Cold and flu season is here, and that means Respiratory Syncytial Virus (RSV) is too. Recent years have shown some variability in the RSV season, but it typically peaks in December through January. This may vary based on your geographic location. RSV is a common respiratory virus, similar in presentation, but more severe than other respiratory viruses. Babies are some of the most vulnerable of peoples, among others like young children and older adults to the threat of RSV. RSV can be particularly serious for babies and can escalate quickly. While there are hundreds of respiratory viruses, RSV is the leading cause of hospitalizations of infants in the United States. Approximately 58,000-80,000 children under age 5 are hospitalized every year due to RSV. Additionally it is estimated that almost all children will contract RSV before their second birthday.
While symptoms of RSV can start out mild, they can progress to serious symptoms. Onset is usually 4-6 days after exposure to the virus. Very young infants, like newborns, may show limited symptoms like decreased activity or lethargy, irritability, or breathing troubles. Increased work of breathing in infants is serious, but can also be hard to identify for parents who haven’t dealt with wheezing, tachypnea (increased respiratory rate) or retractions (pulling of skin and muscles of the chest wall indicating an increased effort to breath). Other nonspecific cold-like symptoms include nasal drainage or congestion, decreased appetite, coughing, sneezing, and fever. RSV has the potential to lead to bronchiolitis and pneumonia—both of which may require hospitalization, oxygen and/or ventilation support.
All of this sounds so scary, but there is good news! In addition to teaching your patients and families good infection prevention practices, there is now a maternal RSV vaccine and infant monoclonal antibodies available to further protect babies from harm.
Let’s do a quick recap of those infection prevention practices first. One of the best methods, is first to stay home if you are sick! Practice good hand hygiene following the CDC or WHO recommendations. Cover your coughs and sneezes by practicing good respiratory etiquette. Clean and disinfect frequently touched surfaces. You can take steps to get fresh air, like getting outdoors or using an air purifier. Lastly you can also practice distancing physically and wear a mask. Keep infants and young children safe not only from RSV, but other respiratory infections. Educate on all these infection prevention practices they can in turn share with their families.
In addition to educating on infection prevention practices, there are also vaccines and antibodies available for mothers and infants to prevent RSV. First the maternal vaccine for RSV is given to the pregnant mother between 32 and 36 weeks. It provides protection which is passed to the baby. This is given between the months of September through January. This is a one-time vaccine, and would not be needed for subsequent pregnancies. It takes about two weeks for the immune protection to be established and lasts an infant for about the first 6 months of the infants’ life. Currently there is only one licensed RSV vaccine to be given to pregnant women.
If a baby is born to a mother who did not receive the RSV vaccine during pregnancy, it is recommended they receive the RSV antibody (nirsevimab). This can be given to all babies under the age of 8 months old, and can be given as early as 1 week old. If outside of RSV season, it should be given shortly before, but if given promptly if in season between the months of October to March. There are also extended recommendations for children 8 to 19 months old if the child is at high risk for severe RSV. Some reasons may include chronic lung disease due to prematurity, severely immunocompromised, cystic fibrosis, or if they are American Indian or Alaska Native.
RSV can be frightening and severe. As a provider it is crucial to educate your patients, families, caregivers, and new parents on the risks of RSV. Teach them the essential infection prevention practices to decrease the risk of transmission. Encourage open dialogue about vaccine and monoclonal antibodies options for mother and baby. By sharing this information, you can help reduce RSV-related complications and hospitalizations in infants. For further details, refer to the resources below.
Resources
Infection Control Guidance: Respiratory Viruses | Project Firstline | CDC
Respiratory Syncytial Virus (RSV) | RSV | CDC
Clinical Overview of RSV | RSV | CDC
RSV Vaccine Guidance for Pregnant People | RSV | CDC
RSV Immunization Guidance for Infants and Young Children | RSV | CDC
RSV in Infants and Young Children | RSV | CDC
WHO guidelines on hand hygiene in health care
Centers for Disease Control and Prevention. (August 30, 2024). Clinical Overview of RSV. Retrieved from Clinical Overview of RSV | RSV | CDC
Centers for Disease Control and Prevention. (August 30, 2024). RSV in Infants and Young Children. Retrieved from RSV in Infants and Young Children | RSV | CDC
Centers for Disease Control and Prevention. (August 30, 2024). RSV Vaccine Guidance for Infants and Young Children. Retrieved from RSV Immunization Guidance for Infants and Young Children | RSV | CDC
Centers for Disease Control and Prevention. (August 30, 2024). RSV Vaccine Guidance for Pregnant People. Retrieved from RSV Vaccine Guidance for Pregnant People | RSV | CDC
Centers for Disease Control and Prevention. (August 30, 2024). Symptoms and Care of RSV. Retrieved from Symptoms and Care of RSV | RSV | CDC
Centers for Disease Control and Prevention. (March 1, 2024). Respiratory Virus Guidance. Retrieved from Respiratory Virus Guidance | Respiratory Illnesses | CDC