Seasonal Viruses: RSV the most “consistent and predictable” virus

It is a common virus that usually causes mild to severe cold symptoms.
“After the attack, most patients recover in one to two weeks. However, RSV infection can be serious, especially for infants and the elderly. RSV is the most common cause of bronchiolitis (inflammation of the small airways of the lung) and pneumonia (infection of the lungs) in children under one year of age.

RSV infection is so common that almost all children by their second birthday will have suffered an RSV infection at least once,” points out Mr. Dimitrios Kafetzis Emeritus Professor of EKPA, Management Consultant of the Pediatric Department of the Metropolitan Hospital.
Each year in the United States, it causes epidemics of respiratory disease in all age groups, and an estimated 58,000-80,000 children under the age of 5 years are hospitalized due to RSV infection.

In most areas of the Northern Hemisphere, RSV circulation begins in the fall and peaks in the winter, but the timing and severity of the RSV season in a given community can vary from year to year.

Clinical description and diagnosis

In infants and young children

Infants with RSV infection almost always have symptoms. This is different for adults, who can be infected with RSV and have no symptoms. In very young infants (under 6 months of age), the only symptoms of RSV infection may be:
• Irritability
• Decreased activity
• Decreased appetite
• Apnea episodes (stopping breathing for more than 10 seconds)

Fever may not always occur with RSV infections.
“In general, RSV infection can cause a variety of respiratory problems in infants and young children. It most commonly causes symptoms of a cold, but often affects the lower respiratory tract so it manifests as bronchiolitis or pneumonia. A small percentage of infants younger than 6 months of age with RSV infection may need to be hospitalized. More severe disease occurs more often in very young infants. In addition, children with any of the following underlying conditions are considered at high risk for severe disease:
• Premature infants
• Infants, especially those 6 months and younger
• Children under 2 years of age with chronic lung disease or congenital heart disease
• Children with suppressed immune system
• Children with neuromuscular disorders, including those who have difficulty swallowing or expectorating mucus secretions.

Infants and young children with RSV infection usually start with a runny nose and refusal to eat before other symptoms appear. The cough usually occurs one to three days later. Immediately after the development of the cough, sneezing, fever and wheezing may occur. In very young infants, irritability, decreased activity, and/or episodes of apnea may be the only symptoms of infection.

Most otherwise healthy infants and young children infected with RSV do not require hospitalization. Those hospitalized may require oxygen, intubation, and/or mechanical ventilation. Most improve with supportive care and are discharged from the hospital in a few days,” explains the doctor.

In the elderly and adults with chronic health problems

Adults infected with RSV usually have mild or no symptoms. Symptoms are usually consistent with an upper respiratory tract infection that may include rhinorrhea, pharyngitis, cough, headache, fatigue, and fever. The illness usually lasts less than five days.

Some adults, however, may have more severe symptoms consistent with a lower respiratory tract infection, such as pneumonia. People at high risk for severe disease from RSV include:
• Older adults, especially those 65 and older
• Adults with chronic lung or heart disease
• Adults with a weakened immune system.
RSV can also sometimes lead to a worsening of serious conditions such as:
• Asthma
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure

Clinical laboratory tests
The clinical symptoms of RSV are non-specific and are similar to other viral respiratory infections, as well as some bacterial ones. Several types of laboratory tests are available to confirm RSV infection. These tests can be performed on samples taken from the upper and lower respiratory tract.
The most commonly used types of RSV clinical laboratory tests are as follows
Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR), which is more sensitive than virus culture and antigen detection. It is particularly sensitive in children but not so sensitive in adults.
Less commonly used tests include:
• Cultivation of virus
• Serological tests, which are usually used only for research or surveillance studies.
Some tests can distinguish between RSV subtypes (A and B), but the clinical significance of these subtypes is unclear.

For babies and toddlers
Both rRT-PCR and assays diagnose RSV infection in infants and young children. The sensitivity of antigen detection tests are effective methods for detecting RSV antigen generally ranges from 80% to 90% in this age group.

For older children, teenagers and adults
Healthcare providers should use highly sensitive rRT-PCR assays when screening older children and adults for RSV. rRT-PCR assays are now commercially available for RSV. The sensitivity of these tests often exceeds the sensitivity of virus isolation and antigen detection methods. Antigen detection tests are not very sensitive for older children and adults because they may have lower viral loads in their respiratory samples.
Prophylaxis for infants and young children at high risk

Palivizumab is a monoclonal antibody recommended by the American Academy of Pediatrics (AAP) and the Greek Ministry of Health to be administered to high-risk infants and young children who may benefit from immunoprophylaxis based on gestational age and certain underlying medical conditions. It is given in monthly intramuscular injections during the peak period of RSV, which generally starts in autumn, in our country from November, peaks in winter and ends in April each year.

For the need or not to give palivizumab to your child, if you have not received instructions from the maternity hospital where he was born or from the neonatal unit of the maternity hospital or hospital where your baby may have been treated, consult your pediatrician.
Vaccination against RSV

“Until now, an effective and safe vaccine has not been achieved.
However, an investigational RSV vaccine in pregnant women has been found to help protect infants from severe disease.

Pfizer recently announced that during a randomized, double-blind, placebo-controlled phase 3 study, the RSVpreF vaccine was nearly 82% effective against severe RSV infection in infants from birth through the first 90 days of life, according to company press release.

The vaccine was also 69% effective against severe disease in the first 6 months of life. A total of 7,400 women had received a single dose of 120 μg of RSVpreF at the end of their second or third trimester of pregnancy. There was no evidence of safety issues for mothers or infants.
Various antiviral treatments have been tried to treat the disease, without particularly satisfactory results,” concludes Mr. Kafetzis.

Written by:

Mr. Dimitrios Kafetzis Emeritus Professor, EKPA,

Management Consultant of the Pediatric Department of the Metropolitan Hospital

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