RSV: A Common Virus Causing Severe Respiratory Infection in infants and Young Children – And Prevention is Now Here!

Most pediatricians and those of us who study and treat respiratory viral infections in children often say that respiratory syncytial virus is the most common illness that few people know about. Called RSV for short, the virus infects almost every child at least once before the age of 2. Why, then, haven’t you heard of it, especially now that preventive strategies are available?

Initially, the symptoms of RSV are very similar to those of other respiratory viruses like influenza—coughing, sneezing, runny nose, fever, breathing difficulties, wheezing, irritability and loss of appetite. In most cases, children infected with RSV recover on their own in a week or so. However, RSV is the single most common reason for hospitalization among children under the age of 1 in the United States. And importantly, the majority of hospitalized infants and children were previously healthy with no underlying medical conditions.

How do you know if your child’s cold may be something more serious? Infants and children with RSV usually show symptoms within four to six days of becoming infected. Most will recover in one week.

If the symptoms last longer or if you think your child’s condition and especially the breathing are worsening, you should see a doctor as the disease may be affecting the lungs and lower airways. This is especially true for children under the age of 2 experiencing their first RSV infection as the infection is worse the first time they get it. Young infants less than 1 month of age can sometimes forget to breathe as well (“apnea”). By swabbing the child’s nose, tests can be done to detect the virus in the breathing passages and diagnose the infection.

There is no specific treatment for RSV, but doctors may recommend medicines to treat the symptoms. If your child is hospitalized, he or she may need supplemental oxygen and suctioning of the airways to remove the mucus and respiratory secretions. In severe cases, your child may need a ventilator to assist with breathing.

You also can reduce the risk of infection to you and your child by washing your hands frequently especially after touching your nose, as well as by wiping hard surfaces and toys with soap and water or disinfectant. RSV is in the mucous from the nose and it spreads to others on our hands and when we touch things that have been contaminated with infected nasal secretions. You should always avoid sharing cups or utensils with your child as they can transmit not just RSV but other viruses and bacteria.

At Nationwide Children’s Hospital, we are doing research on how RSV evades the immune response and causes severe disease. Our goal is to develop a vaccine that can be given to young children to help fight against RSV. Such a vaccine is now available for elderly people as they also can experience severe RSV disease. The same RSV vaccine is now recommended during pregnancy at 32 to 36 weeks gestation to prevent severe RSV infection in their young infants less than 6 months of age.

In addition, a new medication called nirsevimab (Beyfortus) is recommended for all infants less than 8 months of age at the start or during the RSV season that usually lasts from November to March every year in Ohio. In addition, certain children 8 to 19 months of age who have certain medical conditions also may receive nirsevimab. Both the RSV vaccine and nirsevimab work to make the RSV infection less severe in your child. Generally, nirsevimab is given to infants whose mothers did not receive the RSV vaccine. Check with your doctor to see if your child qualifies to get it!     

As pediatricians, we see hundreds of infants with RSV yearly. Hopefully, with the introduction this year of the RSV vaccine for pregnant mothers and nirsevimab for infants, we may see the end of severe RSV infection in young infants and children.