Last Updated:
Apr 2008

Respiratory Syncytial Virus (RSV)

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by Len Leshin, MD, FAAP

Copyright 1996, 1999, 2001, 2008 All rights reserved

Go to List of Past Abstracts The Respiratory Syncytial Virus is a major cause of respiratory illness in all ages. In adults, it tends to cause mild cold symptoms; in school-aged children, it can cause a cold and bronchial cough; in infants and toddlers it can cause bronchiolitis (inflammation of the smaller airways of the lungs) or pneumonia. It has also been found to be a frequent cause of middle ear infections (otitis media) in preschool children. Reinfection throughout life is common. There is concern also that RSV infection in the first year of life may increase the risk of the baby developing asthma later in childhood.

RSV epidemics are common in the late fall to early spring, and spread among households, day care and schools is rampant. From the time of exposure to infection is 4 to 6 days; after an infection, the person may be still contagious for a week.

Send Me Email RSV is especially dangerous in infants less than one year old, children with asthma or other lung disorders, or heart disease. It is a major cause of hospitalizations of children in the winter months. The symptoms of bronchiolitis include a hacky cough and a wheeze on exhalation (a high pitched noise from the chest). There is typically fever and a cloudy nasal drainage. The infant is irritable and oral intake decreases. Danger signs include a respiratory rate over 40 breaths per minute, a bluish discoloration of the skin around the mouth, retractions of the skin between the ribs (this indicates the infant is working so hard to breathe that he is using the muscles between the ribs to help), and/or decreased fluid intake to the point of dehydration.
RSV is diagnosed by checking for signs of the virus (antigens) in nasal washings or swabs, or growing the virus from nasal washes.

The home treatment of RSV is aimed at relieving the symptoms: salt water ("saline") nose drops with suctioning of the nose and using a vaporizer or humidifier to add moisture to the air. Bronchodilators such as albuterol may be given to help relieve chest congestion and wheezing. Infants with RSV who have difficulty breathing or keeping hydrated may need to be admitted to a hospital where oxygen and intravenous fluids may be given until the infant's immune system fights off the virus. In the late 1980's, a medication called ribavirin was developed to be given by aerosol to hospitalized children. Due to its high cost and selective efficacy, it is now only given to those hospitalized infants who are at greatest risk from the virus.

In 1996, the FDA approved a preventative treatment for RSV called RespiGam® (RSV-IGIV). RespiGam® was made from plasma taken from large numbers of normal, healthy individuals, and contained a high concentration of protective antibodies against RSV. These antibodies do not prevent RSV infections, but do help protect children against the most serious consequences of the virus. In a large, multi-center study, the use of RespiGam® decreased the need for hospitalization by 38% from the non-treated group. In 1998, Respigam was replaced by the intramuscular vaccine palivizumab(Synagis®), which contains RSV monoclonal antibodies. Palivizumab is given as monthly injections. Treatment begins in the Fall before the first outbreaks of RSV normally occur. The treatment regimen involves a dose once a month through March or April (regional differences in the RSV season may occur). The monthly doses are required as the antibodies only fight off the RSV for about 4 weeks. It does not interfere with normal immunizations.

The American Academy of Pediatrics has made the following recommendations on the use of palivizumab:

  1. Palivizumab or RSV-IGIV prophylaxis should be considered for infants and children younger than 24 months of age with chronic lung disease who have required medical therapy for their lung disease within 6 months before the anticipated RSV season. Palivizumab is preferred for most high-risk children because of its ease of administration, safety, and effectiveness. Patients with more severe lung disease may benefit from prophylaxis for two RSV seasons, especially those who require medical therapy.
  2. Infants born at 32 weeks of gestation or earlier without chronic lung disease or who do not meet the criteria in the above recommendation also may benefit from RSV prophylaxis. Infants born at 28 weeks of gestation or earlier may benefit from prophylaxis up to 12 months of age. Infants born at 29 to 32 weeks of gestation may benefit most from prophylaxis up to 6 months of age.
  3. Palivizumab is indicated for infants and children under 24 months of age who have hemodynamically significant congenital heart disease. RSV-IGIV is not indicated for this group of infants and children.
  4. Given the large number of patients born between 32 to 35 weeks and the cost of the drug, the use of palivizumab in this population should be reserved for those infants with additional risk factors (day-care attendance, school-aged siblings, four or more people living in the home with the infant, exposure to passive smoke, being a member of a multiple birth).
  5. Palivizumab has not been evaluated in randomized trials in immunocompromised children. Although specific recommendations for immunocompromised patients cannot be made, children with severe immunodeficiencies (eg, severe combined immunodeficiency or severe acquired immunodeficiency syndrome) may benefit from prophylaxis.

For more information on RSV, see:    the RSV Prevention Information Center

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