Respiratory Syncytial Virus (RSV) is a highly contagious virus that typically causes common cold-like symptoms. However, in children under 5 years old, or those with certain health conditions, it can lead to more severe illnesses such as bronchiolitis (inflammation of the small airways in the lungs) and pneumonia (lung infection).

In 2015, it was estimated that there were ‘3·2 million hospital admissions for RSV-associated acute lower respiratory infection’  in children younger than 5 years old.¹

Read on to find out how this virus spreads, what symptoms can occur and what treatments are available.

What are the symptoms of an RSV infection?

Symptoms of RSV in children and adults are similar to those of a common cold and include:

• Sneezing
• Runny nose 
• Coughing  
• Fever
• Breathing difficulties
• Decreased appetite
• Wheezing 

The symptoms of RSV in very young infants may be congestion, fever, breathing difficulties, being irritable and tired.

RSV infection - when should you call a doctor?

It’s important to get immediate medical attention if your child is:

• Having trouble breathing (they may make grunting noises or their chest is sucking in around their ribs)
• Your child’s breathing is laboured (there are pauses when your child breathes)
• The skin, tongue, or lips of your child are bluish 
• Your child is very drowsy and is struggling to wake up or stay awake

Call your healthcare provider or emergency services as soon as possible as these symptoms may be due to more serious illnesses such as bronchiolitis and pneumonia.

What are the causes of an RSV infection?

‘RSV spreads through contact with respiratory droplets, such as from coughing, sneezing, or kissing from an infected person. It can also spread by touching surfaces contaminated with the virus, like worktops and door handles, and then touching your eyes, nose, or mouth. The virus can live on these surfaces if an infected person touches them without washing their hands. 

By the age of 2, the majority of children will have had an RSV infection.

Is an RSV infection contagious?

‘People infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness. However, some infants, and individuals with weakened immune systems, can continue to spread the virus even after they stop showing symptoms, for as long as 4 weeks.³

Who is at risk of severe RSV infection?

Children younger than 5 and children with certain health conditions are most at risk of getting seriously ill from an RSV infection. These include:

• Premature babies
• Babies below 12 months 
• Children under 2 years old with heart or lung disease
• Children with a weak immune system
• Children with muscle diseases
• Children who are in daycare with lots of other children

What are the complications of an RSV infection?

Although in most cases RSV causes mild cold-like symptoms, some children can get severe illnesses such as:

• Bronchiolitis (inflammation of the small airways in the lung)
• Pneumonia (infection of the lungs)
• Lower and upper respiratory tract infections (infections in the parts of the body that help you breathe e.g. your sinuses, throat, airways or lungs).
• Respiratory disease, such as asthma or chronic obstructive pulmonary disease (COPD)
• Hypoxia (low blood oxygen)
• Dyspnea (shortness of breath)
• Acute respiratory failure (your lungs stop being able to release enough oxygen into your blood)
• Congestive heart failure (your heart can’t pump as much blood as your body needs)⁴
• Otitis media (middle ear infection)

Two to three out of every 100 infants with RSV infection may need to be hospitalized. Those who are hospitalized may require oxygen, IV fluids (if they aren’t eating and drinking), and mechanical ventilation (a machine to help with breathing). Most improve with this type of supportive care and are discharged in a few days.⁵

Adults over the age of 60 are also at higher risk of getting seriously ill from an RSV infection. These include:

• Adults who have a weak immune system
• Adults that have long-term health conditions, such as heart and lung  disease
• Adults that live in long-term health facilities like nursing homes

How is an RSV infection diagnosed?

In most cases, your healthcare practitioner will not need to perform any medical testing for RSV. However, when required, RSV can be diagnosed via a nasal swab which is sent to a laboratory for testing to analyse the antigens (a marker that tells your antibodies to make an immune response), in your mucus. 

For more serious cases, your healthcare practitioner may perform a blood test, x-ray or CT scan to check for complications in your airways.

How is an RSV infection treated?

Since RSV is a virus, it cannot be treated with antibiotics (which can only treat bacterial infections).

Medicines available over-the-counter such as those that reduce fever and pain can help you manage your symptoms.

Ensure you drink lots of fluid to stay hydrated and prevent dehydration and rest as much as possible to help your body recover.

Very young children may need hospital treatment if they are having difficulty breathing. 

Is there a vaccine for RSV?

Palivizumab, a monoclonal antibody therapy, is licensed in the UK for the prevention of serious lower respiratory tract infection caused by RSV in infants at high risk of infection.

How do you avoid getting an RSV infection?

RSV is spread when the respiratory droplets of an infected person are released into the air or onto surfaces and then come into contact with your face, eyes or mouth. 

To reduce the chances of getting infected by RSV, ensure that you:

• Frequently wash your hands (especially before touching your face)
• Avoid contacting someone who is ill with the RSV virus
• Cover your mouth and nose when you cough or sneeze
• Don’t share food, cups, bottles or cutlery with someone who is ill with the virus
• Wipe surfaces that are frequently touched often 

RSV - an overview

RSV is a common seasonal virus that affects young children and babies the most which has outbreaks in the colder months. In the majority of people, the symptoms of RSV are mild and only last 1-2 weeks. However, in some cases, symptoms could be more serious which can lead to hospitalisation.

Call your healthcare provider or emergency services if your child is having trouble breathing, the skin, tongue, or lips of your child are bluish, or your child is very drowsy and is struggling to wake up or stay awake.

FAQs

What are the stages of an RSV infection?

Normally symptoms start around 2 to 5 days after coming into contact with the virus.  RSV in babies and young children in the early phase is often mild with similar symptoms to a cold. In children younger than age 5, the infection may affect the lungs and cause coughing and wheezing. In some children, RSV may lead to bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs).

When is an RSV infection most contagious?

People infected with RSV may become contagious a day or two before they have symptoms and are usually contagious for 3 to 8 days. In some cases, infants and people with weakened immune systems can continue to be contagious after their symptoms have stopped - for as long as 4 weeks.

What can I do to help my child recover from RSV as quickly as possible?

You can help speed up your child's recovery by:

• ensuring your child drinks plenty of fluids. You can keep breastfeeding or bottle-feeding your infant as you usually would. 
• try to use saline drops if your child’s nose is congested. 
• keeping the room warm (but not overheated) and keeping the air moist.
• using over-the-counter medicines suitable for your child to control your child’s fever 
• keeping your child away from cigarette smoke.

Should I let my baby sleep with an RSV infection?

Like all viruses, babies and children must get plenty of rest to recover from RSV. It is recommended for babies to sleep in a position with their heads slightly elevated if possible. To achieve this, you can place the pillows or blankets under the mattress so it is up to a 30-degree incline. 

What are the long-term effects of an RSV infection in children?

RSV can lead to severe breathing illnesses such as 0bronchiolitis and pneumonia in high-risk babies and children. If a child catches RSV and their illness is serious enough to need medical care before the age of 3, they may be more likely to develop breathing problems such as asthma later on in their lives. However, for some children, wheezing caused by RSV may improve over time and disappear by the time they are teenagers.