Introduction

Explanation of respiratory syncytial virus (RSV)

RSV is a quite common viral infection that affects the lungs and airways. Its symptoms mimic those perceived in patients with upper respiratory tract infections such as colds or influenza. These symptoms include having a runny nose and coughing or sneezing, and may also be accompanied by a fever or a decreased appetite.¹ It may take between 3 to 5 days for symptoms to appear from the moment of infection.²

RSV is transmitted through respiratory droplets. These can be caught directly from an infected person when they cough or sneeze. It can also be from touching the mouth or nose after touching surfaces on which the droplets have landed.¹ The virus can survive on surfaces for up to 7 hours.²

Importance of preventive measures

RSV can affect people of all age groups, but infants and children are more susceptible to catching this infection. It is estimated that around 90% of children under the age of 2 years would catch RSV at least once.³

It can be more serious in babies born prematurely or who are under the age of 6 months, which is mainly due to their weak immune system.⁴

Potential complications and severity

RSV usually clears out on its own in one to two weeks, during which adequate hydration and medications such as paracetamol and ibuprofen may ease the fever and discomfort.⁴ However,  RSV can sometimes lead to infections of the lower respiratory tract, such as bronchiolitis or pneumonia.

These infections are more serious and may require admission to hospitals to manage severe symptoms like breathing difficulties and dehydration. In extreme cases, these complications may be fatal.

Due to the high prevalence of RSV, and the severity of its complications, following certain preventive methods may help in shielding young children from contracting this infection in the first place. 

Hygiene practices

Many simple hygiene practices can be implemented to prevent children from catching RSV. 

Hand washing

Importance of frequent hand washing

Frequent washing of hands is known to reduce the transmission of germs responsible for some respiratory diseases. RSV can be caught by touching surfaces on which droplets from an infected person have landed. Thus, proper hand washing helps in eliminating these viruses and reducing their uptake by the body from rubbing the nose, eyes or mouth.

Proper hand washing technique

A correct technique needs to be followed to benefit from hand washing and limit the spread of infections. Warm water and soap must be used, and hands rubbed thoroughly, making sure to cover the front and back of the hands, fingers, nails and the space between fingers. This should be done for 20 seconds, which is the time it takes to sing “Happy Birthday” twice from start to end.⁵

Sanitising objects and surfaces

The transmission of RSV can be reduced through upkeeping of affected surfaces and items in its vicinity.

Thorough cleaning of bottles and pacifiers should be maintained. These should also be sterilised regularly to kill any germs on them. The cleaning should also include toys used by the children and any high-touch surfaces like light switches and doorknobs.¹

The aim is to keep these items and surfaces clean through washing or sanitising multiple times throughout the day.

Avoiding sharing items

As mentioned previously, the viruses responsible for RSV can survive on surfaces for up to 7 hours. Therefore, personal items like towels and utensils should not be shared with anyone suspected of having RSV. They should also be regularly washed to remove any germs.

Limiting exposure

Avoiding crowded places

During the autumn and winter seasons, viral infections of the respiratory tract are most prevalent, and many people are seen coughing or sneezing. During this period, infants and young children should avoid being in closed spaces where their chance of contracting RSV is higher. This includes using public transport and being in shopping centres and gatherings.

If this is inevitable, parents need to make sure that a safe distance is kept between their children and others around them. They also need to sanitise their kids’ hands and anything they try to touch.

Minimising contact with sick individuals

Parents should keep a lookout for any individuals displaying symptoms indicative of RSV. They should not allow their children, especially if they are under 6 months of age or born prematurely, to be in close contact with anyone who has a runny nose and is coughing or sneezing.¹

This also includes siblings and family members who display any signs of upper respiratory infections.

Parents need to emphasise the importance of hygiene and maintaining a distance from infants when older siblings are ill. They should always remind them how to sanitise and wash hands properly and to cover their mouths when sneezing.

Medical preventive measures

Immunoprophylaxis

Some infants are more predisposed to catching RSV because of certain risk factors they might possess. These include being born prematurely, having congenital heart or lung diseases, or being immunodeficient. In such cases, the use of monoclonal antibodies is advised for the child to acquire some immunity against the infection.

Monoclonal antibodies are made in laboratories and are identical to those made by the body to fight off infections.¹⁰ When administered, they attach to a specific type of pathogen and aid in its elimination by the immune system.¹⁰

For RSV, two monoclonal antibodies are currently available for use in high-risk infants and are called nirsevimab and palivizumab. They are offered to high-risk infants during the RSV season, which is from October to March, to boost their immune system and prevent their condition from deteriorating and consequent hospitalisation.

Nirsevimab is now being recommended as a first-line option in the UK. This is mainly because its effect lasts longer in the body and only requires a single administration, whereas palivizumab needs to be given monthly because it is eliminated quickly by the body.¹¹

Regular check-ups and vaccinations

Parents are encouraged to attend regular check-up appointments for their babies. These visits allow paediatricians to evaluate the baby’s health notice any symptoms of RSV and act quickly on them.

Babies should also receive vaccinations at regular intervals dictated by the health department.

In the United States, pregnant women are offered a single dose of RSV vaccine (Abrysvo®) during the RSV season if they are in weeks  32 to 36 of gestation.

A newborn is given the RSV vaccine if they are born during the RSV season and their mother has either not received the vaccine or has been vaccinated less than 14 days before the delivery.⁹

In the UK, a vaccine for RSV will be introduced from the 1^st of September 2024 for women who are 28 weeks pregnant or more.⁴

Currently, the Laboratory of Infectious Diseases in the United States is working on developing a nasal vaccine for RSV.⁸

Breastfeeding

According to the World Health Organization, babies should be exclusively breastfed for the first 6 months of their life. The emphasis on this is strong because their immune system is weak but they can acquire some immunity, in the form of antibodies, from their mothers’ milk ⁷. This acquired immunity helps them fight off infections such as RSV.

Breastfeeding is still encouraged after 6 months alongside solid foods.  

Healthy environment

Indoor air quality

The quality of the air being breathed in by children plays a big role in protecting them from catching RSV. Clean air must be maintained through different means, such as ensuring there are no smokers where the children are, and that air is maintained clean and pure.

Avoiding exposure to tobacco smoke

Children should not be around smokers and should not be able to inhale tobacco smoke. Tobacco smoke is a risk factor for developing severe RSV⁴ which might require hospitalisation and supportive care.

Using air purifiers and maintaining clean air

To maintain clean air, it might also be useful to use air purifiers. Air purifiers work by filtering the air and thus removing pollutants from it.⁶

Adequate ventilation

In addition to air quality, adequate ventilation needs to be maintained at all times. This can be achieved by regularly ventilating living spaces to improve airflow and limit air contamination. This is done by opening windows often to allow fresh air to enter and using a ventilation system with regularly cleaned ducts and filters.⁶

Indoor pollutants should also be reduced. This includes limiting the use of aerosols and pesticides, and not overusing cleaning products and detergents which may leave some residuals in the air.

Summary

Despite being a common infection in infants and young children, RSV can cause complications that require specialised care. The best way to reduce the risk of these complications is through implementing measures to prevent infants from catching this infection in the first place.

Simple and common practices such as regular hand washing and cleaning of personal belongings, as well as maintaining a clean environment and avoiding areas with high risks of contamination, can help in reducing the incidence of RSV.

Medicinal prophylaxis in the form of vaccines and monoclonal antibodies is also available for use in pregnant women and infants with a high risk of developing severe RSV.

Parents need to keep a close eye on their children’s health and seek medical help if their symptoms seem to be worsening rather than getting better.

Mothers are encouraged to obtain the RSV vaccine if their third trimester coincides with RSV season, and should also aim to breastfeed their babies for the first six months of their lives. This helps in passing on some immunity to the babies and lowering their chance of catching this infection and its severity.