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RSV Infection: Symptoms, Causes and Treatment

RSV infection is a respiratory illness caused by the Respiratory Syncytial Virus, primarily affecting infants, young children, and older adults.

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Things worth knowing about "RSV Infection"

RSV infection is a respiratory illness caused by the Respiratory Syncytial Virus, primarily affecting infants, young children, and older adults.

What Is an RSV Infection?

An RSV infection is caused by the Respiratory Syncytial Virus (RSV), a common RNA virus belonging to the family Pneumoviridae. RSV is one of the leading causes of respiratory tract infections in young children and can also cause serious illness in older adults and immunocompromised individuals. Almost all children will have been infected with RSV at least once by the time they reach two years of age.

Causes and Transmission

RSV spreads primarily through droplet transmission -- when an infected person coughs or sneezes and others inhale the virus-containing particles. It can also spread via direct contact with contaminated surfaces, as the virus can survive on hard surfaces for several hours.

Close contact with an infected person
Touching contaminated objects such as toys or door handles
Shared spaces such as daycare centers or nursing homes

In temperate climates, RSV season typically runs from autumn through spring.

Symptoms

Symptoms vary depending on the age and overall health of the person affected.

Mild Symptoms (common in older children and adults)

Runny or stuffy nose
Cough
Mild fever
Sore throat
General feeling of illness

Severe Symptoms (common in infants and high-risk groups)

Bronchiolitis: inflammation of the small airways causing breathing difficulties
Wheezing (a whistling sound when breathing)
Rapid breathing and chest retractions
Poor feeding and reduced appetite in infants
Pneumonia in severe cases
Low blood oxygen levels (cyanosis) in very severe cases

Risk Groups

Certain groups of people are at higher risk of developing severe RSV illness:

Infants under 6 months of age, especially premature babies
Children with congenital heart disease or chronic lung conditions
Immunocompromised individuals
Adults aged 65 and older
People with underlying conditions such as COPD or heart failure

Diagnosis

RSV infection is diagnosed based on clinical presentation and confirmed with laboratory testing.

Rapid antigen test: Detects RSV antigens from a nasal swab; results are available quickly but sensitivity is lower
PCR test (polymerase chain reaction): Highly sensitive detection of viral RNA; considered the gold standard
Blood tests and inflammatory markers: Help assess disease severity and rule out secondary bacterial infections
Chest X-ray: Indicated when pneumonia or severe bronchiolitis is suspected

Treatment

There is currently no broadly available specific antiviral therapy for RSV. Treatment is therefore primarily supportive and symptomatic.

General Measures

Adequate fluid intake and rest
Nasal decongestant drops to improve breathing
Fever-reducing medications such as paracetamol or ibuprofen (age-appropriate dosing)

Hospital Treatment for Severe Cases

Supplemental oxygen when blood oxygen levels are low
Intravenous fluids when oral intake is insufficient
Mechanical ventilatory support in very severe cases
Palivizumab: A monoclonal antibody used for prophylaxis in high-risk infants such as premature babies or children with heart defects

Prevention and Vaccination

Significant advances have been made in RSV prevention in recent years:

RSV vaccines for adults aged 60 and over: Since 2023, RSV vaccines (e.g., Abrysvo, mRESVIA) have been approved in Europe and the United States for older adults.
Nirsevimab (Beyfortus): A long-acting monoclonal antibody recommended as passive immunization for newborns and infants during their first RSV season.
Maternal vaccination during pregnancy: The Abrysvo vaccine is also approved for use in pregnancy to protect newborns through maternally transferred antibodies.
General hygiene measures: Regular handwashing and avoiding close contact with infected individuals.

References

World Health Organization (WHO): Respiratory syncytial virus (RSV). WHO Fact Sheet, 2024. www.who.int
Ralston S.L. et al.: Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics, 134(5):e1474-e1502, 2014. doi:10.1542/peds.2014-2742
Simoes E.A.F. et al.: Respiratory syncytial virus. The Lancet, 354(9181):847-852, 1999. doi:10.1016/S0140-6736(99)80040-3

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