Respiratory Syncytial Virus (RSV): A Guide for Public Health Awareness

As one of the most common respiratory illnesses worldwide, an awareness of respiratory syncytial virus (RSV) and its impact on high-risk populations can significantly improve public health outcomes. Raising awareness of RSV and its potential severity can ensure preventative measures are taken to minimize transmission while facilitating appropriate management in the event of severe complications, especially in the context of babies, infants, and older adults.

What is respiratory syncytial virus (RSV)?

According to the Centers for Disease Control and Prevention (CDC), respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms affecting the lungs and respiratory tract. Globally, RSV affects an estimated 64 million people, with symptoms typically resolving on their own in a week or two.

However, RSV can also cause serious health complications requiring hospitalization and medical support, and according to the Global Burden of Disease study in 2019, the total number of global deaths attributed to RSV was 338,495.

Highly contagious, it is spread through the air via respiratory droplets, saliva, or mucus, which can enter the body through the nose, eyes, or mouth. It is most commonly spread when you come into contact with a coughing, sneezing infected individual, or even through direct contact with droplets by shaking hands.

RSV can survive on surfaces and objects for several hours, meaning the virus can also spread through indirect contact when somebody touches a contaminated surface. The majority of people remain contagious for around one week after contracting the infection. However, for infants and those with weakened immunity, the virus may continue to spread for up to 4 weeks.

How does RSV impact people across age groups?

The impact of RSV alters considerably across varying age groups. Healthy adults may come into contact with RSV on more than one occasion, with symptoms resembling those of a common cold, often resolving on their own or with effective home care.

Most children will have been infected with a mild form of RSV by the age of 2. However, for some infants, RSV can lead to complications such as bronchiolitis and pneumonia. High-risk groups include infants under 1, premature babies, and children with health issues. Severe cases in this context can require hospitalization and intensive care.

According to one study, one in every 28 deaths in children aged 28 days to 6 months is attributable to RSV. While complications are often linked with infants and young children, RSV can also trigger pneumonia and worsen chronic respiratory conditions, particularly prevalent in adults over 65, individuals with weakened immunity, those on immunosuppressive therapy, or those with underlying health issues.

RSV symptoms

In mild cases, symptoms mirror those of the common cold, including:

• Congestion
• Runny nose
• Dry cough
• Mild fever (99.1–100.4 ºF/37.3–38.0 ºC)
• Sore throat
• Sneezing
• Headache

In more severe cases, symptoms include:

• High fever (102.4–105.8 ºF/39.1–41 ºC)
• Severe cough
• Wheezing
• Rapid breaths or difficulty breathing
• Alterations to skin color, including pale skin or blue tinge

In babies or small children, symptoms should be monitored closely, with additional symptoms including:

• Irritability
• Reducing feeding, or reduced eating
• Difficulty breathing, or apnea (pause in breathing for more than 10 seconds)
• Short, shallow, or rapid breathing
• Cough
• Extreme lethargy, or reduced activity

Visual and audible cues for infant distress include a change to skin tone, which may indicate a lack of oxygen (including a blueish tinge to the lips or nails), rapid and noisy breathing, chest muscles drawn inward with each breath, flared nostrils, and grunting or wheezing. It is extremely important to note that any changes to signs and symptoms of this nature must be assessed by a medical professional urgently. Early detection and management of RSV complications is the most effective approach to preventing severe outcomes.

RSV diagnosis

Diagnosing RSV involves a thorough physical exam, history review, pulse oximetry, chest X-rays, and blood tests to assess infection or inflammation. Nasopharyngeal swabs are also sent for lab testing, similar to diagnosing COVID-19.

Treatment of RSV

For mild cases, treatment predominantly centers around techniques that can be self-administered at home, such as rest, increased fluid intake, and use of over-the-counter medications such as paracetamol or ibuprofen to alleviate symptoms of mild fever or pain.

Over-the-counter cold relief tablets can be taken by adults, but self-medication without medical guidance is highly discouraged. In addition, it is important to note that cold and flu tablets should not be given to children unless specifically formulated for children and prescribed by a physician. Always read labels carefully, follow recommended instructions for use by the manufacturer, and seek advice from a healthcare professional.

Antibiotics aren't typically prescribed for cases of RSV, as it is a viral illness rather than a bacterial infection. However, in some cases, your doctor may prescribe antibiotics for secondary bacterial infections that may cause pneumonia.

In severe cases, or those requiring hospitalization, treatment includes the use of supplemental oxygen, administration of IV fluids, administration of bronchodilators, and anti-fever medications. Hospitalization management predominantly revolves around the assessment and treatment of additional complications such as pneumonia, respiratory failure, or other bacterial infections, which may require additional intervention, including antibiotics, mechanical ventilation, and intensive care support.

Risk factors of RSV

RSV is most prevalent during September through January, considered ‘RSV season’. Alongside the aforementioned vulnerable groups at risk, including babies and the elderly, more specific groups include:

• Premature babies
• Infants up to 12 months, especially those 6 months and under
• Children younger than 2 years old with chronic lung disease or congenital heart disease
• Children and adults with weakened immune systems
• Children who have neuromuscular disorders
• Older adults, over the age of 65
• Adults with chronic heart or lung disease
• Adults with certain underlying medical conditions
• Adults living in nursing homes or long-term care facilities

In addition, smokers are at increased risk of RSV complications due to existing lung damage, which can impede the body's ability to combat the infection.

How to stop RSV from spreading

Preventative measures to reduce the spread of RSV are one of the most widely underutilized means of limiting the spread of infection. Simple methods such as washing your hands regularly (for 20 seconds), disinfecting high-touch surfaces such as door knobs and handles, opening doors and windows to encourage airflow, not sharing cups or utensils with others, and ensuring you cover your nose or mouth when coughing and sneezing can contribute significantly to the prevention of RSV spread.

Limiting exposure to the virus can prevent you or your children from contracting it. This means staying away from those who may have the virus and keeping high-risk family and friends away from high-traffic social situations during RSV season. We grew accustomed to isolating high-risk people during the COVID-19 pandemic, something we can learn from in the management of RSV.

People with RSV are contagious 1–2 days prior to the onset of symptoms and remain contagious for an additional 3–8 days. An awareness of RSV characteristics and potential complications can ensure those affected seek urgent and vital medical treatment.