Respiratory Syncytial Virus

American Academy of Pediatrics. Respiratory Syncytial Virus. In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. American Academy of Pediatrics; 2018; 682-692

Respiratory syncytial virus (RSV) causes acute respiratory tract infections in people of all ages and is one of the most common diseases of early childhood. Most infants infected with RSV experience upper respiratory tract symptoms, and 20% to 30% develop lower respiratory tract disease (eg, bronchiolitis and/or pneumonia) with the first infection. Signs and symptoms of bronchiolitis typically begin with rhinitis and cough, which progress to increased respiratory effort with tachypnea, wheezing, rales, crackles, intercostal and/or subcostal retractions, grunting, and nasal flaring. Infection with RSV during the first few weeks of life, particularly among preterm infants, may produce minimal respiratory tract signs, lethargy, irritability, and poor feeding, sometimes accompanied by apneic episodes. These infants are at particular risk of life-threatening apnea even in the absence of any other severe respiratory symptoms. Most previously healthy infants who develop RSV bronchiolitis do not require hospitalization, and most who are hospitalized improve with supportive care and are discharged after 2 or 3 days. However, approximately 1% to 3% of all children in the first 12 months of life will be hospitalized because of RSV lower respiratory tract disease, with most RSV hospitalizations occurring in the first 6 months of life. RSV hospitalization rates are highest between 30 and 60 days of age. Factors that increase the risk of severe RSV lower respiratory tract illness include prematurity, especially infants born before 29 weeks’ gestation; chronic lung disease of prematurity (CLD [formerly called bronchopulmonary dysplasia]); certain types of hemodynamically significant congenital heart disease (CHD), especially conditions associated with pulmonary hypertension; and certain immunodeficiency states. Additional risk factors for severe RSV lower respiratory tract infections in children worldwide include low birth weight, having siblings, maternal smoking during pregnancy, exposure to secondhand smoke in the household, history of atopy, not breastfeeding, and household crowding. Mortality is rare when supportive care is available. Fewer than 125 deaths in children <2 years of age are associated with RSV infection annually in the United States, and fewer than 50 deaths occur in those with a primary diagnosis of RSV.

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