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Out of Breath
By: Laura Weidenfeld, M.D.

It’s winter virus season: Educate yourself about RSV

Along with December’s holiday festivities comes the inevitable winter virus season. And one of the more menacing viruses is RSV. Many people have heard these letters and know they stand for something bad, but aren’t sure what. Respiratory syncytial virus is a common virus that causes respiratory illness in people of all ages. The reason we talk about RSV so much in pediatrics is that the younger the patients, the more likely they are to be severely affected. In fact, in infants and children, RSV is the most important cause of bronchiolitis and pneumonia.

When older children and adults are infected, symptoms tend to be limited to upper respiratory tract infection (common cold), and occasionally bronchitis. Infants, however, may show little in the way of upper respiratory signs; their symptoms may be lethargy, poor feeding, and apneic episodes (in which they do not breathe). Other infants and children may have episodes of wheezing and difficulty breathing. Most children tolerate the infection well, requiring supportive measures only and recover within a week. However, hospitalization may be necessary, and in rare cases infection can be fatal. Fatalities that occur are almost always in children with other risk factors such as complicated congenital heart disease, underlying lung disease, prematurity, and immunodeficiency (abnormal or absent immune system).

There is an interesting “chicken or the egg” theory about RSV. It appears that having early RSV infection may damage the lungs, causing children to have further episodes of wheezing and respiratory problems. This, however, may reflect the fact that children with underlying problems such as asthma may be more susceptible to symptomatic RSV infection. It is difficult to know “which came first”, but either way it’s wise to closely monitor a child who has had early RSV infection.

Treatment of RSV infection can include therapy such as hydration, nebulizer treatments (use of breathing machine to administer medicine called albuterol, commonly given to asthmatics), and supplemental oxygen when needed. There is a controversial antiviral medicine called ribavarin that has been shown to be effective against RSV in the lab. However, its high cost, high incidence of side effects, potential toxic effects to health-care workers (it is given via an aerosol machine that pumps the medicine into the air) and questionable efficacy in clinical trials make its use of limited value. It is usually reserved for only the most severe cases.

As is often the case, the best treatment is prevention. Practicing good hygiene, with hand washing and isolation of infected children, is important. The disease is spread by direct or close contact with contaminated secretions. RSV can remain on surfaces for hours and on hands for approximately 30 minutes. Unfortunately, re-infection is common, and no vaccine currently exists. There are, however, two products available to prevent RSV infection. One is RSV-IVIG, the other is palivizumab (Synagis). The former is given as an intravenous infusion, the latter as an injection. Both are given monthly during the RSV season. The recommendations for the administration of these products include premature babies (born at less than 35 weeks gestation) and children under 2 years of age with chronic lung disease.

Most children, however, do not meet the criteria for these preventative medicines. Therefore good hand washing and hygiene are all that is required during the winter flu season. Certainly, however, if you think your child may be a candidate for these preventive medicines, discuss it with your doctor.

Now if your friend tells you her child has RSV, you’ll know what she is talking about. You’ll also know not to invite them over for a play date until the child is feeling well. Remember that you can only do so much to prevent illness. So relax, enjoy the holidays, and have a happy New Year.

Laura Weidenfeld, M.D.
Sunshine Valley Pediatrics in Summerlin