RSV can be severe for some young and old
- Written by Mark Fishaut MD FAAP
Submitted by Mark Fishaut MD FAAP: Prior to this season, most of us had never heard of the virus with the weird name respiratory syncytial (sin-SISH-uhl) virus or RSV, That odd word “syncytium” means a glob of virus-fused tissue culture cells as viewed under a microscope in a lab.
This is a common annual seasonal virus that usually causes mild, cold-like symptoms and is spread by coughing , sneezing, and contact with secretions on surfaces. Many people never are ill but still may easily infect others.
The infection typically peaks in January and February but this winter has co-occurred with COVID-19 and influenza A in the so-called “tripledemic” causing misery for millions of families.
Whether the seasonal changes are random or have something to do with the restrictions that were in place at the height of the COVID-19 pandemic is not clear. Unlike influenza and COVID, there is currently no available vaccine against RSV.
Most people with symptoms recover within a week or two, but RSV can be serious, especially in both ends of life. While virtually ALL children get a mild RSV infection by the time they are two years old. It is likely a frequent cause of otitis which is why so many kids’ ear infections foo NOT respond to antibiotics.
However, it is the commonest cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children under a year of age. One to two out of every children younger than 6 months with RSV infection may need to be hospitalized in the United States, and a staggering 58,000-80,000 kids younger than 5 years old overall.
Children at higher risk for severe RSV include:
Very premature infants who may be preventively treated with anti-RSV antibody injections
Full term infants, especially those 6 months and younger
Children younger than 2 years old with chronic lung disease such as cystic fibrosis severe asthma or congenital (present from birth) heart disease
Children with weakened immune systems
Children who have neuromuscular disorders such as muscular dystrophy, including those who have difficulty swallowing or clearing mucus secretions
They may require oxygen, IV fluids (if they aren’t eating and drinking), and/or mechanical ventilation (a machine to help with breathing). Most improve with this type of supportive care and are discharged in a few days.
Very young infants who get an RSV infection almost always show symptoms. In very young infants (less than 6 months old), the only symptoms of RSV infection may be:
Apnea (pauses in breathing more than 10 seconds)
Fever may not always occur with RSV infections.
RSV infections can be dangerous for certain adults. Each year, it is estimated that between 60,000-120,000 older adults in the United States are hospitalized and 6,000-10,000 of them die due to RSV infection. The same adults at risk for severe influenza and COVID-19 are also those highest risk for severe RSV infection:
Older adults, especially those 65 years and older
Adults with chronic heart or lung disease such as COPD or congestive heart failure
Adults with weakened immune systems
Strategies for home and school management and prevention are available through websites such as: