What is Respiratory Syncytial Virus?
Respiratory Syncytial Virus (RSV) is a common respiratory virus that can cause severe respiratory infection. RSV usually has a typical seasonality, that is, it often follows consistent infection outbreaks during the year. These outbreaks normally occur from October or November until April or May, with a peak season around early February. However, in 2021, RSV season was observed to continue through spring, summer, and fall.
Book an appointmentRespiratory Syncytial Virus is a nonsegmented, negative-strand ribonucleic acid (RNA) virus and is a member of the Paramyxoviridae family. There are two types of RSV infection, type A, and type B, which are simultaneously present in most outbreaks although subtype A typically causes more severe illness than type B. Dominant strains shift with each season and the dominant strains account for the most frequent infections.
Respiratory Syncytial Virus is the most common cause of lower respiratory tract infections in children younger than 5 years old. Almost all children are infected with RSV by the time they are 2 years old. Infection is most likely to happen during their first fall or winter season of life. RSV can also cause illness in older adults and immunocompromised individuals.
Respiratory Syncytial Virus Transmission and Infection
Transmission of the Respiratory Syncytial Virus is done by direct contact with virus-containing secretions from the nose or mouth. RSV can survive several hours on hands and fomites (clothes, utensils, and furniture). Infection is caused by droplet particles that are exhaled into the air by breathing, coughing, or sneezing. These droplets can be carried on the hands, and can then be transmitted to the nose, mouth, or eyes. Someone becomes infected after touching their eye, nose, or mouth with the virus.
Respiratory Syncytial Virus is particularly contagious during the 3-to-7-day period a person has symptoms. RSV infections are contagious, on average, from day 2 to day 8.
In one study, 42% of individuals were asymptomatic with the Respiratory Syncytial Virus virus, which may increase transmission rates. Virtually all individuals will be infected with RSV by the age of two, while interestingly, the previous infection of RSV does not appear to protect against reinfection, even in patients with high immunity cell markers.
Respiratory Syncytial Virus infection can last several days. It takes between 2 to 8 days from the time a person is exposed to RSV to show symptoms. Symptoms then last on average 3 to 7 days while most children and adults recover fully in one to 2 weeks.
RSV Causes and Preventions
Respiratory Syncytial Virus causes acute respiratory illness in persons of all ages but mostly infects children aged 2 and younger. Hospitalization among children is the highest for those less than 6 months old. Some 57,000 children under the age of 5 require hospital care due to RSV each year in the United States.
Healthy adults are infected with the Respiratory Syncytial Virus repeatedly throughout their lives and typically have symptoms restricted to the upper respiratory tract. Among adults, about 177,000 older adults are hospitalized each year for RSV infections. Adults often transmit RSV to children, which is why it is important not to visit young children when they feel ill.
The following are people most at risk for severe RSV illness.
Infants younger than 6 months of age
Infants born during the RSV season
Infants who attend daycare
Infants with older siblings
Infants with underlying lung disease or who were born prematurely (before 35 weeks gestation)
Adults with asthma, cardiopulmonary disease, or chronic pulmonary disease
Adults who are institutionalized
Prevention measures are used to combat the transmission and infection of Respiratory Syncytial Virus. Hand washing is the most important measure to prevent severe RSV illness. Contact precautions, such as wiping down surfaces with a cleaning agent, also helps slow the spread of RSV.
Other prevention measures to reduce the risk of RSV include:
Avoid smoking in the child’s home (smoking increases the risk of respiratory illnesses).
Wash hands frequently with soap and water for 20 seconds.
Use alcohol-based hand rubs when soap and water is not available.
Avoid other adults and young children with respiratory infections.
Avoid other adults and young children when you are ill.
Respiratory Syncytial Virus Signs and Symptoms
Respiratory Syncytial Virus seems to affect the lower respiratory system in infants and toddlers, while it also affects the upper respiratory tract in older children and adults. Upper and lower respiratory symptoms may present differently. RSV that causes lower respiratory infections often includes following signs and symptoms:
Bronchiolitis
Lower lobe pneumonia
Apnea or trouble breathing
Wheezing (usually lasts 7 days)
Fever higher than 100.4°F
Nasal congestion and discharge, sneezing
Decreased appetite
Emergency symptoms in children include:
Nasal flaring (widening), cyanosis (blue-colored skin, mouth or fingers), decreased urine output, decreased ability to feed, increased rate of breathing, worsening chest retractions.
Severe RSV should be evaluated in an emergency department as this can be life-threatening symptoms.
Respiratory Syncytial Virus that causes upper respiratory infections may include the following signs and symptoms:
Cough (persistent cough usually lasting 14 days)
Coryza (irritation and inflammation of the mucus membranes inside the nose)
Rhinorrhea (runny nose)
Sinus or ear infection involvement
Fever higher than 100.4°F
Symptoms in children and adults may appear differently. Children often have runny noses that progress into wheezing while adults have a cough and fever. Clinical manifestations vary with age, health status, and whether the infection is considered a primary or secondary infection. RSV can be confirmed with laboratory testing by analyzing respiratory secretions. Samples are taken from a nasal swab.
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Respiratory Syncytial Virus Treatment
Respiratory Syncytial Virus treatment is aimed at treating the symptoms, as there is no cure for the illness. Symptomatic care such as monitoring, fever control, and comfort measures are used to treat RSV. You should contact your healthcare provider to determine if an office visit is needed or if there are any concerns.
During the interseasonal spread of RSV in 2021, the American Academy of Pediatrics suggested consideration of the use of Synagis (palivizumab) in qualifying patients. They continue to support the use of palivizumab in high risk infants in 2022 based on 2021’s RSV disease trends. Palivizumab is a monoclonal antibody used to protect against severe RSV infection in high risk patients.
Patients who qualify for the use of palivizumab include infants younger than 12 months at the start of RSV season with high risk conditions. This includes patients born with less than 29 weeks of gestation, patients with chronic lung disease of prematurity, patients with significant congenital heart disease, airway abnormalities, or neuromuscular disease with impaired airway clearance, patients with cystic fibrosis with chronic lung disease or nutritional compromise, or patients undergoing cardiac transplantation during RSV season. This also includes patients aged 1-2 years old with chronic lung disease of prematurity requiring medical support within 6 months of the start of RSV season, who are severely immunocompromised, who have cystic fibrosis with manifestations of severe lung disease, or who are undergoing cardiac transplantation during RSV season. Speak to a physician to discuss if palivizumab is recommended for your child.
Fever reducer medications such as acetaminophen or ibuprofen can be given to reduce discomfort caused by fever. Saline nasal drops can be used to help with nasal congestion and runny nose. Fluids should be encouraged as being ill with RSV can make you dehydrated.
Other therapies such as antibiotics, cough medicines, and decongestants are not recommended to treat RSV infection. RSV is a virus; therefore, antibiotics do not work. Cough medication and decongestants have not been proven helpful when treating RSV either. In severe cases, supplemental oxygen, intravenous hydration, or hospitalization may be required to treat RSV.
If you or your child have symptoms of RSV, make an appointment to speak with one of our expert physicians today to talk about treatment options and to determine the severity of the illness.
1
Book on our free mobile app or website.
Our doctors operate in all 50 states and same day appointments are available every 15 minutes.
2
See a doctor, get treatment and a prescription at your local pharmacy.
3
Use your health insurance just like you normally would to see your doctor.
RSV FAQs
Can adults get RSV?
Yes, adults can get RSV, although RSV in adults usually appears with milder cold like symptoms. Although they may only have mild symptoms, adults with RSV can transmit the disease to other adults and children.
Is RSV contagious?
Yes, RSV is highly contagious. RSV spreads through droplets containing the virus when someone sneezes or coughs. It can remain on surfaces for a few hours, which is why it is important to wash hands frequently to prevent RSV.
How long is RSV contagious?
RSV infection is usually most contagious during the 3 to 7 day period that a person is showing symptoms. RSV is usually contagious for up to 3 to 8 days, although there have been cases where it remains contagious for up to 4 weeks. RSV infection is more likely to stay contagious for longer in young infants and individuals with weakened immune systems.
Read More About Respiratory Syncytial Virus
Sources:
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Munywoki PK, Koech DC, Agoti CN, Bett A, Cane PA, Medley GF, Nokes DJ. Frequent Asymptomatic Respiratory Syncytial Virus Infections During an Epidemic in a Rural Kenyan Household Cohort. Journal of Infectious Disease. 2015 Dec 1;212(11):1711-8. Accessed on July 10, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633757/
Centers for Disease Control and Prevention. Respiratory Syncytial Virus Infection (RSV). Accessed on July 20, 2021 at https://www.cdc.gov/rsv/index.html
Collins PL, Fearns R, Graham BS. Respiratory Syncytial Virus: Virology, Reverse Genetics, and Pathogenesis of Disease. Current topics in microbiology and immunology. U.S. National Library of Medicine. 2016 Mar 16. Accessed on July 20,2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794264/
Laham FR et al., Clinical Profiles of Respiratory Syncytial Virus Subtypes A and B among Children Hospitalized with Bronchiolitis. The Pediatric infectious disease journal. U.S. National Library of Medicine. 2018 Aug 1.Pediatr Infect Dis J. 2017 Aug; 36(8): 808–810. Accessed on July 20, 2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556381/
Cleveland Clinic. Respiratory Syncytial Virus in Children and Adults. Accessed on July 20, 2021 at https://my.clevelandclinic.org/health/diseases/8282-respiratory-syncytial-virus-in-children-and-adults
American Academy of Family Physicians. Respiratory Syncytial Virus Infection in Children. Accessed on July 20, 2021 at
https://www.aafp.org/afp/2011/0115/p141.htmlAmerican Academy of Pediatrics. Updated Guidance: Use of Palivizumab Prophylaxis to Prevent Hospitalization From Severe Respiratory Syncytial Virus Infection During the 2022-2023 RSV Season. Accessed on October 27, 2022 at https://www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/interim-guidance-for-use-of-palivizumab-prophylaxis-to-prevent-hospitalization/
