When it’s not just a cold

Your baby’s case of the sniffles may be RSV – a serious, sometimes fatal, respiratory illness

OUR holiday season was a symphony of sneezes.

It’s inevitable, we joked, as family members from as far away as Illinois and Italy joined our celebrations in suburban Philadelphia, in the US.

We added packages of colourful tissues to last-minute shopping lists, drank ginger tea with lemon and recalled wryly how much worse it was a few years back when three generations in close quarters shared a stomach bug.

Until the youngest member of our clan started struggling for breath – and our cold-like symptoms suddenly seemed more sinister.

On New Year’s Eve, his parents took him to an urgent care clinic. The doctor called an ambulance and sent them to a nearby emergency room. Later that day they were transferred, again by ambulance, to the Nemours/Alfred I duPont Hospital for Children in Wilmington, where 5-month-old Timo spent the next four nights receiving supplemental oxygen, having mucus suctioned out of his nose and lungs, and being closely monitored for complications.

The diagnosis? RSV, or respiratory syncytial virus, an often overlooked infection.

It is the leading cause of hospitalisation for children under the age of 1 in the US.

A quick test can distinguish RSV from flu or other common colds, but most healthy young adults never find out because their symptoms don’t seem threatening. But RSV can present problems for the elderly and people with compromised immune systems.

In cases such as Timo’s, it causes bronchiolitis, or inflammation of the small airways in the lungs. Some infants develop pneumonia.

RSV is a killer in countries where respiratory support is not so readily available, causing 60 000 deaths annually around the world in children under 5. Experts estimate that a few hundred children die each year.

Some children become very ill, with the infection lingering beyond the expected few days and require highly specialised care, including IV fluids and intubation.

Complications often occur in children who suffer from underlying conditions, such as congenital heart disease or chronic lung disease, or in babies who arrived prematurely before having received the full complement of maternal antibodies.

All infants have small airways that are easily blocked by mucous.

RSV is not a new problem. It was recognised in the late 1950s and may have received more attention recently because infections with many of the other germs that cause lower respiratory tract infections can be prevented or treated.

Swift in-office tests now allow doctors to distinguish RSV from bacterial infections and thus avoid the overuse of antibiotics.

They also enable doctors to give parents specific advice about what to watch for and how the disease might progress, said Ruth Karron, a pediatrician and professor in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

But doctors can do little to combat RSV.

There is no effective antiviral drug, such as Tamiflu, which is used against influenza. Monthly injections of an antibody, Synagis, can help prevent serious infections but is expensive and given only to babies at very high risk.

“A good vaccine for RSV would probably have a bigger impact on childhood disease than almost any other vaccine could,” Miller said.

Until then, practise good respiratory hygiene with frequent hand washing and by coughing or sneezing into a tissue or elbow rather than into bare hands, advised Susan Gerber, chief of the respiratory viruses branch at the CDC’s Division of Viral Diseases.

Doctors recommend that adults and children, even with mild cold symptoms, avoid contact with at-risk infants. | The Washington Post