The ABCs of RSV

Crying baby receives vaccine in the hospital

(Adobe Stock 669414390 by Yuwarin)

Recently, Infection Control Today spoke with Edward Walsh, MD, professor of Medicine, Infectious Diseases, at the University of Rochester Medical Center in New York about RSV, who the disease impacts, available treatments, and how to best manage in health care settings.

What is respiratory syncytial virus (RSV), and what are its common symptoms?

RSV is a very common virus that circulates widely from fall until spring. It causes typical respiratory symptoms of runny nose and cough and can also induce wheezing and shortness of breath. All age groups, from the youngest infants to oldest adults are susceptible. The illness generally lasts from 10 to 30 days.

Can RSV infections lead to long-term health complications in children or adults?

RSV infection in early childhood has been linked to the development of asthma later in childhood and adulthood. In one study, severe RSV in childhood was associated with progression of COPD in adults who smoke.

Are there vaccines available for RSV, and what is their effectiveness?

Currently, there are 2 licensed RSV vaccines, both based on one of the RSV proteins. A vaccine made by GSK is available for adults over age 60, while the vaccine made by Pfizer is available for adults over age 60 and also for pregnant women in order to prevent illness in their newborns by transfer of maternal antibody to the infant at birth. In adults, the vaccines were 85% effective at preventing severe RSV infections. Infants born to mothers vaccinated with the Pfizer vaccine had more than a 60% reduction in RSV infection including medically attended illness.

What are the key differences in RSV symptoms and severity between infants, older children, and adults?

Symptoms in infants, older children, and adults are very similar with the exception that infants are more likely to wheeze. Severity of RSV is greatest in the very young infant, less that 3 months of age, and also in the oldest adults above age 75 and those with certain underlying medical conditions, such as COPD, asthma and heart disease.

Edward Walsh, MD, professor of infectious diseases at the University of Rochester Medical Center

(Photo Credit of University of Rochester Medical Center)

How can health care providers differentiate between RSV and other respiratory illnesses when diagnosing patients?

The only definitive way to differentiate RSV from influenza, SARS-CoV-2 (COVID-19), or other viruses that cause common the cold is to perform a diagnostic test. This is generally done by collecting a nasal swab and testing.

What should individuals do to minimize the risk of RSV infection, especially during RSV season?

The virus is quite prevalent and thus hard to avoid, especially during the holiday season when there is so much person-to-person contact. Nevertheless, avoiding persons with respiratory illness is important, especially close hands-on contact. Of course, for the older adult, the vaccine would reduce illness risk.

How has the COVID-19 pandemic affected the incidence and management of RSV infections?

During the first 18 months of the COVID pandemic, RSV completely disappeared, as did most of the other respiratory viruses, such as influenza. It was thought this was in large part related to social distancing, school closures, and masking. When public activity started to resume, normal RSV illness rose to high levels in July 2021 among children but not in adults. The following year the annual epidemic started in late August and ended by early January. This year, RSV illnesses started in October, and I expect it to return to normal and end in April.

Are there specific recommendations for RSV prevention in health care settings or long-term care facilities?

Yes, any health care worker with a respiratory illness should not care for patients when secretions cannot be controlled. Hand washing and wearing gowns and a mask are also of great help in reducing spread. Identification of infected residents of Long-Term Care Facilities should be attempted, and if RSV is identified, they should be prevented from having contact with other residents until the illness passes.