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RSV can be life-threatening in babies younger than 6 months

October 2, 2018

Dear Doctor: I’ve been reading a lot lately about something called RSV, which acts like a cold but turns out to be way worse, especially in kids. What is it, and how is a parent supposed to know the difference?

Dear Reader: You’re referring to respiratory syncytial virus, which is often shortened to its initials, RSV. It’s both very common and quite contagious. In fact, most children will have had a case of it by age 2.

The virus, which infects the respiratory epithelium, the specialized layer of cells that line the nasal and lung passages, causes inflammation. You’re correct that the initial symptoms are just like those of a cold. Often, you’ll also see a noticeable drop in the child’s appetite, and he or she may run a fever as well. The symptoms come on slowly, appearing in stages. Parents report that first they’ll notice their child becoming increasingly fussy, and then gradually listless. As you pointed out in your question, this all lines up with the symptoms and onset of a typical cold.

The good news is that for most children, infection with RSV stays within the parameters of a bad cold. In those cases, the symptoms can be managed with over-the-counter medications like ibuprofen or acetaminophen to relieve pain and bring down the fever. During the week or two that it takes to recover from a typical bout with the virus, it’s also important to make sure the child stays hydrated.

But for some babies, particularly those younger than 6 months old, and those born prematurely, the virus can be life-threatening. Also at heightened risk are babies and children with Down syndrome, people with suppressed immune systems and the elderly. For that reason, it’s vital to monitor RSV symptoms and act quickly if they escalate.

The danger arises from the degree of inflammation the virus causes in some individuals, as well as the increase in mucus production. Both make it increasingly difficult to breathe. RSV can also lead to pneumonia and bronchiolitis, an acute lower respiratory infection. As soon as you realize that a case of RSV has moved into dangerous territory, it’s vital to see your primary care physician. Although there is no specific medication that targets the virus at this time, your doctor will know whether hospitalization is the next necessary step. In the hospital, the medical staff can initiate interventions to help with the patient’s breathing and hydration, as well as provide close monitoring of the progress of the virus. In the majority of cases, hospitalization lasts only a day or two.

Up to one-third of all hospitalizations for respiratory viruses each year are due to severe cases of RSV -- approximately 57,000 children younger than 5, according to the Centers for Disease Control and Prevention. All of which makes the recent announcement from Canadian researchers that they have identified a promising antiviral compound to target RSV welcome news. It is said to be similarly effective against the mosquito-borne Zika virus, which is responsible for severe defects in the unborn children of women who become infected while pregnant. The researchers say that drug development of this antiviral is now underway.

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