Respiratory Syncytial Virus - RSV

 

Clinical Background

Respiratory syncytial virus (RSV) is one of the most common causative agents of lower respiratory illnesses (including bronchiolitis and pneumonia) in infants and young children worldwide.

Epidemiology

  • Prevalence
    • Epidemics occur in late fall and winter – account for 5-15% of community-acquired pneumonias  
  • Age
    • 50% of children ≤1year are infected
    • 100% are infected by 3 years
    • Immunity wanes with age; disease may reoccur in patients >65 years
  • Transmission – via respiratory droplet

Organism

  • RSV, an enveloped RNA virus, is a member of the Paramyxoviridae family

Risk Factors for Severe Disease

  • Premature birth
  • Compromised immune system
  • Advanced age (>65 years)
  • Chronic lung/heart disease

Clinical Presentation

  • Symptoms
    • Children
      • Infection varies from nasal congestion and upper respiratory tract infection (URTI) to bronchiolitis, pneumonia, severe respiratory distress and respiratory failure
      • RSV can be fatal; virus often believed to be the cause of sudden death in infants with respiratory disease
    • Adults
      • Infection is generally mild; may cause severe pneumonitis in immunocompromised patients and the elderly
      • In older children and adults, RSV can also cause influenza-like syndromes, bronchopneumonia or exacerbation of chronic bronchitis

Treatment

  • Supportive
  • Antivirals frequently used in immunocompromised patients and children <2 years

Prevention

  • RSV prophylaxis with immunoglobulin for children <2 years and for at-risk populations (preterm infants, immunosuppressed patients and those with congenital heart disease)