Respiratory syncytial virus treatment guidelines

Overview of RSV

RSV is a Pneumoviridae single-stranded RNA virus. It mainly infects the nose-to-lung tract. The main genotypes of RSV-A and RSV-B differ in their surface glycoproteins, specifically G and F. Newborns under one year old are the main source of lower respiratory tract infections. The infection also affects the elderly and people with cardiac, pulmonary, and immunocompromised conditions. These causes lead to approximately 3.6 million hospitalizations and around 100,000 deaths each year among children under 5, with 97% of pediatric mortality occurring in low- and middle-income countries.

Respiratory syncytial virus in the lungs

Pathogenesis

• Virus binds via G and fuses with host cells via F.
• Repeats in epithelial cells, generating inflammation, mucus, and airway blockage.
• Apnea, pneumonia, bronchiolitis, and rare respiratory failure can all result from it.

Signs and symptoms

• Mild: Cough, congestion, fever.
• Severe: Bronchiolitis, pneumonia, wheezing, hypoxia.
• High-risk categories include infants under 6 months, the elderly, and those with chronic conditions.

Immunization, prevention

• Abrysvo (Pfizer) offers maternal vaccinations during pregnancy.
• The monoclonal antibody nirsevimab is now available for infants and high-risk toddlers.
• Comorbid elderly individuals can now be vaccinated.

Public Health Impact

• According to local conditions, RSV increases during cooler months.
• Interventions include vaccination, infection control, and early detection in vulnerable groups.
• In infants and young children, RSV symptoms can be severe, particularly in newborns who are under 12 months of age. Symptoms may develop gradually:

Early signs:

• Nose congestion
• Reduced appetite
• A little cough or sneeze
• Low-grade fever

Worsening symptoms:

• Rapid, shallow breathing
• Skin pulls in with each breath when the chest retracts
• Snoring or wheezing
• Blue lips or fingertips: cyanosis
• Poor diet or fatigue
• Discontent or fussiness

RSV may appear quietly in babies as irritation, decreased activity, or breathing problems.

Older children may experience cold-like symptoms.

• Nose congestion
• Dry cough
• Sore throat
• Sneezing
• Mild headache
• Low-grade fever

While some may develop wheezing or recurring respiratory symptoms, most recover within 1–2 weeks.

Adults (especially immunocompromised or 65+)

• Slight cold symptoms:
• Symptoms: Cough, nasal congestion
• Fatigue
• Sore throat
• Headache

Severe (particularly comorbid):

• Shortness of breath
• Wheezing
• Painful chest
• Cyanosis

Emergency Care When

• Rapid or difficult breathing
• Bluish lips or skin
• Drinking nothing
• High fever or worsening symptoms
• Infant breathing pauses (apnea)

How RSV Spreads

Transmission Methods

• Highly contagious RSV spreads through:
• When infected people cough or sneeze, droplets might enter the eyes, nose, or mouth.
• Direct contact: Kissing a child's face can spread RSV.
• Contaminated surfaces: RSV survives for hours on rough surfaces but less on tissues or fingertips.

Infectious Period

• Most People are contagious for 3–8 days.
• Infants and immunocompromised people may shed the virus for 4 weeks after symptoms resolve.

Community Share

• Children typically contract RSV in schools or daycares and bring it home.
• Nearly all children are infected by age 2, with reinfections likely throughout life.

Ways to prevent

• Sanitizing or washing hands often.
• Hi-touch surfaces should be disinfected regularly.
• Cover coughs/sneezes with a tissue or elbow.
• Especially with symptomatic people, avoid close touch.
• Improve indoor air quality or congregate outdoors with ventilation.

High-risk groups

• High-Risk Groups for RSV: Infants (under 6 months)
• Narrow airways and immature immune systems enhance vulnerability.
• Hospitalization rates are highest in this age group.
• Low-birth-weight and premature babies are in danger.

Underlying Conditions Kids

• Chronic lung disease (BPD)
• Congenital heart disease
• Airway-clearing neuromuscular syndromes

Adults over 65

• Immunity declines with age
• They frequently sMany adults over 65 suffer from heart failure, COPD, or diabetes.
• RSV hospitalizes 160,000 and kills 6,000–10,000 in this population annually.

Immunocompromised People

• Patients with cancer, chemotherapy, HIV/AIDS, or organ transplants are included.
• Long-term corticosteroid use
• Breathing problems, pneumonia, and extended viral shedding are more likely.

Chronic Heart/Lung Disease Adults

• CHF, COPD, and asthma worsen.
• CHF individuals are 8x more likely to be hospitalized.
• Low-resource populations face limited access to supporting care.
• Causes 97% of global pediatric RSV fatalities

Prevention of RSV: Immunization and Passive Protection

• Late-pregnancy maternal vaccination: Protects infants with transplacental antibodies.
• Monoclonal antibody (nirsevimab): Given early after birth to high-risk neonates.
• Adult vaccines: Suitable for individuals over 60 and those with chronic heart/lung disease.

Cleanliness and Behavior

• Spend at least 20 seconds washing your hands with soap, especially after touching shared surfaces or coughing or sneezing.
• Respiratory manners: Cover coughs/sneezes with a tissue or elbow.
• After contacting public surfaces, avoid touching your face, especially your eyes, nose, and mouth.

Environmental Controls

• Disinfect surfaces: Doorknobs, toys, and counters should be cleaned routinely.
• Use air purifiers, fans, or open windows to increase ventilation and reduce the viral load.
• Stay away from crowds: Particularly during RSV season (fall–winter).

Special considerations for high-risk groups

• Limit exposure: Keep babies and immunocompromised people away from sick people.
• Daycare safety: Promote childcare infection control.
• Fast care: If vulnerable, seek medical attention for cold-like symptoms.

Public Health Advice

• CDC recommends five methods to decrease respiratory virus transmission:
• Maintain immunizations.
• Maintain hygiene
• Improve indoor air quality
• Be cautious when symptomatic.
• If at risk for serious illness, be tested/treated soon.

Hand and respiratory hygiene

• Hand and Respiratory Hygiene: Essentials
• Coughing Etiquette
• Cough and sneeze into a tissue.
• Please ensure that tissues are promptly disposed of in a closed container.
• If no tissue is available, cough or sneeze into your elbow.
• Keep your hands away from your mouth, nose, and eyes, and refrain from spitting.
• After touching respiratory secretions or contaminated surfaces, wash hands.

Clean Hands

• Wash your hands for 20 seconds with soap and water:
• Post-cough/sneeze
• Before eating or cooking
• Right after peeing
• Contacting common surfaces or animals
• If soap and water are unavailable, use hand sanitizer with ≥60% alcohol.
• Educate kids about handwashing and provide hygiene materials.

Aid the Environment

• Place hand sanitizers near elevators, doorways, and common equipment.
• Make sure you have liquid soap, clean water, and paper towels (not bar soap).
• Keep hygiene signs accessible to encourage behavior.

Why It Matters

• These techniques prevent the spread of respiratory viruses such as RSV, influenza, and COVID-19.
• These techniques are particularly crucial during peak respiratory seasons, in high-risk environments, or during community transmission.

RSV diagnosis

Clinical Suspicion

• Influenza, COVID-19, and RSV symptoms often overlap.
• Infants, the elderly, and immunocompromised patients need a diagnosis to guide care and prevent complications.

Lab Test Methods

• With high sensitivity and specificity, real-time RT-PCR can identify RSV RNA. Gold standard for all ages
• Antigen Detection Tests: Nasal swabs are quick, but they are less sensitive than PCR. Point-of-care, especially for kids
• Viral Culture Used historically; sluggish and inefficient now. Now rarely used
• Immunofluorescence Assays detect RSV antigens in respiratory samples. Some hospital labs use
• Clinical care is similar for RSV subtypes A and B, although PCR-based testing can distinguish them.

Collection of Samples

• Nasopharyngeal swabs or aspirates are best for upper respiratory sampling.
• Severe or hospitalized cases may require lower respiratory specimens.

Considerations for Diagnosis

• Testing helps most in:
• Infants <12 months with bronchiolitis or apnea
• Seniors or high-risk people with pneumonia-like symptoms
• Long-term care, NICUs, outbreaks
• Early diagnosis guides infection control, reduces antibiotic use, and supports tailored therapy.

Treatment of RSV

The video explains how to care for your child at home.

• Supportive Care (Mainstay for Most Cases)
• RSV usually self-limits in healthy people.
• Symptom alleviation is the goal:
• Encourage fluids to avoid dehydration.
• Rest: Vital for recuperation, especially in kids and seniors.
• Administer acetaminophen or ibuprofen for fever, pain, and discomfort.
• Nasal Saline & Suctioning: Clears newborn and toddler mucous.
• Air humidity may improve breathing and lessen airway discomfort.
• Most instances heal in 1–2 weeks with home treatment.

Hospital-Based Management (For Severe Cases)

• Recommended for high-risk or respiratory distress patients:
• Oxygen for hypoxia or respiratory issues.
• IV fluids are administered to treat dehydration or inadequate oral intake.
• Mechanical ventilation: Rare yet necessary in emergencies.
• For secondary bacterial infections like pneumonia, antibiotics are prescribed.

Prevention and targeted therapies

• High-risk newborns receive monoclonal antibodies like nirsevimab for passive protection.
• Vaccines: Accepted for elderly individuals and pregnant women to lessen severity and transmission.

Also, read https://www.healthshots.com/daily-health/what-is-rsv-or-respiratory-syncytial-virus/.

Seek medical help if you notice a persistent high fever (greater than 103°F).

• Wheezing, breathlessness
• Bluish lips or skin
• Infant lethargy or malnutrition
• Adult confusion or inability to reply

Conclusion

RSV, a common respiratory infection, can be harmful in infants, elderly individuals, and those with underlying health issues. RSV is the largest cause of hospitalization in young children and a growing concern for elderly populations, even though most infections are mild and self-limiting.

Prevention and early intervention have been enhanced by vaccination, monoclonal antibodies, and public health awareness. However, sanitation, caregiver education, and appropriate diagnosis remain essential for limiting transmission and consequences.