RSV – Respiratory Syncytial Virus – What you need to know.

RSV – Respiratory Syncytial Virus – What you need to know.

You may have seen respiratory syncytial virus, or R.S.V., in the news recently, as rates of the virus have ticked up across Ireland. R.S.V. usually circulates from late December to mid-February. But this year, an early spike in cases is resulting in markedly higher numbers of infections and hospitalisations.  As rising R.S.V. rates coincide with the expected wintertime surge in Covid-19 as well as an early flu season, experts are worried about a “tripledemic” and the strain it could place on hospitals and emergency departments that are already stretched thin.

Respiratory syncytial (sin-SISH-uhl) virus, or 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.

What is R.S.V. and why is it on the rise?

R.S.V. is a common winter virus that typically causes mild cold-like illness in most people, but can occasionally be very dangerous for young children and older adults. The youngest infants have a high risk of being admitted into hospital in what may be their first R.S.V. season. If a child is born in the summer and they get exposed for the first time in the winter, they are at risk of having more serious disease.

In a normal pre-pandemic year, 1 to 2 percent of babies younger than 6 months with an R.S.V. infection may need to be hospitalised. And virtually all children have had an R.S.V. infection by the time they are 2 years old.   But many experts believe masking, social distancing, school closures and other precautions taken during the first year or two of the pandemic protected most children from exposure to the virus and other germs. As a result, there are still many children who are less than 3 years old who’ve never been exposed to R.S.V.  The virus is now playing catch-up in all these kids.

Can adults get R.S.V.?

They can. Adults still get R.S.V. fairly regularly and they can get reinfected multiple times throughout adulthood.  Because adults already have a lot of antibodies against the virus from previous exposures, their illness tends to be much milder. In fact, it can be almost indistinguishable from the common cold or even a mild case of the flu or Covid-19.

Most adults with R.S.V. are able to shake off an infection in a week or two, but seniors and those who have weakened immune systems, as well as those with chronic lung or heart disease, can develop more severe cases.

What are the symptoms of an R.S.V. infection?

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 as well as general lethargy, irritability and a decreased appetite.  Parents should also be on the lookout for signs that their child is having difficulty breathing. For example, if an infant or toddler is breathing faster than usual, if you notice more of their ribs or belly moving as they breathe or if their nostrils are flaring, those are all signs that you should take them to see a doctor.

Almost all children will have had an RSV infection by their second birthday  -  at least this was the case before the Covid pandemic.  In figures - around 65pc of children will be infected with the virus by the age of one. By age three, this rises to well over 90pc.  Around one in 50 children who get RSV will need medical care.

Call your healthcare professional if you or your child is having difficulty breathing, not drinking enough fluids, or experiencing worsening symptoms.

Treatment and 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 paracetamol 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 Pharmacistbefore giving your child non-prescription cold medicines. Some medicines contain ingredients that are not good for children.

RSV can cause more serious health problems

RSV can also cause more severe infections such as bronchiolitis, an inflammation of the small airways in the lung, and pneumonia, an infection of the lungs. It is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age.

Healthy adults and infants infected with RSV do not usually need to be hospitalised. But some people with RSV infection, especially older adults and infants younger than 6 months of age, may need to be hospitalised if they are having trouble breathing or are dehydrated. In the most severe cases, a person may require additional oxygen, or IV fluids (if they can’t eat or drink enough), or intubation (have a breathing tube inserted through the mouth and down to the airway) with mechanical ventilation (a machine to help a person breathe). In most of these cases, hospitalisation only lasts a few days.

Young children tend to struggle more, not just because their immune systems are still learning to recognise and fight off viruses, but also because their airways are so small.  An R.S.V. infection can dramatically increase mucus secretions in the airways, which older children and adults are able to cough or sneeze out. But infants and toddlers do not yet have strong enough muscles to cough up all the extra fluid, so parents or health care providers need to do the job for them by suctioning their airways.

Is there a test for R.S.V.?

There are rapid antigen tests and P.C.R. tests to check for R.S.V., but they are typically reserved for young children or older adults, because there is limited treatment for an infection if you do not need hospitalisation. If a patient is showing signs of a severe infection, a health care provider may also check their breathing with a stethoscope and order a white blood cell count or other tests, such as a chest X-ray or CT scan.

What can you do to avoid R.S.V.?

R.S.V. can spread when people touch contaminated surfaces. It also spreads through respiratory droplets.  So it’s a good idea to disinfect surfaces, particularly in settings like day care centres, where young children are constantly touching things, sneezing on things and sticking them in their mouths.

Premature infants and children with certain medical conditions can also take a monthly monoclonal antibody medication called palivizumab during R.S.V. season to help keep them out of the hospital.

In summary,

• Ireland has seen record levels of RSV in recent years leading to a rise in illness and in some cases hospitalisations of very young children. It can also affect the over-65s and adults with chronic heart or lung disease. If the virus moves into the lungs, it can trigger coughing and wheezing.
• It may develop into a severe respiratory disease, such as bronchiolitis – inflammation of the small airways in the lungs – and pneumonia.
• Babies, the over-65s and people with heart and lung disease, along with those with weakened immune systems are most vulnerable to a more serious infection.
• It spreads easily through airborne droplets that transmit the virus when someone coughs or sneezes. It can also be found on surfaces. One study showed it could survive on a person's hands for more than half an hour.
• Most children can be looked after at home and it goes away in around two weeks. Drinking plenty of fluids is very important.
• Paracetamol syrup is available from Grants pharmacies and it can ease a fever, sore throat and pain, which will help a child to feed and sleep normally.
• I recommend a humidifier in the room for the children, it helps with the breathing and the coughing and is available from pharmacies.
• Basics such as coughing or sneezing to the elbow are advised and also hand washing. Children who are at home should not be looked after by older relatives who could be put at risk.

If you have any questions about RSV, please feel free to contact me in Grant’s Pharmacy or by email at leoniegrant@grantspharmacy.ie

We do offer flu vaccine which is free for kids under 17yrs old, and is given as a nasal spray.  It does not work against RSV but it does prevent the flu virus from infecting young kids and possibly keeping them out of school, or spreading the infection to vulnerable adults in their close circles.  Email grantsvaccinations@gmail.com for information and an appointment.

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