Health Encyclopedia

Respiratory syncytial virus (RSV)

Definition

Respiratory syncytial virus (RSV) is a very common virus that leads to mild, cold-like symptoms in adults and older healthy children. It can be more serious in young babies, especially those in certain high-risk groups.

Alternative Names

RSV; Palivizumab; Respiratory syncytial virus immune globulin; Bronchiolitis - RSV; URI - RSV; Upper respiratory illness - RSV; Bronchiolitis - RSV

Causes

RSV is the most common germ that causes lung and airway infections in infants and young children. Most infants have had this infection by age 2. Outbreaks of RSV infections most often begin in the fall and run into the spring.

The infection can occur in people of all ages. The virus spreads through tiny droplets that go into the air when a sick person blows their nose, coughs, or sneezes.

You can catch RSV if:

A person with RSV sneezes, coughs, or blows their nose near you.
You touch, kiss, or shake hands with someone who is infected by the virus.
You touch your nose, eyes, or mouth after you have touched something contaminated by the virus, such as a toy or doorknob.

RSV often spreads quickly in crowded households and day care centers. The virus can live for a half an hour or more on hands. The virus can also live for up to 5 hours on countertops and for several hours on used tissues.

The following increase the risk for RSV:

Attending day care
Being near tobacco smoke
Having school-aged brothers or sisters
Living in crowded conditions

Symptoms

Symptoms can vary and differ with age:

They usually appear 2 to 8 days after coming in contact with the virus.
Older children most often have only mild, cold-like symptoms, such as a barking cough, stuffy nose, or low-grade fever.

Infants under age 1 year may have more severe symptoms and often have the most trouble breathing:

Bluish skin color due to a lack of oxygen (cyanosis) in more severe cases
Breathing difficulty or labored breathing
Nasal flaring
Rapid breathing (tachypnea)
Shortness of breath
Whistling sound (wheezing)

Exams and Tests

Many hospitals and clinics can rapidly test for RSV using a sample of fluid taken from the nose with a cotton swab.

Treatment

Antibiotics and bronchodilators are not used to treat RSV.

Mild infections go away without treatment.

Infants and children with a severe RSV infection may be admitted to the hospital. Treatment will include:

Supplemental oxygen
Moist (humidified) air
Suctioning of nasal secretions
Fluids through a vein (by IV)

A breathing machine (ventilator) may be needed.

Outlook (Prognosis)

More severe RSV disease may occur in the following infants:

Premature infants
Infants with chronic lung disease
Infants whose immune system does not work well
Infants with certain forms of heart disease

Rarely, RSV infection can cause death in infants. However, this is unlikely if the child is seen by a health care provider in the early stages of the disease.

Children who have had RSV bronchiolitis may be more likely to develop asthma.

Possible Complications

In young children, RSV can cause:

Bronchiolitis
Lung failure
Pneumonia

When to Contact a Medical Professional

Contact your provider right away if you or your child have:

Bluish skin color
Difficulty breathing
High fever
Shortness of breath

Any breathing problems in an infant are an emergency. Seek medical help right away.

Prevention

To help prevent RSV infection, wash your hands often, especially before touching your baby. Make certain that other people, especially caregivers, take steps to avoid giving RSV to your baby.

The following simple steps can help protect your baby from getting sick:

Insist that others wash their hands with warm water and soap before touching your baby.
Have others avoid contact with your baby if they have a cold or fever. If necessary, have them wear a mask.
Be aware that kissing your baby can spread RSV infection.
Try to keep young children away from your baby. RSV is very common among young children and easily spreads from child to child.
Do not smoke inside your house, car, or anywhere near your baby. Exposure to tobacco smoke increases the risk for RSV illness.

Parents of high-risk young infants should avoid crowds during outbreaks of RSV. Moderate-to-large outbreaks are often reported by local news sources to provide parents with an opportunity to avoid exposure.

The drug Synagis (palivizumab) is approved for the prevention of RSV disease in children younger than 24 months who are at high risk for serious RSV disease. Ask your provider if your child should receive this medicine. At this time, there is no RSV vaccine that can be given to children to protect them from RSV, but research is ongoing.

As recommended by the Centers for Disease Control and Prevention, adults age 60 and older may want to talk with their provider about receiving the RSV vaccine. The RSV vaccine can prevent lower respiratory tract disease caused by the RSV virus.

References

Simões EAF, Bont L, Manzoni P, et al. Past, present and future approaches to the prevention and treatment of respiratory syncytial virus infection in children. Infect Dis Ther. 2018;7(1):87-120. PMID: 29470837 pubmed.ncbi.nlm.nih.gov/29470837/.

Smith DK, Seales S, Budzik C. Respiratory syncytial virus bronchiolitis in children. Am Fam Physician. 2017;95(2):94-99. PMID: 28084708 pubmed.ncbi.nlm.nih.gov/28084708/.

Talbot HK, Walsh EE. Respiratory syncytial virus and human metapneumovirus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 330.

Walsh EE, Englund JA. Respiratory syncytial virus. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 158.

Review Date:2/24/2022
Reviewed By:Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 08/23/2023.

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