Purpose and Goal: CEARP #1093
- Describe the risk factors for acquiring respiratory syncytial virus (RSV).
- Identify strategies for the prevention of RSV.
None of the planners, faculty or content specialists has any conflict of interest or will be presenting any off-label product use. This presentation has no commercial support or sponsorship, nor is it co-sponsored.
Requirements for Successful Completion
- Successfully complete the post-test.
- Complete the evaluation form.
- December 2013 - December 2015
- Describe the risk factors for acquiring RSV infection.
- Describe the detrimental effects of RSV infection.
- Identify at least two strategies for the prevention of RSV infection.
Infection and Incidence
- RSV is a contagious viral infection that causes respiratory illness.
- There are two strains of RSV (RSV-A and RSV-B).
- RSV can cause an upper respiratory infection.
- RSV can cause a lower respiratory tract infection.
- RSV is the most common cause of bronchiolitis in infants <1 year of age.
- RSV infection in infancy is a risk factor for long-term complications.
- Bronchial hyperreactivity
- Obstructive sleep apnea
- RSV infections generally occur during fall, winter and early spring.
- In the United States, generally November-April
- In western Washington state, generally December-March
- The timing and severity of RSV can vary from year to year.
- First time exposure
- 25%-40% of infants will develop bronchiolitis or pneumonia.
- 0.5%-2% will require hospitalization.
- Most infants that are hospitalized are <6 months of age.
- Most children have had an RSV infection by 2 years of age.
- Persons infected with RSV are contagious for 3-8 days.
- Infants with weakened immune systems can be contagious for as long as 4 weeks.
- RSV is generally spread by school-aged children.
- RSV can be rapidly spread by coughing or sneezing.
- RSV can be spread by direct contact with infected persons.
- RSV can also be spread by indirect contact.
- RSV can survive on hard surfaces for many hours.
- RSV survives on soft surfaces for shorter amounts of time.
- Most infants will recover within 1-2 weeks.
- After recovery, infants continue to spread the virus for 1-4 weeks.
- Infants that are reinfected generally have less severe illness.
- All infants are at risk of acquiring RSV infection.
- Some infants are at higher risk.
- Demographic factors
- Premature birth
- Male gender
- Low birth weight for age
- <12 weeks at start of RSV season
- Twins or higher multiples
- Clinical factors
- Chronic lung disease
- Congenital heart disease
- Cystic fibrosis
- Down syndrome
- Neuromuscular disease
- Congenital malformations
- Environmental factors
- Daycare attendance
- School-age siblings
- Crowded home environment
- Sharing a bedroom
- Lack of breastfeeding
- Tobacco smoke exposure
- Use of wood-burning stoves
- Nosocomically acquired RSV
- Most infants will show symptoms 4-6 days after exposure.
- Primary symptoms
- Runny nose
- Decreased appetite
- Secondary symptoms
- Symptoms in very young infants
- Decreased activity
- Breathing difficulties
- There is no specific treatment for RSV.
- Supportive care is the most common approach.
- For severe symptoms:
- IV hydration
- Supplemental oxygen
- Frequent suctioning
- Intubation and mechanical ventilation
- There are currently no vaccines to prevent RSV infection.
- Frequent hand washing is most important.
- Frequent washing of hard surfaces
- Frequent washing of toys and bedding
- Minimize spread if family member is infected.
- Infected persons should minimize contact with infant.
- Visitors should be restricted during RSV season.
- Limiting time spent in daycare can be beneficial.
- Synagis prophylaxis can help prevent serious illness.
- Synagis (palivizumab) is a monoclonal antibody.
- Provides antibody protection against RSV
- Decreases risk of serious RSV infection
- Reduces hospitalizations due to severe RSV illness
- Given monthly as an IM injection during RSV season
- Missing or delaying a dose increases risk of infection.
- American Academy of Pediatrics Guidelines
- Infants born at or before 28 weeks' gestation and younger than 12 months of age at the start of RSV season (5 doses)
- Infants born at 29-32 weeks' gestation and younger than 6 months of age at the start of RSV season (5 doses)
- Infants born at 32-35 weeks' gestation and younger than 3 months of age at the start of RSV season (up to 3 doses) if they:
- Will be attending daycare
- Have a sibling younger than 5 years of age
- Infants born at or before 35 weeks' gestation and younger than 12 months at the start of RSV season (5 doses) if they:
- Have a congenital abnormality of the airways
- Have a congenital neuromuscular disease that compromises handling of respiratory secretions
- Infants and children younger than 24 months of age with cyanotic or complicated congenital heart disease (5 doses)
- Especially if they are on medication for CHF
- Especially if they have pulmonary hypertension
- Infants and children younger than 24 months of age who have been treated for chronic lung disease within 6 months of the start of RSV season (5 doses)
- Teach proper hand hygiene.
- Discuss benefits of breastfeeding.
- Discuss importance of avoiding tobacco smoke.
- Direct exposure
- Secondhand exposure
- Discuss importance of avoiding crowds.
- Discuss importance of avoiding travel.
- Review measures to prevent spread of RSV.
- Daycare environment
- Pediatrician office environment
- Home environment
- Avoiding infected persons
- Review Synagis prophylaxis for qualified infants.
- Provide written information.
- Enroll infant in Synagis prevention program.
- Bracht, M., Basevitz, D., Cranis, M., Paulley, R. & Paes, B. Practical Resources for Nurses and Other Health Care Providers Involved in the Care of Children at Risk for Respiratory Syncytial Virus Infection. 2012. Neonatal Network. 31 (6), p 387-392.
- Bracht, M., Heffer, M., & O'Brien, K. Preventing RSV Infection. 2005. Advances in Neonatal Care. 5(1), p. 50-51.
- Bracht, M., Basevitz, D., Cranis, M., Paulley, R. & Paes, B.Strategies for Reducing the Risk of Respiratory Syncytial Virus Infection in Infants and Young Children. 2012. Neonatal Network, 31 (6), p.357-368.
CDC Guidelines: Respiratory Syncytial Virus Infection
American Academy of Pediatrics Clinical Practice Guideline: Diagnosis and Management of Bronchiolitis
RSV Info Center: Respiratory Syncytial Virus
Test and Evaluation