Respiratory Syncytial Virus I... Health Article

Home care

Home treatment for RSV infection is primarily supportive. It involves taking steps to ease the child's breathing. Dehydration can be a problem, so children should be encouraged to drink plenty of fluids. Antibiotics have no effect on viral illnesses. In time, the body will make antibodies to fight the infection and return itself to health.

Home care for keeping a child with RSV comfortable and breathing more easily includes:

• use of a cool mist room humidifier to ease congestion and sore throat
• elevation of that baby's head by putting books under the head end of the crib
• acetaminophen (Tylenol, Pandol, Tempra) for fever (Aspirin should not be given to children because of its association with Reye's syndrome, a serious disease.)
• For babies too young to blow their noses, suctioning mucus with an infant nasal aspirator

Hospital treatment

In the United States, RSV infections are responsible for 90,000 hospitalizations and 4,500 deaths each year. Children who are hospitalized receive oxygen and humidity through a mist tent or vaporizer. They also are given intravenous fluids to prevent dehydration. Mechanical ventilation may be necessary. Blood gases are monitored to assure that the child is receiving enough oxygen.

Medications

Bronchiodilators, such as albuterol (Proventil, Ventilin), may be used to keep the airways open. Ribavirin (Virazole) is used for desperately ill children to stop the growth of the virus. Ribavirin is both expensive and has toxic side effects, so its use is restricted to the most severe cases.

Prognosis

RSV infection usually runs its course in seven to 14 days. The cough may linger for weeks. There are no medications that can speed the body's production of antibodies against the virus. Opportunistic bacterial infections that take advantage of a weakened respiratory system may cause ear, sinus, and throat infections or pneumonia.

Hospitalization and death are much more likely to occur in children whose immune systems are weakened or who have underlying diseases of the lungs and heart. People do not gain permanent immunity to respiratory syncytial virus and can be infected many times. Children who suffer repeated infections seem to be more likely to develop asthma in later life.

Prevention

As of 2004, there were no vaccines against RSV. Respiratory syncytial virus infection is so common that prevention is impossible. However, steps can be taken to reduce a child's contact with the disease. People with RSV symptoms should stay at least six feet away from young children. Frequent hand washing, especially after contact with respiratory secretions, and the correct disposal of used tissues help keep the disease from spreading. Parents should try to keep their children under 18 month of age away from crowded environments where they are likely to come in contact with older people who have only mild symptoms of the disease. Childcare centers should regularly disinfect surfaces that children touch.

Parental concerns

Because symptoms of severe respiratory distress may be subtle in very young babies, parents need to keep a high level of suspicion when young babies contract a respiratory illness, particularly young babies with a history of prematurity or other risk factor for severe RSV infection.

BOOKS

McIntosh, Kenneth. "Respiratory Syncytial Virus." In Nelson Textbook of Pediatrics. Edited by Richard E. Behrman et al. Philadelphia: Saunders, 2004.

Tristram, Debra A., and Robert C. Welliver. "Respiratory Syncytial Virus." In Principles and Practice of Pediatric Infectious Diseases, 2nd ed. Edited by Sarah S. Long et al. St. Louis, MO: Elsevier, 2003.

Tish Davidson, A.M. Rosalyn Carson-DeWitt, MD