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What You Should Know About RSV

What is RSV? RSV (Respiratory Syncytial Virus) is a respiratory illness that affects all ages. It has a peak season and in Montana most cases begin in late December and can last through spring (i.e., June!). The most frequent infections usually occur between February and April. There is a test a nose swab to detect RSV.

Is there a vaccine for it? There is a vaccine but unfortunately it is very expensive. It needs to be given by injection before the season starts and repeated monthly throughout the season as cases continue locally. In clinical trials, there are limitations in how effective the vaccine is on a cost/benefit basis in preventing the illness and complications including hospitalizations in healthy populations. Studies showed a 50% reduction in hospitalization for high-risk groups. Therefore, the vaccine is only available for very high risk groups.

In 2014, the AAP updated its policy on administration of the palivizumab (RSV) vaccination.Evidence of these falling rates of RSV hospitalizations, along with new data about which children are at highest risk of RSV hospitalization, guided the AAP recommendation that palivizumab prophylaxis be limited to infants born before 29 weeks gestation, and to infants with certain chronic illnesses like congenital heart disease or chronic lung disease. For all infants, particularly those born at preterm, the AAP emphasizes that it’s important to minimize the risk of infection with RSV and other viruses by offering breast milk, immunizing members of the household against influenza, practicing good hand and cough hygiene, avoiding smoke exposure, limiting attendance in large group child care during the first winter season whenever possible, and avoiding contact with anyone who is ill.” AAP Policy Statement 7/28/2014

Do only babies get sick? All ages can get RSV and pass it along. It is spread by droplet (cough, nasal secretions) and can live on surfaces (like toys, etc.). In most healthy kids and adults it is a “bad cold” with nasal congestion, runny nose, cough without fever or respiratory complications that resolves on its own within about a week. Treatment is supportive sinus rinses, bulb syringe, rest, fluids, and vaporizer treatment like other cold viruses. However, in the outlying age groups of the very young especially under one year of age, or elderly, or those with certain underlying health conditions such as being born prematurely, having a suppressed immune system, heart disease or lung diseases like COPD, cystic fibrosis, or Asthma, it can be a much more severe Illness with risk for complications including the need for oxygen support and for hospital admission and care. Most mothers have had the RSV infection and have antibodies that can be passed through breast milk to help prevent illness in infants who are breastfed. These antibodies allow babies to recover faster from the illness if they catch it.

RSV specifically effects the bronchioles of the lungs. As I explain to parents, imagine your lungs are broccoli upside down in our chest, the bronchioles are the tiny balls at the end of the broccoli that are responsible for air and oxygen exchange. RSV, more so than many other cold viruses, causes the bronchioles to be inflamed which causes “Bronchiolitis”. It can cause mucous production and the bronchioles lose elasticity so they collapse and can’t exchange air as well. It can cause symptoms such as wheezing, and decreased blood oxygen levels and increase the work of breathing and shortness of breath. This also increases the risk of developing secondary complications like pneumonia both viral and bacterial, ear infections, and dehydration from not drinking enough due to fatigue from working so hard just to breathe.

The main message I would like to pass along is that, like other viral illnesses, antibiotics are NOT effective as they only treat bacterial infections. Treatment for RSV is generally supportive and the best treatment is PREVENTION of a viral illness through good hand washing, staying home when sick, good nutrition, drinking plenty of water, and restful sleep so our immune system can fight off infections that are caused by viruses. It is also very important to immunize against viruses that are available such as the Influenza and measles.

Viruses and bacteria are different germs. More education in elementary and high school about what germs are (i.e., bacteria, fungus, viruses, and parasites), how they make us sick and how they are prevented would be SO helpful in preventing illness. This education also helps parents and loved ones make decisions about treatment. Be a lifelong learner and keep educating yourselves and children about how our bodies get and fight off infections, how we can prevent infections using our own immune systems or vaccinations and when other medications such as an antibiotic for a bacterial infection are needed.

Dayna Leavens Thergesen, CPNP, MSN is a Pediatric Primary Care Provider at The Ruby Valley Rural Medical Clinic and SWMTCHC Pediatrics. She lives in Sheridan and enjoys a very wide variety of outdoor activities throughout the year with her family.

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