RSV, respiratory syncytial virus

RSV is the common abbreviation for respiratory syncytial virus, the causative virus for many common colds, but more importantly for the majority of cases of infant bronchiolitis. It occurs in outbreaks chiefly during the cooler months. In and of itself it is a harmless cold virus but is sometimes mentioned in news stories as a terrible new plague. However, it is one of the most common infections of childhood: one half of all children will have an RSV infection in the first year, and essentially all children have had an RSV infection by age 2.

These respiratory infections cause an estimated 120,000 hospital admissions in young children in the US annually.

RSV is a member of the paramyxovirus family. The virus attacks the lining cells of the respiratory tree (bronchi - the major breathing tubes - and bronchioles - the tinyest breathing tubes that lead directly to the air sacs). The cell walls of these lining cells break down and they merge into giant cells with multiple nuclei ("syncytial" cells).

Interest in the virus accelerated in recent years for two reasons:

we developed a rapid viral identification test performed on bronchial secretions to confirm the the virus
new therapies were developed to treat and now, to prevent the disease; the therapies and preventative treatments are all quite expensive and debate continues about how medically effective and cost effective they are

In general, prematures and babies who had other significant respiratory problems in the immediate postnatal period are the target population for the preventative treatment strategies, as well as babies with immune deficiencies or congenital heart disease.

The infection is transmitted directly from person to person, usually hands to nose or eyes. Large droplets produced by coughing are also infectious. The virus survives on toy surfaces, and on unwashed hands for up to an hour.

Incubation is 2 to 8 days, average 5 days. Babies younger than a month of age shed the most active virus particles, and infants tend to shed the virus for up to a month or longer. Older children and adults only spread the virus for 3 or 4 days of illness.

Symptoms of RSV infection are mild to severe upper respiratory tract symptoms, with runny nose, cough and fever. Chest symptoms with worsening croupy cough develops in almost half of infected children over the next several days. In young children, the illness can progress to rapid, shallow, difficult breathing with retractions. Babies may show irritability, poor feeding, and apneic episodes.

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