It is possible that most of us at some point of time have suffered from respiratory syncytial virus (RSV). With symptoms identical to the common cold, it is likely that we remain ignorant of the fact that we have contracted RSV, especially if the virus did not spread to our lower respiratory tract. In fact, among most adults, home remedies and over-the-counter cold medicines might help effectively deal with RSV as well. However, RSV among children, especially very young children (those less than a year old), can prove to be much more serious, sometimes resulting in loss of life as well. If not detected and treated in time, this seemingly innocuous virus could lead to serious complications in your child and result in a lifetime of breathing problems. Dr Passorn Punyahotra of Samitivej Hospital discusses RSV in children, its symptoms, what parents should watch out for, when to consult a doctor, and prevention strategies.
If you are a new parent or know someone who is, it is important that you learn a little bit about respiratory syncytial virus (RSV) in children. RSV is a common infection of the respiratory tract that manifests symptoms similar to those of the common cold. It can affect children and adults alike but is most dangerous for infants and children with weak heart or lungs. Approximately 1% to 3% of all children in the first 12 months of life will be hospitalized because of RSV.
Among adults and older children, symptoms of RSV could include congested or runny nose, dry cough, sore throat, and mild headache. These symptoms are remarkably similar to those of the common cold and the attendant discomfort can often be treated using simple care remedies.
Infants with their fragile immune systems are particularly susceptible to RSV and the first infection could result in severe symptoms. Subsequent infections are likely to be milder due to the impact of anti-bodies in their body. Children with underlying heart and lung problems might suffer breathing problems if they contract RSV and might require hospitalization and even a ventilator to reduce distress. About 20 – 40% of Thai children with lower respiratory tract infection is cause by RSV. In high-risk cases like babies with heart and lung problems and pre-term infants or very small infants, RSV infection could be fatal.
For RSV infection, better outcome might achieve if the patient was treated early. About 20 – 30% of patients, the virus spread to the lower respiratory tract, which then develops into bronchiolitis (infection of small airways) or pneumonia. There might be some association between RSV bronchiolitis early in the life and subsequent asthma. Symptoms of RSV include severe, chesty cough; difficulty in breathing; lips/face turning blue when coughing; and high fever. If your child is coughing and this is disturbing its sleep, consult a doctor. If your baby has a high fever, is unable to eat or play, and breathes with a wheeze, consult a doctor immediately.
If you suspect RSV, it is best to get your little one to a hospital immediately. We will conduct a nasal swab and within 20-30 minutes, we will be able to tell if your child has RSV. Sometimes, it might be necessary to conduct an X-ray to determine if the child has pneumonia. Tests might also have to be conducted to determine the level of oxygen in the bloodstream so that treatment can be adjusted accordingly.
There are no specific medicines for RSV; instead, we treat the symptoms. Once RSV is diagnosed, treatment involves hydration and oxygenation. Feeding your baby warm liquids helps since it clears congestion and helps keep the baby hydrated, which is critical in the treatment of RSV.
A prophylaxis has been introduced in the West that is used in the prevention of pre-term infants or babies with congenital heart disease or weak lungs. The prophylaxis generates antibodies that helps improve the infant’s resistance or immunity. Unfortunately, this prevention is not yet available in Thailand.
There is no vaccine for RSV. It is transmitted through secretions and can be contracted by shaking hands with, touching, or kissing an infected person or even an object that has the RSV germs. How does an object get germs on it? When an infected person sneezes or coughs or blows their nose, germs escape into the surroundings. A strict hygiene routine is the only way to keep infection at bay. Older siblings who go to school or day care can bring the virus back home and infect the infant. The virus can survive for hours on toys or other objects. If you touch such an object and then touch your baby, you could end up transferring the virus. So, hand hygiene is particularly important in the prevention of RSV, and it is helpful to encourage this among older children to ensure that they don’t inadvertently infect younger siblings. This cleanliness can extend to the child’s general environment as well. It makes immense sense to reduce your child’s exposure to people suffering from fever or colds.
Seasons are also important in the spread of the virus. In the northern hemisphere, spring to winter is peak RSV season, but in Thailand, June to October, or the monsoon, is when RSV spreads rapidly. It helps, therefore, to exercise greater caution during this time. Since the first year of a child’s life is when RSV might be particularly dangerous, breastfeeding exclusively for the first six months helps build the infant’s immunity, thus lowering the risks of RSV. While the jury is still out on the influence of smoking in the spread of RSV, general medical opinion is that smoking is best avoided around children. Similarly, if you can prevent your child’s exposure to air pollution, it can’t harm the baby’s respiratory system.
The First Class Honors M.D., Faculty of Medicine, Chulalongkorn University, 2004.