What is RSV and how to protect your family from it

Q: What do I need to know to protect myself and my family from RSV?

RSV, or Respiratory Syncytial Virus, is circulating again and may be part of another “tripledemic” as flu and COVID infections are also increasing. RSV is a very common respiratory virus that most of us have experienced by the time we were 2 years old. It is a seasonal virus that causes many infections typically from November through March. Unfortunately, we are susceptible to getting infected with RSV annually as previous infection does not confer lifelong immunity.

RSV enters the body through the eyes, nose, or mouth. This can occur through infected airborne droplets when a sick person coughs or sneezes, via contact with an infected surface and touching our face without washing hands, and through direct contact with someone who is sick. Unfortunately, a person may be contagious for a couple days before showing any symptoms.

Understanding what the name of this virus means helps to explain the cause of the symptoms. A syncytium is the fusion of several cells into one large cell. The cells of our respiratory tract have small hairs, or cilia, on the outer border that help to move foreign material out (akin to small escalators). When RSV infects cells of the respiratory tract it causes those cells to fuse together and disables their debris-removing ability. Symptoms of RSV include fever, runny nose, cough, sneezing, poor appetite, and wheezing. It can also cause bronchiolitis (inflammation of the smaller airways in the lungs) and pneumonia (an infection of the lung tissue).

Secondary problems such as dehydration and ear infections may also occur. Symptoms are the most severe around the third to fifth day of the illness and may last up to 14 days. Treatment focuses on alleviating the symptoms as there is no antiviral medication to address this infection. Pushing fluids, using nasal saline rinses, running a humidifier, using acetaminophen or ibuprofen to treat discomfort from fever, and giving honey for a cough may help.

There are a few caveats to treatment: over-the-counter cold medicines are not safe or effective for kids under 4 to 6 years of age; ibuprofen should not be given to babies younger than 6 months-old; and honey may be given after the child’s first birthday, but agave syrup may be given to treat a cough in those younger than 1.

Typically, RSV is an annoying upper respiratory infection, but in some instances, may be more serious. Most hospitalizations and deaths from RSV occur in babies and older adults. Hospitalization may be required to treat dehydration and respiratory distress and RSV is the most common cause of hospitalization in babies under 1 year of age. Signs of respiratory distress in babies include rapid breathing (more than 40 times per minute), nasal flaring, using extra muscles to breathe (sucking in above the breastbone, in between the ribs, between the ribs and stomach, and seesaw breathing between the chest and belly), making grunting sounds with breathing, and wheezing. A helpful video demonstrating what this looks like can be found at HealthyChildren.org.

Younger babies may not show any signs of respiratory distress but may be irritable, not feed well, and have pauses in breathing. If you have any concerns, contact your child’s health care provider.

Handwashing, not touching one’s face, cleaning high-touch surfaces regularly, avoiding contact with sick people, and staying home when you are sick can help prevent many infections.

Thankfully, there are some additional options in preventing RSV infections. Nirsevimab, or Beyfortus, is a single injection of a long-acting monoclonal antibody against RSV that is approved for all babies under 8 months old during the RSV season, and those 9 to 19 months old who are considered high risk for severe disease. Unfortunately, there is a severely limited supply for this season, and it is not generally available. Palivizumab, or Synagis, is a monthly preventive antibody injection given through RSV season but is only approved for the highest risk babies.

Thankfully, there are two products available for adults to keep them from getting sick that can also prevent spread to others. Abrysvo (RSVpreF vaccine) is a single shot approved to give during pregnancy to mothers who will deliver a baby between September and January. This vaccine not only protects moms but enables them to pass immunity to their baby, as well. Abrysvo and Arexvy (RSVPreF3) are single injection vaccines approved for adults 60 years and older.

To locate RSV vaccines, as well as the recommended flu and updated covid vaccines, please visit vaccine.doh.nm.gov.

Melissa Mason is a general pediatrician with Journey Pediatrics in Albuquerque. Please send your questions to melissaemason@gmail.com.