of respiratory disease, including flu and RSV.  In 2020, RSV cases dropped by 97.4% from seasonal averages. In 2021, RSV cases exceeded those in 2019 with the infectious season starting as early as June coinciding with the loosening of masking and social distancing rules.  In 2022, RSV cases are even higher than 2021. Flu cases have also been increasing. Many states are filling up hospital beds quickly, and the number of emergency department and urgent care visits has doubled and even tripled in some areas.  Although the exact reasons are not fully understood, one of the leading theories raised by researchers is increased susceptibility to RSV infection due to decreased exposure to respiratory viruses due to taking COVID-19 precautions.

RSV Infection among Children

RSV is the main cause of respiratory tract infections in children worldwide and is the leading cause of hospitalization in infants.  According to the US Center for Disease Control and Prevention (CDC) data, RSV causes around 58,000 hospitalizations and 100-500 deaths in children younger than 5 years each year. The majority (~90%) of them are younger than 2 years old, and frequent reinfection in older children and adults also occurs.

The majority of patients with RSV infection will have an upper respiratory tract illness (including the nasal cavity, paranasal sinuses, pharynx and the upper portion of the larynx).  Children under the age of 1 year are likely to develop lower respiratory tract illness (including the lower part of the larynx, the trachea, bronchi, bronchioles and the lungs).

Transmission

RSV can spread from person to person via respiratory droplets containing the virus from:

• Cough or sneeze by an infected person

• Touching a surface that has the virus on it

• Direct contact with an infected person

Most people infected with RSV are usually contagious for 2 to 8 days.  However, some infants and people with weakened immune systems, can be contagious for as long as 4 weeks.

Symptoms

People usually show symptoms within 4 to 6 days after infection.  Symptoms of RSV vary, are nonspecific, and can overlap with other viral respiratory infections, as well as some bacterial infections.

If the infection is limited to the upper respiratory tract, patients may experience runny nose, nasal congestion, cough, sneezing, and sometimes fever.  In some patients, infection may progress to the lower respiratory tract with more serious symptoms such as wheezing, lung infection, and rapid breathing.  In severe cases, it could lead to asthma, allergy, chronic lung disease, pneumonia, and heart failure.

People of any age can be reinfected with RSV but with generally less severe symptoms. Testing for RSV is not always used unless it is to differentiate it from other respiratory conditions such as COVID-19.

Treatment

The majority of RSV cases are self-limiting without requiring specific medical interventions or hospitalization. Some RSV cases may require treatments including supportive care for nasal congestion, fever, hydrations and/or oxygen supply.  There are FDA-approved medications for children at high risk.

Prevention

Prevention plays an essential part in reducing the burden of RSV infection.  Along with masking and social distancing, the CDC recommends the following:

• Cover your coughs and sneezes with a tissue or shirt sleeve, not with your hands.

• Wash your hands often with soap and water for at least 20 seconds.

• Avoid close contact, such as kissing, shaking hands, and sharing cups and utensils.

• Clean frequently touched surfaces such as doorknobs and mobile devices.

• If infected, avoid potentially contagious settings and interacting with people at high risk, including children.

• While no RSV vaccine exists, get a flu vaccine.  Everyone 6 months of age or older can get flu and COVID-19 vaccines.  Children younger than that are more protected when those around them are vaccinated.

Stay safe and healthy this holiday and travel season!  

REFERENCES

1. Centers for Disease Control and Prevention. Respiratory Syncytial Virus Infection. https://www.cdc.gov/rsv/clinical/index.html

2. World Health Organization. Respiratory Syncytial Virus Disease. https://www.who.int/teams/health-product-policy-and-standards/standards-and-specifications/vaccine-standardization/respiratory-syncytial-virus-disease

Seek immediate medical attention if you or your children have difficulty breathing or high fever. As always, this information is provided for your reference and you use at your own risk; you should rely on your medical professional for medical advice.