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Respiratory Syncytial Virus (RSV) Infection

Respiratory Syncytial Virus (RSV) Infection is a topic covered in the 5-Minute Clinical Consult.

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Basics

Respiratory syncytial virus (RSV) is a medium-sized, membrane-bound ribonucleic acid (RNA) virus that causes acute respiratory tract illness in patients of all ages. The most clinically significant disease occurs in infants and children <3 years old.

Description

A major cause of upper respiratory tract (URT) or lower respiratory tract (LRT/bronchiolitis) illness

  • In adults, RSV causes URT infections (URTIs).
  • In infants and children, RSV causes URTIs and LRT infections (bronchiolitis and pneumonia-LRTI).
Pediatric Considerations
  • 90–95% of children are infected by the age of 24 months; reinfection is common.
  • Leading cause of pediatric bronchiolitis (50–90%)
  • Premature infants are at increased risk for severe acute RSV infection.

Epidemiology

  • Seasonality: Highest incidence of RSV in the United States occurs between December and March.
  • Morbidity: RSV infection leads to over 100,000 annual hospitalizations.
  • Mortality: Deaths associated with RSV are uncommon. Children with complex chronic conditions account for the majority of deaths, and the relative contribution of RSV infection to their deaths is unclear (1)[B].

Etiology and Pathophysiology

  • RSV-induced bronchiolitis causes acute inflammation, edema, and necrosis of small airway epithelium, air trapping, bronchospasm, and increased mucus production.
  • RSV develops in the cytoplasm of infected cells and matures by budding from the plasma membrane.
  • Infection spreads through droplets, either airborne or personal contact, that inoculate the nose of a susceptible individual.

Genetics
  • A genetic predisposition to severe RSV infections may be associated with polymorphisms in cytokine- and chemokine-related genes, including CCR5; IL4; and affiliated receptors, IL8, IL10, and IL13.
  • Infants with transplacentally acquired antibody against RSV are not fully protected against infection but may have milder symptoms.

Risk Factors

  • Risk factors for severe disease
    • Prematurity
    • Age <12 weeks
    • Underlying cardiopulmonary disease
    • Immunodeficiency
  • Other risk factors
    • Low socioeconomic status
    • Exposure to environmental air pollutants
    • Child care attendance
    • Severe neuromuscular disease
    • Adults: occupational exposure to young children, hospital staff, teachers, and daycare workers

General Prevention

  • Hand hygiene is the most important step to prevent the spread of RSV.
    • Alcohol-based rubs are preferred. Hand washing with soap and water is acceptable but less effective (2)[B].
  • Avoid passive smoke exposure, especially in infants and children (3)[A].
  • Isolate patients with proven or suspected RSV.
  • Palivizumab (Synagis) is a monoclonal antibody directed against the fusion (F) protein of RSV; indicated for prophylaxis for:
    • Infants and children <24 months of age with
      • Chronic lung disease of prematurity requiring medical therapy within 6 months of the start of RSV season
      • Hemodynamically significant congenital heart disease
      • Congenital abnormalities of the airway or neuromuscular disease that compromises handling airway secretions
    • Infants born at ≤29 weeks’ gestation if they are <12 months of age at the start of the RSV season; prophylaxis should be maintained through the end of the RSV season.
    • Infants born at 29 to 32 weeks’ gestation if they are <6 months of age at the start of the RSV season; prophylaxis should be maintained through the end of the RSV season.
    • Infants born at 32 to 35 weeks’ gestation who are <3 months of age at the start of the RSV season or who are born during the RSV season if they have one of the following two risk factors:
      • Infant attends child care
      • ≥1 more siblings or other children <5 years of age living permanently in the child’s household
  • Dosage: maximum of 5 monthly doses beginning in November or December at 15 mg/kg per dose IM
  • Current palivizumab guidelines in the Red Book

Commonly Associated Conditions

  • Asthma
  • Otitis media
  • Serious bacterial infection (SBI) in infants and children with concurrent RSV infection is rare.

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Citation

Stephens, Mark B., et al., editors. "Respiratory Syncytial Virus (RSV) Infection." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688011/all/Respiratory_Syncytial_Virus__RSV__Infection.
Respiratory Syncytial Virus (RSV) Infection. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688011/all/Respiratory_Syncytial_Virus__RSV__Infection. Accessed April 19, 2019.
Respiratory Syncytial Virus (RSV) Infection. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688011/all/Respiratory_Syncytial_Virus__RSV__Infection
Respiratory Syncytial Virus (RSV) Infection [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 19]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688011/all/Respiratory_Syncytial_Virus__RSV__Infection.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Respiratory Syncytial Virus (RSV) Infection ID - 1688011 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688011/all/Respiratory_Syncytial_Virus__RSV__Infection PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -