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Respiratory Syncytial Virus (RSV) Symptoms and Causes

written by Tessa Chatham Registered Nurse Written by Tessa Chatham Registered Nurse
Tessa Chatham Registered Nurse

Tessa Chatham Registered Nurse

Tessa is a MSN prepared Registered Nurse with 10 years of critical care experience in healthcare. When not practicing clinical nursing, she enjoys academic writing and is passionate about helping those affected by medical aliments live healthy lives.

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August 24, 2021 Read Time - 6 minutes

What is Respiratory Syncytial Virus?

Respiratory Syncytial Virus (RSV) is a common respiratory tract illness caused by a virus. RSV has a typical seasonality, that is, it usually follows consistent infection outbreaks during the year. These outbreaks normally occur from October or November until April or May, with a peak season in January or February. 

Respiratory Syncytial Virus is a nonsegmented, negative-strand ribonucleic acid (RNA) virus and is a member of the Paramyxoviridae family. There are two types of RSV, type A and type B, which are simultaneously present in most outbreaks although subtype A typically causes more severe illness than type B. Dominant strains shift with each season and the dominant strains account for the most frequent infections. 

Respiratory Syncytial Virus is the most common cause of lower respiratory tract infections in children younger than 5 years old. Almost all children are infected with RSV by the time they are 2 years old. RSV can also cause illness in older adults and those who are immunocompromised.

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Respiratory Syncytial Virus Transmission and Infection

Transmission of Respiratory Syncytial Virus is done by direct contact of virus-containing secretions from the nose or mouth. RSV can survive several hours on hands and fomites (clothes, utensils, and furniture). Infection is caused by droplet particles which are exhaled into the air by breathing, coughing or sneezing. These droplets can be carried on the hands, which can then be transmitted into the nose, mouth, or eyes. Someone becomes infected after touching their eye, nose or mouth with the virus.

Respiratory Syncytial Virus is particularly contagious during the 3-to-7-day period a person has symptoms. RSV infections are contagious, on average, on day 2 to day 8 with the longest incubation period observed up to 4 weeks. Infants and people with weakened immune systems may remain contagious longer than the average person. 

In one study, 42% of individuals were asymptomatic with the Respiratory Syncytial Virus virus, which may increase transmission rates. Virtually all individuals will be infected with RSV by the age of two, while interestingly, previous infection of RSV does not appear to protect against reinfection, even in patients with high immunity cell markers.

Respiratory Syncytial Virus infection can last several days. It takes between 2 to 8 days from the time a person is exposed to RSV to show symptoms. Symptoms then last on average 3 to 7 days while most children and adults recover fully in one to 2 weeks.

RSV Causes and Preventions

Respiratory Syncytial Virus causes acute respiratory illness in persons of all ages, but mostly infects children aged 2 and younger. Hospitalization among children is the highest for those less than 6 months old. Some 57,000 children under the age of 5 require hospitalization care due to RSV each year in the United States.

Healthy adults are infected with Respiratory Syncytial Virus repeatedly throughout their lives and typically have symptoms restricted to the upper respiratory tract. Among adults, about 177,000 older adults are hospitalized each year for RSV. Adults often transmit RSV to children, which is why it is important not to visit young children when you feel ill.

The following are people most at risk for severe RSV illness.

  • Infants younger than 6 months of age
  • Infants born during RSV season
  • Infants who attend daycare
  • Infants with older siblings
  • Infants with underlying lung disease or who were born prematurely (before 35 weeks gestation)
  • Adults with asthma, cardiopulmonary disease, or chronic pulmonary disease
  • Adults who are institutionalized

Prevention measures are used to combat the transmission and infection of Respiratory Syncytial Virus. Hand washing is the most important prevention measure. Contact precautions, such as wiping down surfaces with a cleaning agent, also helps slow the spread of RSV. 

Other prevention measures to reduce the risk of RSV include:

  • Avoid smoking in the child’s home (smoking increases the risk of respiratory illnesses).
  • Wash hands frequently with soap and water for 20 seconds.
  • Use alcohol-based hand rubs when soap and water is not available.
  • Avoid other adults and young children with respiratory infections.
  • Avoid other adults and young children when you are ill.

Respiratory Syncytial Virus Signs and Symptoms

Respiratory Syncytial Virus seems to affect the lower respiratory system in infants and toddlers, while it also affects the upper respiratory tract in older children and adults. Upper and lower respiratory symptoms may present differently. RSV that causes lower respiratory infections may include the following signs and symptoms:

  • Bronchiolitis
  • Lower lobe pneumonia
  • Apnea or shortness of breath
  • Wheezing (usually lasts 7 days)
  • Fever higher than 100.4°F
  • Nasal congestion and discharge, sneezing
  • Decreased appetite

Emergency symptoms in children include:

  • Nasal flaring (widening), cyanosis (blue-colored skin, mouth or fingers), decreased urine output, decreased ability to feed, increased rate of breathing, worsening chest retractions. 
  • Severe RSV should be evaluated in an emergency department as this can be life-threatening symptoms.

Respiratory Syncytial Virus that causes upper respiratory infections may include the following signs and symptoms:

  • Cough (persistent cough usually lasting 14 days)
  • Coryza (irritation and inflammation of the mucus membranes inside the nose)
  • Rhinorrhea (runny nose)
  • Conjunctivitis (pink eye)
  • Sinus or ear infection involvement
  • Fever higher than 100.4°F

Symptoms in children and adults may appear differently. Children often have runny noses that progress into wheezing while adults have a cough and fever. Clinical manifestations vary with age, health status, and whether the infection is considered a primary or secondary infection. RSV can be confirmed with laboratory testing by analyzing respiratory secretions. Samples are taken from a nasal swab.

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Respiratory Syncytial Virus Treatment

Respiratory Syncytial Virus treatment is aimed at treating the symptoms, as there is no cure for the illness. Symptomatic care such as monitoring, fever control, and comfort measures are used to treat RSV. You should contact your healthcare provider to determine if an office visit is needed or if there are any concerns. 

Fever reducer medications such as acetaminophen or ibuprofen can be given to reduce discomfort caused by fever. Saline nasal drops can be used to help with nasal congestion and runny nose. Fluids should be encouraged as being ill with RSV can make you dehydrated.

Other therapies such as antibiotics, cough medicines, and decongestants are not recommended to treat RSV. RSV is a virus; therefore, antibiotics do not work. Cough medication and decongestants have not been proven helpful when treating RSV either. In severe cases, supplemental oxygen, intravenous hydration, or hospitalization may be required to treat RSV.

If you or your child have symptoms of RSV, make an appointment to speak with a PlushCare provider today to talk about treatment options and to determine the severity of the illness. 


Read More About Respiratory Syncytial Virus


Sources:

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Munywoki PK, Koech DC, Agoti CN, Bett A, Cane PA, Medley GF, Nokes DJ. Frequent Asymptomatic Respiratory Syncytial Virus Infections During an Epidemic in a Rural Kenyan Household Cohort. Journal of Infectious Disease. 2015 Dec 1;212(11):1711-8. Accessed on July 10, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4633757/

Centers for Disease Control and Prevention. Respiratory Syncytial Virus Infection (RSV). Accessed on July 20, 2021 at https://www.cdc.gov/rsv/index.html

Collins PL, Fearns R, Graham BS. Respiratory Syncytial Virus: Virology, Reverse Genetics, and Pathogenesis of Disease. Current topics in microbiology and immunology. U.S. National Library of Medicine. 2016 Mar 16. Accessed on July 20,2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794264/

Laham FR et al., Clinical Profiles of Respiratory Syncytial Virus Subtypes A and B among Children Hospitalized with Bronchiolitis. The Pediatric infectious disease journal. U.S. National Library of Medicine. 2018 Aug 1.Pediatr Infect Dis J. 2017 Aug; 36(8): 808–810. Accessed on July 20, 2021 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556381/

Cleveland Clinic. Respiratory Syncytial Virus in Children and Adults. Accessed on July 20, 2021 at https://my.clevelandclinic.org/health/diseases/8282-respiratory-syncytial-virus-in-children-and-adults

American Academy of Family Physicians. Respiratory Syncytial Virus Infection in Children. Accessed on July 20, 2021 at
https://www.aafp.org/afp/2011/0115/p141.html

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