RSV can be life-threatening for babies
DEAR DOCTOR: I’ve been reading a lot lately about something called RSV, which acts like a cold but turns out to be way worse, especially in kids. What is it, and how is a parent supposed to know the difference?
DEAR READER: You’re referring to respiratory syncytial virus, which is often shortened to its initials RSV. It’s both very common and quite contagious. In fact, most children will have had a case of it by age two.
The virus, which infects the respiratory epithelium, the specialised layer of cells that line the nasal and lung passages, causes inflammation. You’re correct that the initial symptoms are just like those of a cold. Often, you’ll also see a noticeable drop in the child’s appetite, and he or she may run a fever as well. The symptoms come on slowly, appearing in stages. Parents report that first they’ll notice their child becoming increasingly fussy, and then gradually listless. As you pointed out in your question, this all lines up with the symptoms and onset of a typical cold.
The good news is that for most children, infection with RSV stays within the parameters of a bad cold. In those cases, the symptoms can be managed with overthe-counter medications like ibuprofen or acetaminophen to relieve pain and bring down the fever. During the week or two that it takes to recover from a typical bout with the virus, it’s also important to make sure the child stays hydrated.
But for some babies, particularly those younger than six months old, and those born prematurely, the virus can be life-threatening. Also at heightened risk are babies and children with Down syndrome, people with suppressed immune systems and the elderly. For that reason, it’s vital to monitor RSV symptoms and act quickly if they escalate.
The danger arises from the degree of inflammation the virus causes in some individuals, as well as the increase in mucus production. Both make it increasingly difficult to breathe. RSV can also lead to pneumonia and bronchiolitis, an acute lower respiratory infection. As soon as you realise that a case of RSV has moved into dangerous territory, it’s vital to see your primary care physician. Although there is no specific medication that targets the virus at this time, your doctor will know whether hospitalisation is the next necessary step. In the hospital, the medical staff can initiate interventions to help with the patient’s breathing and hydration, as well as provide close monitoring of the progress of the virus. In the majority of cases, hospitalisation lasts only a day or two.
Up to one-third of all hospitalisations for respiratory viruses each year in the US are due to severe cases of RSV — approximately 57,000 children younger than five, according to the US Centers for Disease Control and Prevention. All of which makes the recent announcement from Canadian researchers that they have identified a promising antiviral compound to target RSV welcome news. It is said to be similarly effective against the mosquito-borne Zika virus, which is responsible for severe defects in the unborn children of Dr Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health.