Respiratory syncytial virus (RSV)
Respiratory syncytial virus (RSV) is a common respiratory virus that usually causes mild, cold-like symptoms. However, infants and adults who are older or have certain risk factors can become very sick with RSV and may need to be hospitalized. RSV spreads in the Fall and Winter and typically peaks in December or January. CDC has an RSV surveillance system where physicians can monitor activity.
Transmission
RSV spreads from person to person predominantly through respiratory droplets from the nose and throat of infected people when they cough and sneeze. RSV can also spread through contact with contaminated surfaces. The virus can survive on hard surfaces for many hours and typically survives on soft surfaces, such as tissues and hands, for shorter amounts of time. RSV is primarily transmitted in households and community settings. People are typically contagious for 3 to 8 days, including 1 to 2 days before symptoms start.
Signs & symptoms
RSV typically causes upper respiratory symptoms in children. Symptoms usually start with runny nose and decreased appetite, followed by a cough 1 to 3 days later. After the cough, sneezing and wheezing may occur. Most adults are asymptomatic or have mild upper respiratory symptoms like runny nose, sore throat, headache and fever. However, those with underlying chronic medical conditions can develop severe disease. RSV can be especially dangerous for infants and adults 75 and older as well as those 60-74 years old with risk factors.
Infants: 58,000-80,000 hospitalized yearly. High risk:
- American Indian, Alaska Native children
- Premature children
- Children with chronic lung or heart disease
- Children with neuromuscular disorders
Adults: 100,000-150,000 hospitalized yearly. High risk:
- ≥75 years
- Adults with chronic lung or heart disease
- Adults with weakened immune systems
- Adults who live in nursing homes
Diagnosis
RSV causes similar symptoms to other viruses and bacteria that cause respiratory illnesses. Diagnosis is through nucleic acid amplification tests (NAATs) or antigen tests done on either upper or lower respiratory samples. There are no home tests for RSV at this time.
Prevention strategies
Health care settings require multi-faceted approaches to prevent the transmission of RSV, as it is effectively spread both person-to-person and indirectly through fomites. Core prevention strategies include vaccination, hand hygiene, environmental cleaning with approved products, and engineering controls.
Vaccination
There are now several immunization options for RSV.
- Adults ≥75 years / Adults 50-74 years with risk factors: One-time vaccination with any of the available vaccines: GSK’s Arexvy, Moderna’s mResvia, and Pfizer’s Abrysvo
- Pregnant patients at 32 to 36 weeks of pregnancy during September–January: Maternal RSV vaccine (Pfizer’s Abrysvo)
- Infants under 8 months of age born during or entering their first RSV season, if the pregnant parent did not receive maternal vaccine during this pregnancy: Monoclonal antibody nirsevimab or clesrovimab
- Infants and children 8 through 19 months of age at high risk of severe RSV disease and entering their second RSV season, regardless of prior RSV vaccination status: Monoclonal antibody nirsevimab
To prevent severe RSV disease in infants, either maternal RSV vaccination or infant immunization with RSV monoclonal antibody is recommended. Most infants will not need both.
All vaccine adverse events must be reported to the Vaccine Adverse Event Reporting System (VAERS).
RSV immunization recommendations infographic for clinicians
RSV immunization recommendations vary by age, comorbidities and time of the year. This infographic (PDF) helps busy clinicians make the best recommendations for their patients.
Coadministration with other vaccines
RSV vaccines may be given with other vaccines in the same visit for eligible patients. If the patient prefers to receive each vaccine at a separate visit, there is no minimum waiting period between vaccines.
Treatment
There is no specific treatment for RSV beyond supportive care.
Infection prevention and control
Recommended Personal Protective Equipment (PPE) for RSV is Contact + Standard precautions. For RSV, Standard precautions include mask usage because of the respiratory nature of this virus. Duration of PPE is for the duration of illness, longer if the patient is immunocompromised.
