Introduction 

Respiratory Syncytial Virus (RSV) is an incredibly common respiratory virus which primarily affects children, in particular those under the age of one. This is evident as almost 80% of lower respiratory tract infections in children younger than the age of one was attributed to RSV annually.¹ Despite its high epidemiology, it is commonly mistaken for the common cold which is incredibly dangerous as this virus is the most common cause of paediatric pneumonia (lung infection that causes inflammation in the air sacs) and bronchiolitis (inflammation of the small airways in the lungs).¹ As a result, RSV has a significant impact on school attendance affecting both the infected children and their families. This article will, therefore, look at the ways in which RSV can have an impact on school attendance drawing upon scientific research and real-world examples. 

Understanding RSV

RSV is a highly contagious virus belonging to the Paramyxoviridae family of viruses.² This virus is characteristically presented through classic symptoms such as a runny nose, fever, coughing, and wheezing.³ It is important to note that in most cases RSV only causes a mild illness displaying cold-like characteristics. However, in severe cases or in those infants or adults with an immunocompromised system or perhaps adults with other underlying medical conditions such as asthma, may develop pneumonia or bronchiolitis.⁴ The virus tends to spread through close contact with infected individuals, exposure to respiratory droplets as well as through contact with contaminated surfaces.⁵ Viruses such as RSV tend to have an incubation period and this is the time between when a person is exposed to the virus and when they start to show symptoms. It's like the waiting period before you know you’re sick. For RSV, the average incubation period is typically 4-6 days and people who are infected can remain contagious for 3-8 days.⁶

RSV and school-age children

So from what we have explored so far we can see that RSV has the ability to impact people of all ages though pertinently, certain groups of individuals are more vulnerable than others. Certainly, school-aged children under the age of 5 are amongst those who are more susceptible to this virus with it not being uncommon for the infection to spread within school settings. This is supported by studies conducted in daycares showing that RSV follows a seasonal variation in its incidence with it being more prevalent during winter months.⁷ Additionally, it has also been shown that RSV is one of the leading causes of respiratory illness-related school absences.⁸ Furthermore, in comparison to other common respiratory infections such as influenza and the common cold, RSV has a tendency to produce a more prolonged impact on children’s health and in turn their school attendance. 

Direct impact on school attendance

The duration of RSV illness and the time required for complete recovery can have a significant impact on school attendance. On average, RSV can last for up to 3 weeks with children experiencing symptoms for 3-8 days particularly those that are immunocompromised.⁹ During this period, children can become too ill to attend school leading to long school absences. In the most severe cases, children may sometimes require hospitalisation to fully recover and before they can return to school in full capacity. This is supported by studies showcasing that of the 100 children under the age of 3 almost 65% missed more than one day of daycare with the average absenteeism being 3 days.¹⁰ Moreover, for every 100 children with RSV, the rate of absenteeism from school was significantly higher in children aged 3 or under, compared to those over the age of 3.¹⁰ Therefore, we can begin to picture the large and arguably profound impact that RSV can have on children and their school attendance. 

With the onset of the coronavirus as well as other virus outbreaks in the past, schools have policies and guidelines regarding contagious illnesses which, as a result, can also have an impact on when children are able to return to class. Many schools have set regulations such that children should be fever-free for at least 24 hours as well as to have shown vast improvement in their symptoms prior to their school return.¹¹ Additionally, some schools may also require that in certain cases there be proof of medical clearance from a healthcare provider to ensure that the child is no longer contagious and can therefore return to school in full capacity to partake in school activities.¹²

Indirect impact on school attendance

The impact of RSV on school attendance can also extend beyond directly impacting the child through infection. For example, when a child becomes infected with RSV, there is an incredibly high chance that the virus will go on to spread to other family members such as their siblings. Such transmission can occur through fomites, which are things like clothing and furniture, and more importantly can also spread through close contact with the infected individual or contaminated surfaces.¹³ Such a spread, can therefore lead to additional school absences when siblings also become ill and in turn require care at home. Furthermore, parents may also require the need to take time off work to look after their sick children. This could impact the parent's ability to manage childcare arraignments and thereby ensure their children’s regular school attendance.

Notably, RSV-related school absences may also have a psychological impact and an academic effect on school children. Missing school for long periods of time can lead to stress and anxiety with children worrying about falling behind their studies as well as missing out on social interactions with their peers.¹⁴ In addition, even when children ultimately return to school, they may struggle to understand and catch up on missed work and assignments in turn impacting their academic performance.¹⁵

Case studies and statistical data

There have been several noticeable studies that have investigated and supported the impact of RSV on school attendance. For example, it has been noted that RSV, alongside other respiratory viruses like influenza and rhinoviruses, were the highest detected viruses in children between the ages of 5-17 years old and these accounted for 75% of missed school days.¹⁶ Furthermore, studies in other countries such as Germany revealed similar details with further evidence supporting that parents and caregivers lost a notable number of workdays due to RSV related respiratory infections impacting their children.¹⁷ Moreover, for children who were hospitalised not only was school attendance impacted but cost-related impacts also incurred as an indirect impact, such as travel costs to hospitals for parents/caregivers, as well as expenses of additional meals and medical related costs.¹⁷ This indicates that RSV can have a negative impact on both parents/caregivers and children impacting economic, academic, and social wellbeing.  

Real world examples from school data also illustrate the impact of influenza on absenteeism. For example, a study conducted by McLean et al, showed that the mean number of school days missed was 0.79 for those infected with RSV and these numbers were typically lower compared to influenza (1.01 days absence) but very similar to other non-influenza like viruses such as the coronavirus and rhinovirus.¹⁶ Moreover, children with RSV were less likely to have prolonged absence (>2 days) compared to those with influenza.¹⁶ Although RSV's impact on school absenteeism was less than that of influenza, the combined burden of RSV and other non-influenza respiratory viruses was substantial.

Preventative measures and management 

Due to the significant impact of RSV on absenteeism we should look to find ways to mitigate this so as to reduce the indirect impact on parents/caregivers as well as to lessen the psychological and economic burdens due to RSV-related illnesses. 

One of the ways we can do this is by taking preventative measures to combat RSV with vaccinations being the most common way. As of August 2023, two RSV vaccines have been approved for market use. Arexvy was the first RSV vaccine approved by the FDA in May 2023 for the prevention of lower respiratory tract disease caused by RSV in adults aged 60 years and older. In August 2023, Abrysvo developed by Pfizer was also approved by the FDA for the prevention of RSV-associated lower respiratory tract disease in older adults and for use in pregnant women during the third trimester to protect infants. Abrysvo is currently the only approved vaccine for passive immunisation of infants through maternal vaccination.

In addition to these two approved vaccines, there are currently 22 other RSV vaccine candidates in various stages of clinical development, targeting different age groups such as young children, pregnant women, and older adults. These vaccine candidates are based on different technologies, including mRNA, live-attenuated or chimeric, subunit, and recombinant vector-based vaccines.

The availability of these approved vaccines and the diverse pipeline of vaccine candidates in clinical development suggest that RSV vaccination could potentially reduce the burden of the virus on school attendance in the future. However, further research is needed to assess the long-term effectiveness and impact of these vaccines on school absenteeism.

In the meantime, schools can implement hygiene practices and policies to prevent the spread of RSV. Encouraging frequent handwashing, providing access to hand sanitizers, and promoting respiratory etiquette (covering coughs and sneezes) can help reduce transmission. Schools may also need to isolate symptomatic students and send them home to prevent further spread within the classroom.

Healthcare providers play a crucial role in managing RSV cases and providing guidance to schools and parents. They can offer recommendations on when it is safe for children to return to school based on their recovery progress and the risk of contagion. Healthcare providers can also educate parents on recognizing the signs and symptoms of RSV, as well as provide advice on home care and when to seek medical attention.

Conclusion 

In conclusion, RSV has a significant impact on school attendance, affecting both the infected children and their families. The prolonged duration of illness, school policies on contagious diseases, and the indirect effects on siblings and parents all contribute to RSV-related school absences. The psychological and academic consequences of missing school further compound the problem.

To minimise the impact of RSV on school attendance, a multifaceted approach is necessary. This includes the development and implementation of effective RSV vaccines, the promotion of hygiene practices in schools, and the active involvement of healthcare providers in managing RSV cases and providing guidance to schools and parents.

The recent approval of two RSV vaccines, Arexvy and Abrysvo, and the diverse pipeline of vaccine candidates in clinical development offer hope for reducing the burden of RSV on school attendance in the future. However, further research is needed to assess the long-term effectiveness and impact of these vaccines on school absenteeism.

By understanding the complex ways in which RSV influences school attendance and taking proactive measures to prevent and manage the virus, we can work toward reducing the burden of RSV on children's health and education.

Summary 

• RSV is a highly contagious respiratory virus that significantly impacts school attendance, especially in children under 5 years old.
• The prolonged duration of RSV illness, school policies on contagious diseases, and the indirect effects on families contribute to increased school absenteeism.
• RSV-related school absences can have psychological and academic consequences for children, such as anxiety about falling behind and difficulty catching up on missed work.
• The recent approval of two RSV vaccines, Arexvy and Abrysvo, and the diverse pipeline of vaccine candidates in clinical development offer hope for reducing the burden of RSV on school attendance in the future.
• A multifaceted approach, including effective vaccines, hygiene practices in schools, and guidance from healthcare providers, is necessary to minimise the impact of RSV on children's health and education.

FAQ

How long does RSV typically last in children? 

On average, children with RSV experience symptoms for 3-8 days, with the illness lasting up to 3 weeks in some cases.

Can RSV spread to other family members? 

Yes, RSV is highly contagious and can easily spread to other family members, particularly siblings, through close contact or exposure to contaminated surfaces.

Are there any vaccines available for RSV? 

As of August 2023, two RSV vaccines, Arexvy and Abrysvo, have been approved for market use. Arexvy is approved for adults aged 60 years and older, while Abrysvo is approved for older adults and pregnant women in their third trimester.

What can schools do to prevent the spread of RSV? 

Schools can implement hygiene practices and policies such as encouraging frequent handwashing, providing access to hand sanitizers, promoting respiratory etiquette, and isolating symptomatic students.

When is it safe for a child with RSV to return to school? 

Healthcare providers can offer recommendations on when it is safe for children to return to school based on their recovery progress and the risk of contagion. Generally, children should be fever-free for at least 24 hours and have a significant improvement in symptoms before returning to school.