Respiratory syncytial virus (RSV)
Respiratory syncytial virus (RSV) causes infections of the lungs and respiratory tract. It's so common that most children have been infected with the virus by age 2. Respiratory syncytial (sin-SISH-ul) virus can also infect adults.
In adults and older, healthy children, RSV symptoms are mild and typically mimic the common cold. Self-care measures are usually all that's needed to relieve any discomfort.
RSV can cause severe infection in some people, especially premature babies, older adults, infants and adults with heart and lung disease, or anyone with a very weak immune system (immunocompromised).
Signs and symptoms of respiratory syncytial virus infection most commonly appear about four to six days after exposure to the virus. In adults and older children, RSV usually causes mild cold-like signs and symptoms. These include:
- Congested or runny nose
- Dry cough
- Low-grade fever
- Sore throat
- Mild headache
In severe cases
Respiratory syncytial virus infection can spread to the lower respiratory tract, causing pneumonia or bronchiolitis — inflammation of the small airway passages entering the lungs. Signs and symptoms may include:
- Severe cough
- Wheezing — a high-pitched noise that's usually heard on breathing out (exhaling)
- Rapid breathing or difficulty breathing — the child may prefer to sit up rather than lie down
- Bluish color of the skin due to lack of oxygen (cyanosis)
Infants are most severely affected by RSV. You may notice your child's chest muscles and skin pull inward with each breath. This is a sign that he or she is struggling to breathe. Other signs and symptoms of severe RSV infection in infants include:
- Short, shallow and rapid breathing
- Poor feeding
- Unusual tiredness (lethargy)
Most children and adults recover in one to two weeks, although some might have repeated wheezing. Severe or life-threatening infection requiring a hospital stay may occur in premature babies or infants and adults who have chronic heart or lung problems.
When to see a doctor
Seek immediate medical attention if your child — or anyone at risk of severe RSV infection — has difficulty breathing, a high fever, or a blue color to the skin, particularly on the lips and in the nail beds.
Respiratory syncytial virus enters the body through the eyes, nose or mouth. It spreads easily through the air on infected respiratory droplets. You or your child can become infected if someone with RSV coughs or sneezes near you. The virus also passes to others through direct contact, such as shaking hands.
The virus can live for hours on hard objects such as countertops, crib rails and toys. Touch your mouth, nose or eyes after touching a contaminated object and you're likely to pick up the virus.
An infected person is most contagious in the first few days after infection. However, the virus may continue to spread for up to a few weeks.
By age 2, most children will have been infected with respiratory syncytial virus. Children who attend child care centers or who have siblings who attend school are at a higher risk of exposure. RSV season — when outbreaks tend to occur — is the fall to the end of spring.
People at increased risk of severe or sometimes life-threatening RSV infections include:
- Premature infants
- Young children who have congenital heart or lung disease
- Children with weakened immune systems, such as those undergoing chemotherapy or transplantation
- Infants in crowded child care settings
- Older adults
- Adults with asthma, congestive heart failure or chronic obstructive pulmonary disease
- People with immunodeficiency, including those with certain transplanted organs, leukemia or HIV/AIDS
Complications of respiratory syncytial virus include:
- Hospitalization. A severe RSV infection may require a hospital stay so that doctors can monitor and treat breathing problems and give intravenous (IV) fluids.
- Pneumonia. RSV is the most common cause of inflammation of the lungs (pneumonia) or the lungs' airways (bronchiolitis) in infants. These complications can occur when the virus spreads to the lower respiratory tract. Lung inflammation can be quite serious in infants, young children, immunocompromised individuals, or people with chronic heart or lung disease.
- Middle ear infection. If germs enter the space behind the eardrum, you can get a middle ear infection (otitis media). This happens most frequently in infants and young children.
- Asthma. There may be a link between severe respiratory syncytial virus in children and the chance of developing asthma later in life.
- Repeated infections. Once you've had RSV, it's common for the infection to come back. It's even possible for it to happen during the same RSV season. However, symptoms usually aren't as severe — typically it's in the form of a common cold. But they can be serious in older adults or people with chronic heart or lung disease.
Your doctor may suspect respiratory syncytial virus based on the findings of a physical exam and the time of year the symptoms occur. During the exam, the doctor will listen to the lungs with a stethoscope to check for wheezing or other abnormal sounds.
Laboratory and imaging tests aren't usually needed. However, they can help diagnose RSV complications or rule out other conditions that may cause similar symptoms. Tests may include:
- Blood tests to check white cell counts or to look for viruses, bacteria and other germs
- Chest X-rays to check for lung inflammation
- Swab of secretions from inside the mouth or nose to check for signs of the virus
- Sometimes, painless skin monitoring (pulse oximetry) to detect lower than normal levels of oxygen in the blood
Treatment for respiratory syncytial virus generally involves self-care measures to make your child more comfortable (supportive care). But hospital care may be needed if severe symptoms occur.
Your doctor may recommend an over-the-counter medication such as acetaminophen (Tylenol, others) to reduce fever. Frequent use of nasal saline drops and suctioning can help clear a stuffy nose. Your doctor may prescribe antibiotics if there's a bacterial complication, such as bacterial pneumonia.
Keep your child as comfortable as possible. Offer plenty of fluids and watch for signs of dehydration, such as dry mouth, little to no urine output, sunken eyes, and extreme fussiness or sleepiness.
If the RSV infection is severe, a hospital stay may be necessary. Treatments at the hospital may include:
- Intravenous (IV) fluids
- Humidified oxygen
- Mechanical ventilation (breathing machine)
The doctor may recommend an inhaled form of an antiviral medicine called ribavirin (Virazole) for people with very weakened immune systems (immunocompromised).
An inhaler (bronchodilator) or steroids are not proved to be helpful in treating RSV infection.
Preparing for an appointment
Unless severe symptoms result in an emergency room (ER) visit, you're likely to start by seeing your family doctor or your child's doctor. The following information will help you prepare for your visit, and understand what to expect from your doctor.
What you can do
- Write down any symptoms you noticed and when they started, even if they seem unrelated to an upper respiratory infection.
- Write down key medical information, such as if your child was born prematurely or if he or she has a heart or lung problem.
- Write down details about child care, considering other locations where your family may have been exposed to respiratory infections.
- Write down questions to ask your doctor. Your time with your doctor is limited. Preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out.
For respiratory syncytial virus, some basic questions to ask your doctor include:
- What is likely causing these symptoms? Are there other possible causes?
- What tests might be needed?
- How long do symptoms usually last?
- What is the best treatment?
- Is medication needed? If you're prescribing a brand-name medication, is there a generic alternative?
- What can I do to make my child feel better?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend?
- To what extent should I isolate my child while infected?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask any additional ones you may think of during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time for you to discuss information in greater detail. Your doctor may ask:
- When did you first notice symptoms?
- Do the symptoms come and go or persist?
- How severe are the symptoms?
- What, if anything, seems to improve symptoms?
- What, if anything, appears to worsen symptoms?
- Is anyone else in the family ill? What symptoms does he or she have?
What you can do in the meantime
If your child has a fever, you can give him or her acetaminophen (Tylenol, others). Have your child drink plenty of fluids to prevent dehydration. Keeping your child upright and the air moist with a humidifier also may help ease congestion.
Lifestyle and home remedies
You may not be able to shorten the length of a respiratory syncytial virus infection, but you can try to relieve some signs and symptoms.
If your child has RSV, do your best to comfort or distract him or her — cuddle, read a book or play a quiet game. Other tips for relieving symptoms are:
- Create moist air to breathe. Keep the room warm but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds. An ideal indoor humidity is around 50 percent.
- Drink fluids. Keep a steady supply of cool water at the bedside. Offer warm fluids, such as soup, which may help loosen thickened secretions. Ice pops may be soothing as well. Continue breast-feeding or bottle-feeding your infant as you would normally.
- Try saline nasal drops. Over-the-counter (OTC) drops are a safe, effective way to ease congestion, even for young children. Drip several drops into one nostril to loosen hardened or thick mucus, then immediately suction that nostril, using a bulb syringe. Repeat the process in the other nostril. Do this before feedings and before putting your baby to sleep.
- Use over-the-counter pain relievers. OTC pain relievers such as acetaminophen (Tylenol, others) may help reduce fever and relieve a sore throat. Ask a doctor for the correct dose for your child's age.
- Stay away from cigarette smoke. Secondhand smoke can aggravate symptoms.
No vaccine exists for respiratory syncytial virus. But common-sense precautions can help prevent the spread of this infection:
- Wash your hands frequently. Teach your children the importance of hand-washing.
- Avoid exposure. Limit your infant's contact with people who have fevers or colds. This is especially important if your baby is premature and during any baby's first two months of life.
- Keep things clean. Make sure kitchen and bathroom countertops are clean. Discard used tissues right away.
- Don't share drinking glasses with others. Use your own glass or disposable cups when you or someone else is sick. Label each person's cup.
- Don't smoke. Infants who are exposed to tobacco smoke have a higher risk of getting RSV and potentially more-severe symptoms. If you do smoke, never do so inside the house or car.
- Wash toys regularly. Do this especially when your child or a playmate is sick.
The medication palivizumab (Synagis) can help protect certain children who are at high risk of serious complications of RSV. The medication is recommended for infants under age 1 who were born prematurely (before 29 weeks gestation). It's not recommended for healthy preemies born after 29 weeks.
The medication is also recommended for the following children:
- Premature infants with chronic lung disease
- Certain infants younger than 12 months old with congenital heart disease
- Babies and toddlers under age 2 who needed at least a month of supplemental oxygen at birth and continue to require lung-related treatments
- Children age 2 and younger who may be immunocompromised during RSV season
The medication is given monthly for five months during peak RSV season. It only helps prevent RSV infection. It doesn't help treat it once symptoms develop.
Scientists are working to find a nasal-spray vaccine to protect against the respiratory syncytial virus.
Last updated: July 22nd, 2017