Respiratory syncytial virus (RSV)
Respiratory Syncytial Virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. However, infants and adults who are older or have certain risk factors can become very sick with RSV and may need to be hospitalized. RSV spreads in the fall and winter and typically peaks in December or January. Physicians can monitor RSV activity via the RSV surveillance system.
Transmission
RSV spreads from person to person predominantly through respiratory droplets from the nose and throat of infected people. The droplets get into the air when they cough and sneeze. RSV can also spread through contact with contaminated surfaces. The virus can survive on hard surfaces for many hours. It typically survives on soft surfaces, such as tissues and hands, for shorter amounts of time. RSV is primarily transmitted in households and community settings. People are typically contagious for 3 to 8 days, including 1 to 2 days before symptoms start.
Signs & symptoms
RSV typically causes upper respiratory symptoms in children. Symptoms usually start with runny nose and decreased appetite, followed by a cough 1 to 3 days later. After the cough, sneezing and wheezing may occur. Most adults are asymptomatic or have mild upper respiratory symptoms like runny nose, sore throat, headache and fever. However, those with underlying chronic medical conditions can develop severe disease. RSV can be especially dangerous for infants and adults 75 and older, as well as those 50-74 years old with risk factors.
Infants: 58,000-80,000 hospitalized yearly. High risk:
- American Indian, Alaska Native children
- Premature children
- Children with chronic lung or heart disease
- Children with pulmonary abnormalities or neuromuscular disorders
- Children with Down Syndrome or chromosomal abnormalities
Adults: 100,000-150,000 hospitalized yearly. High risk:
- ≥75 years
- Adults with chronic lung or heart disease
- Adults with weakened immune systems
- Adults who live in nursing homes
Diagnosis
RSV causes similar symptoms to other viruses and bacteria that cause respiratory illnesses. Diagnosis is through nucleic acid amplification tests (NAATs) or antigen tests done on either upper or lower respiratory samples. There are no home tests for RSV at this time.
Prevention strategies
Healthcare settings require multi-faceted approaches to prevent the transmission of RSV, as it is effectively spread both person-to-person and indirectly through fomites. Core prevention strategies include vaccination, hand hygiene, environmental cleaning with approved products, and engineering controls.
Vaccination
There are now several immunization options for RSV. American Academy of Pediatrics, American College of Obstetrics and Gynecology, American Academy of Family Physicians, and the Infectious Diseases Society of America created recommendations for different populations.
- Adults ≥75 years / Adults 50-74 years at increased risk of severe RSV: One-time vaccination with any of the available vaccines: GSK’s Arexvy, Moderna’s mResvia, and Pfizer’s Abrysvo
- One-time RSV vaccine in first eligible pregnancy if 32-36 weeks pregnant, given between Sept. 1 and March 1: Maternal RSV vaccine: Pfizer’s Abrysvo
- Immunocompromised: Single dose of RSV vaccine for those ages≥18 years and for those ages <18 years, administration should be guided by shared decision making: One-time vaccination with any of the available vaccines: GSK’s Arexvy, Moderna’s mResvia, and Pfizer’s Abrysvo
- Infants under 8 months of age born during or entering their first RSV season (Oct. 1–March 31), if no protection from RSV vaccine during pregnancy: Monoclonal antibody nirsevimab or clesrovimab
- Children 8 through 19 months of age at high risk of severe RSV disease and entering their second RSV season (Oct. 1–March 31), regardless of prior RSV immunization status: Monoclonal antibody nirsevimab
To prevent severe RSV disease in infants, either maternal RSV vaccination or infant immunization with RSV monoclonal antibody is recommended. Most infants will not need both.
Coadministration with other vaccines
RSV vaccines may be given with other vaccines in the same visit for eligible patients. If the patient prefers to receive each vaccine at a separate visit, there is no minimum waiting period between vaccines.
Treatment
There is no specific treatment for RSV beyond supportive care.
Infection prevention and control
Recommended Personal Protective Equipment (PPE) for RSV is Contact + Standard precautions. For RSV, Standard precautions include mask usage because of the respiratory nature of this virus. Duration of PPE is for the duration of illness, longer if the patient is immunocompromised.
