Respiratory syncytial virus (RSV) causes respiratory tract infections.

It is the leading cause of hospitalization in children less than one year of age.

Babies less than six months of age are at the highest risk for severe infection from RSV due to their lack of immunity to the virus and their naturally small airways.

RSV has traditionally been linked to seasonal outbreaks in the Northern Hemisphere, typically between the months of October through April. The pandemic temporarily altered the seasonality of RSV, but last year, we settled into a more traditional pattern of infections with a peak in the early months of 2024.

Infants and young children with immune system deficiency, heart disease, and chronic lung disease are at highest risk for severe disease.

Symptoms

In adults, RSV typically causes common cold symptoms, including nasal congestion, runny nose, sneezing, and cough. Symptoms are typically limited to the upper airways.
In infants and young children, RSV causes upper airway infection like adults, but it can also cause lower airway infections, such as bronchiolitis, which is the infection and inflammation of the bronchioles (small airways in the lungs), and pneumonia, which is infection of the alveoli (tiny air sacs in the lungs).

Lower airway infection can cause difficulty in breathing, which can manifest as retractions. Retractions can be seen when a child is working harder to inhale air, and they are using extra muscles to move air in and out of the lungs.

“Belly breathing,” or sucking in the belly upon inspiration, is a common sign for respiratory distress.

Other signs include retractions, which can be below the rib cage, between the ribs, and above the collar bones. Nasal flaring, or widening of the nostrils during inspiration, can also be seen with respiratory distress.

Treatment

There are no effective treatments for RSV infection.

Prevention remains the most effective method of avoiding infection.

Hand hygiene with alcohol-based hand sanitizer or soap and water is a key component of prevention.

If you are coughing or sneezing, try to do so into a tissue to limit spread of respiratory droplets that contain the virus. Throw that tissue away and sanitize your hands.

For infants, maintaining adequate hydration can be a challenge for various reasons, as infected babies often do not feed well, lose lots of fluids in secretions, and sometimes develop a fever. Suctioning the nostrils before feeding and again as needed can often help your baby breathe easier.

Another method for prevention is the medication called nirsevimab (also known as Beyfortus™). This medication is known as a monoclonal antibody. It is an immunization and not technically a vaccine.

These monoclonal antibodies are designed to attach to the RSV after it enters the body. When the antibodies attach, they prevent the virus from infecting human cells and replicating.

All infants less than eight months of age at the beginning of RSV season (October 1) and some children up to 19 months are eligible for nirsevimab.

At WVU Medicine Children’s, we have administered many doses of nirsevimab in our hospitals and clinics. A recent study from the CDC showed that nirsevimab effectiveness was 90 percent against RSV-associated hospitalization, with the greatest protection appearing to be within 45 days of injection.

Another option to protect your baby from RSV is the RSV vaccine (Abrysvo), which is given to an expectant mother between 32 to 36 weeks of pregnancy during the months of September to January. Antibodies formed by the mother are shared through the bloodstream with her baby, providing protection against the RSV. If the vaccine is given two weeks prior to birth, the protective antibodies can reduce a baby’s risk of being hospitalized from RSV by 57 percent in the first six months of life.

What does it all mean?

RSV’s days of being the leading cause of hospitalization in infants are hopefully numbered.

While RSV, like most other viruses, has to “run its course” and doesn’t have effective treatments, supportive care, including ensuring good hydration and nasal suctioning, will help your infant feel better.

For prevention, nirsevimab (infants and some children) and Abrysvo (expectant mothers) can help to keep your baby well and help to keep our hospitals caring for all the children who need us.

Please talk to your doctor or pediatrician to learn more.

To schedule an appointment for your child to discuss RSV or seasonal vaccines and immunizations, visit WVUKids.com or call 1-855-WVU-CARE(2273).