VPMD: RSV Bronchiolitis (Respiratory Syncytial Virus)

What is RSV?

Respiratory Syncytial Virus (RSV) is known to cause severe respiratory disease in infants and older persons, immunocompromised and cold symptoms in others. The most severe manifestation of RSV in infants is bronchiolitis, a lower respiratory tract infection that causes inflammation of the smallest airways of the lungs. Bronchiolitis often leads to hospitalization due to respiratory failure and dehydration. RSV is transmitted through respiratory droplets via coughing, talking, sneezing etc.

What are the symptoms of bronchiolitis?

Bronchiolitis often start with upper respiratory symptoms including nasal congestion and runny nose; they may also have fever and cough. As the infection progresses, cough becomes very prominent with abnormal lung sounds that may accompany obvious signs of difficulty breathing (retractions). As the severity of symptoms progress, complications may arise including bacterial infections including pneumonia, ear infection, dehydration due to difficulty eating and drinking, respiratory failure and death. Literature often states that symptoms tend to peak within 5 days of symptom onset with complete resolution of cough not occurring for weeks.

How is RSV bronchiolitis diagnosed?

Bronchiolitis is diagnosed clinically, by recognition of characteristic signs and symptoms. Bronchiolitis can be caused by different viruses, viral testing can help determine the virus associated with the infection, though it may not add value to the therapeutic approach except when the diagnosis is not clear.

How is RSV bronchiolitis treated?

There is no medication used that specifically targets the virus, therefore, treatment is targeted at managing symptoms and preventing complications. Clearing the nasal airway using nasal suctioning and nasal saline, tends to be an important part of treatment. Preventing dehydration by ensuring adequate fluid intake. When hospitalization is required, it is often to support breathing and hydration, using oxygen, positive pressure ventilation and IV fluids.

How is RSV bronchiolitis prevented?

RSV immunization with antibodies (pavlizumab) has been a recommendation for babies at increased risk for severe disease, including those whom are premature, have congenital heart and/or lung disease. In the last few years, immunization has been expanded to all infants < 8 born during RSV season ( October to March) and < 8 months through administration of RSV antibodies (nirsevimab) or indirectly through administration of vaccine (Abrysvo) to pregnant mothers between 32-36 weeks. It is also indicated for those up to 24 months old with underlying conditions that increase their risk for severe disease.

For adults 75 yo and older to 50-74 yo, with underlying health conditions, it is recommended to have a single dose of vaccine.

Sources: WHO, CDC, NHS