RSV, or respiratory syncytial virus is the most common identified cause of infections of the lungs and airways in young children. New research has found that RSV is involved in more than 1 in 4 cases of infections of this type in children under the age of 5 and is responsible for an estimated 3 million admissions a year to hospitals worldwide. The study also shows that RSV is estimated to be responsible for around 120,000 deaths of young children around the world every year.
The majority of these are in developing countries with India, China, Nigeria, Pakistan and Indonesia accounting for around half of the estimated 33 million cases worldwide. Although the number of deaths is very very small compared with the number of infections, severe infections are more common in these areas and there may be ways these childhood deaths can be prevented.
What are the symptoms of RSV?
The virus causes inflammation of the lungs and airways and symptoms can range from a mild cold-like illness, cough and fever to severe breathing difficulty, pneumonia and death. In children less than a year of age it can be the cause of a condition called bronchiolitis, which around 1 in 3 babies in the UK will suffer from. The severity of bronchiolitis also varies and some will have nasal congestion (be snotty), mild fever and a cough whereas others may have difficulty breathing (their chest may draw in under the ribs when breathing and between ribs if very severe) and struggle to feed because of the extra work required to breathe. Symptoms will gradually worsen over the first 2 – 3 days, then plateau and resolve over the following 1 – 2 weeks.
How do you catch RSV?
RSV is passed on by close contact and can survive on door handles and toys for several hours. Cleaning hands after sneezing and coughing can help to prevent RSV from spreading. It is very difficult to completely avoid RSV as it is so common but keeping those with colds away from very young babies would also be sensible.
How do you treat RSV?
Unfortunately, antibiotics do not help with treating RSV as it is a viral infection. Ribavirin is an antiviral drug that has been experimentally used to treat RSV but it has not shown to be that effective and causes side-effects, some of which can be severe. Therefore the main treatments are supportive and at home this is ensuring that your child is feeding normally and not working hard with their breathing.
If a child becomes more unwell then treatment in hospital would include oxygen and other breathing support. The child may also need feeding support which may involve passing a tube into the stomach via the nose or mouth through which food can be given. These may be given in an intensive care setting and is not always available in developing countries.
Why does more need to be done to prevent RSV infections?
As well as preventing childhood deaths, reducing RSV infections would also bring down the number of children needing to go into hospital. Given that symptoms can persist for up to 2 weeks and may require intensive breathing and feeding support, these admissions can place a high burden on hospitals and can be very costly to health services. In developing countries there may not be the resources that are available in more developed countries. Therefore, helping to support hospitals by reducing RSV admissions could save more lives in turn.
What more can be done?
Work is underway to develop a vaccine against RSV. Some authors involved in this work did declare that they had received financial support from companies involved in vaccine development. However, a number of different companies are in the later stages of development of a vaccine against RSV. This may mean that providing a vaccine would be a cost-effective way to reduce admissions as well as preventing deaths caused by RSV infections.
Additionally, education and encouragement around hygiene measures in hospitals and in the community may help to reduce the number of cases seen during a break out.
Those carrying out this research also admit that the numbers of deaths and admissions are likely to be higher than their figures show, as countries in in Africa and South Asia did not have comprehensive statistics. More work is needed to establish how common RSV is in these areas, and work then is needed to prevent infections, admissions and deaths from this very common virus.
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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.
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Links and Further Reading
- Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study, Prof Harish Nair, PhD et al., The Lancet, doi: 10.1016/S0140-6736(17)30938-8, published 6 July 2017
- Aljabr W, Touzelet O, Pollakis G, Weining W, Munday DC, et al. Investigating the influence of ribavirin on human respiratory syncytial virus RNA synthesis using a high-resolution RNAseq approach. J. Virol. JVI.02349-15. Available online via:http://jvi.asm.org/content/early/2015/12/08/JVI.02349-15#cited-by