This year, respiratory syncytial virus (RSV) is spreading rapidly among children who are attending school.
Most RSV infections are mild and can be treated with supportive measures at home.
Most RSV infection symptoms peak at five days and resolve within seven to 10 days.
It may be difficult, if not impossible to differentiate an RSV infection from COVID, cold, or flu without further testing.
Only the most severe RSV infections are treated with antiviral medicines or prevented with monoclonal antibodies.
Precautions are similar to other respiratory illnesses such as COVID. Pregnant women should especially heed these precautions.
The surge may be related to several reasons, including decreased childhood immunity as a result of children not going to school during the pandemic and the lack of precautions such as the end of mask-wearing and social distancing.
RSV is treated with supportive care
Supportive care is the mainstay of treatment for RSV infection. Fortunately, most children suffer a mild infection that resolves on its own. Most children get RSV prior to the age of two years.
Severe RSV infections are possible, particularly in those children who are disposed to lung infections such as those with asthma. RSV infections can spread through the air, usually with close contact with others who are sneezing or coughing.
The dilemma is always whether the RSV is merely causing cold-like symptoms like a runny or stuffy nose and fever or if the infection is turning to something more severe. Although more severe RSV infections are still handled mostly with supportive care, many children may need closer monitoring and interventions which cannot be easily performed at homes, such as IV fluids or bronchodilators.
The main focus in dealing with a sick infant or child who may have RSV is to make sure the diagnosis is correct. Most cases of RSV are diagnosed by clinical presentation. Laboratory studies are not typically helpful and considered nonspecific.
There are specific diagnostic tests that are available for confirmation of RSV infection. They are highly specific and sensitive, but the results can take hours or days. It should be noted that substantial morbidity and mortality is higher in younger infant or elderly person.
How is suspected or confirmed RSV treated?
Many children can be diagnosed with a fairly high degree of certainty by the way they are acting and if they have the following symptoms:
- Fever (typically low-grade).
- Tachypnea (fast heart rate).
- Sepsis (severe infection) like a presentation or apneic episodes (in very young infants).
- Cyanosis (turning blue).
- Chest retractions.
- Rales (RSV can cause rattling sounds in the lungs that sound like pneumonia or bronchitis).
The decision of whether or not to bring the child into the doctor’s office or hospital can be challenging. Most children do not need to be admitted to the hospital. Most parents are good judges as to how sick their child is acting.
There is a lot of overlap in clinical presentation with COVID, croup or a cold and it may be difficult to tell what the diagnosis is, so bringing the child to the doctor is warranted so proper testing can be done.
The time to get concerned is when the child appears to be getting dehydrated or has stopped drinking fluids. RSV diarrhea may be a differentiating sign of the illness. Many of the RSV symptoms tend to peak around the fifth day after the illness begins with improvement by day seven to 10. About half of the children have coughing and wheezing or seem to have increased difficulty breathing intermittently.
Serious RSV infections, or signs of alarm, may include poor feeding and respiratory distress which can include flaring of the nostrils, fast breathing (tachypnea), and signs of insufficient oxygen or turning blue.
How to treat RSV at home
For RSV infections that appear mild enough for home treatment, supportive measures may include:
- Humidification of the air with a humidifier or hot steam from a shower.
- Pushing the child to drink fluids or breastfeed.
- Nasal saline drops or clearing the nose with a bulb syringe.
- Analgesics such as ibuprofen. Tylenol should not be given to children under age two.
- Aerosol bronchodilators such as albuterol. Some doctors will recommend these for home use.
Treatment if your child is admitted to hospital
Most children do not need hospital care. Those who do usually have worsening symptoms, look ill, are dehydrated, and have developed increased respiratory distress. Most parents will recognize the symptoms. Alternately, RSV in the elderly that becomes severe usually manifests with poor respiratory effort and low oxygenation.
Once the child (or elderly adult) is admitted to the hospital, supplemental oxygen is the first step in treatment. The goal is to maintain sufficient oxygenation levels. Mechanical ventilation is seldom used but can be a temporary measure for those with respiratory failure or those suffering from stopping breathing or apnea.
Other treatments for severe RSV infection include:
Bronchodilators (inhaled) such as nebulized (aerosol) albuterol and epinephrine. Some of these treatments are still under debate as to whether they are helpful, but most children or elderly adults respond well to these treatments.
Corticosteroids (oral, inhaled, intravenous, or intramuscular) are not routinely recommended for RSV infection but can be very helpful in cases where the child has asthma or reactive airway disease.
Antibiotics may be prescribed in certain cases but are not routinely recommended since RSV is a viral illness.
Antiviral therapy (Ribavirin) is recommended only for the most severe RSV cases.
Methods to prevent RSV infection
Specific monoclonal antibodies have been developed for the prevention of high-risk patients from getting RSV (Palivizumab is an example of one).
Prevention from RSV includes thorough handwashing, cleaning of environmental surfaces, wearing masks, and gowns (in hospital settings), and isolation of the RSV patient, if possible.
Pregnant women must take special precautions because they are at greater risk for hospitalization and further complications if they are exposed to RSV. There are some doctors who believe prenatal exposure to RSV may alter the newborn’s subsequent immunity.