Respiratory syncytial (sin-SISH-uhl) virus (RSV)*

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in Canada and the United States.

Symptoms and Care

Symptoms

People infected with RSV usually show symptoms within 4 to 6 days after getting infected. Symptoms of RSV infection usually include

• Runny nose
• Decrease in appetite
• Coughing
• Sneezing
• Fever
• Wheezing

These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties. Almost all children will have had an RSV infection by their second birthday.

Care

Most RSV infections go away on their own in a week or two. There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals (medicines that fight viruses). Take steps to relieve symptoms

• Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give aspirin to children.)
• Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration (loss of body fluids).
• Talk to your healthcare provider before giving your child non-prescription cold medicines. Some medicines contain ingredients that are not good for children.

RSV in Infants and Young Children

RSV can be dangerous for some infants and young children. Each year in the United States, an estimated 58,000 children younger than 5 years old are hospitalized due to RSV infection. Those at greatest risk for severe illness from RSV include

• Premature infants
• Very young infants, especially those 6 months and younger
• Children younger than 2 years old with chronic lung disease or congenital (present from birth) heart disease
• Children with weakened immune systems
• Children who have neuromuscular disorders, including those who have difficulty swallowing or clearing mucus secretions

Severe RSV Infection

Virtually all children get an RSV infection by the time they are 2 years old. Most of the time RSV will cause a mild, cold-like illness, but it can also cause severe illness such as

• Bronchiolitis (inflammation of the small airways in the lung)
• Pneumonia (infection of the lungs)

One to two out of every 100 children younger than 6 months of age with RSV infection may need to be hospitalized. Those who are hospitalized may require oxygen, intubation, and/or mechanical ventilation (help with breathing). Most improve with this type of supportive care and are discharged in a few days.

Early Symptoms of RSV

RSV may not be severe when it first starts. However, it can become more severe a few days into the illness. Early symptoms of RSV may include

• Runny nose
• Decrease in appetite
• Cough, which may progress to wheezing

RSV in Very Young Infants

Infants who get an RSV infection almost always show symptoms. This is different from adults who can sometimes get RSV infections and not have symptoms. In very young infants (less than 6 months old), the only symptoms of RSV infection may be

• Irritability
• Decreased activity
• Decreased appetite
• Apnea (pauses while breathing)

Fever may not always occur with RSV infections.

What you should do if your child is at high risk for severe RSV infection

RSV season occurs each year in most regions of the U.S. during fall, winter, and spring. If you have contact with an infant or young child, especially those who were born prematurely, are very young, have chronic lung or heart disease or a weakened immune system, you should take extra care to keep the infant healthy by doing the following:

• Wash your hands often with soap and water for at least 20 seconds, and help young children do the same. If soap and water are not available, use an alcohol-based hand sanitizer. Washing your hands will help protect you from germs.
• Keep your hands off your face Avoid touching your eyes, nose, and mouth with unwashed hands. Germs spread this way.
• Avoid close contact with sick people Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms.
• Cover your coughs and sneezes Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing. Throw the tissue in the trash afterward.
• Clean and disinfect surfaces** Clean and disinfect surfaces and objects that people frequently touch, such as toys, doorknobs, and mobile devices. When people infected with RSV touch surfaces and objects, they can leave behind germs. Also, when they cough or sneeze, droplets containing germs can land on surfaces and objects.
• Stay home when you are sick If possible, stay home from work, school, and public areas when you are sick. This will help protect others from catching your illness.

What is the Status of a Vaccine?

There is no vaccine yet to prevent RSV infection, but scientists are working hard to develop one. And there is a medicine that can help protect some babies at high risk for severe RSV disease. Healthcare providers usually give this medicine (called palivizumab) to premature infants and young children with certain heart and lung conditions as a series of monthly shots during RSV season. The drug can help prevent serious RSV disease, but it cannot help cure or treat children already suffering from serious RSV disease, and it cannot prevent infection with RSV. If you are concerned about your child’s risk for severe RSV infection, talk to your child’s healthcare provider.

RSV Transmission

RSV can spread when

• An infected person coughs or sneezes
• You get virus droplets from a cough or sneeze in your eyes, nose, or mouth
• You touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands
• You have direct contact with the virus, like kissing the face of a child with RSV

People infected with RSV are usually contagious for 3 to 8 days. However, some infants, and people with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks. Children are often exposed to and infected with RSV outside the home, such as in school or child-care centers. They can then transmit the virus to other members of the family. RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time.* People of any age can get another RSV infection, but infections later in life are generally less severe. People at highest risk for severe disease include

• Premature infants
• Young children with congenital (from birth) heart or chronic lung disease
• Young children with compromised (weakened) immune systems due to a medical condition or medical treatment
• Adults with compromised immune systems
• Older adults, especially those with underlying heart or lung disease

In the United States and other areas with similar climates, RSV infections generally occur during fall, winter, and spring. The timing and severity of RSV circulation in a given community can vary from year to year.

RSV Prevention

There are steps you can take to help prevent the spread of RSV. Specifically, if you have cold-like symptoms you should

• Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
• Wash your hands often with soap and water for at least 20 seconds
• Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
• Clean frequently touched surfaces such as doorknobs and mobile devices

Ideally, people with cold-like symptoms should not interact with children at high risk for severe RSV disease, including premature infants, children younger than 2 years of age with chronic lung or heart conditions, and children with weakened immune systems. If this is not possible, they should carefully follow the prevention steps mentioned above and wash their hands before interacting with such children. They should also refrain from kissing high-risk children while they have cold-like symptoms. Parents of children at high risk for developing severe RSV disease should help their child, when possible, do the following

• Avoid close contact with sick people
• Wash their hands often with soap and water for at least 20 seconds
• Avoid touching their face with unwashed hands
• Limit the time they spend in child-care centers or other potentially contagious settings, especially during fall, winter, and spring. This may help prevent infection and spread of the virus during the RSV season