Respiratory syncytial virus (RSV) infection - including symptoms, treatment and prevention

Respiratory syncytial virus (RSV) infection is the most common cause of bronchiolitis and pneumonia among infants under 1 year of age.

Bronchiolitis is inflammation of small air passages in the lungs and pneumonia is inflammation of the lung tissue itself.

Infections may recur throughout life. In South Australia, infections are most common during autumn and winter.

How RSV is spread

RSV is spread when an infected person talks, coughs or sneezes small droplets containing the virus  into the air. The droplets in the air may be breathed in by those nearby. Infection may be spread by contact with hands, tissues and other articles soiled by infected nose and throat fluids.

The virus survives outside the body for a few hours.

Signs and symptoms of RSV infection

Most RSV cases present with a mild to moderate respiratory illness, but some groups of people may develop more severe disease.

First infection with RSV — most often seen in infants and young children under 2 years — is generally more severe than subsequent infections at older ages.

RSV is also an important cause of respiratory disease and hospitalisation in older people, Aboriginal and Torres Strait Islander adults, and people with conditions that increase their risk of severe RSV disease (such as existing lung conditions, immunocompromised).

Clinical features typically include:

  • fever
  • runny nose and nasal congestion
  • sore throat
  • cough
  • ear infections

Babies aged under 6 months can present with more severe clinical features, including:

  • wheezing
  • breathing difficulties
  • irritability
  • poor feeding.

Serious complications of RSV infection at any age can include:

  • pneumonia
  • acute respiratory distress
  • congestive heart failure
  • myocarditis (inflammation of heart muscle) (rarely)
  • seizures and encephalopathy (fewer than 1% of patients)
  • worsening of some chronic conditions, such as chronic lung and heart disease.

Diagnosis

RSV is usually diagnosed through laboratory testing by Polymerase chain reaction (PCR). This test involves taking samples from the nose and throat.

Incubation period

(time between becoming infected and developing symptoms)

The average incubation period is 5 days, with a range of 2 to 8 days.

Infectious period

(time during which an infected person can infect others)

The infectious period is unclear but is probably from before symptoms start until recovery. Most people recover from the infection within about 10 days, although a cough may last for weeks.

Treatment

There is usually no need for treatment other than paracetamol for fever and maintaining adequate fluid intake. Aspirin should not be given to children under 12 years of age unless specifically recommended by a doctor.

Very ill children and people at risk may require admission to hospital and treatment is supportive.

Because RSV is a virus, antibiotics do not help. There are no safe and effective antiviral drugs for routine use for RSV.

Prevention of RSV infection

  • Exclude people with RSV from childcare, preschool, school and work until they are well.
  • Frequent handwashing while unwell is the most effective means of preventing spread, as the virus is easily killed by soap and water or hand sanitiser.
  • Avoid sharing cups, glasses and eating utensils with people who have respiratory infections.
  • Cover a cough or sneeze with a tissue or your arm. Drop used tissues immediately into a rubbish bin, and then wash your hands.

Immunisation

RSV Immunisations are recommended for pregnant women, at-risk infants infants and children, adults aged greater than 75 years, Aboriginal and Torres Strait Islander people aged greater 60 years and above, and for people with medical conditions that increase the risk of severe RSV disease.

The RSV vaccines Abrysvo® and Arexvy® are available for adults.

The National Immunisation Program provides:

  • the RSV vaccine (Abrysvo®) from 28 weeks of pregnancy. Maternal antibodies protect the baby against RSV for approximately 6 months after birth. Getting vaccinated against RSV during pregnancy is recommended to pass on immunity the baby and reduce the risk of severe RSV-related illness from birth.
  • the RSV vaccine (Arexvy®) for Aboriginal and Torres Strait Islander people from 60 years of age and above and all adults from 75 years of age and above.

The RSV monoclonal antibody, Beyfortus® is available through a seasonal program (1 April to 30 September) in South Australia for eligible children up to 24 months of age. The monoclonal antibody provides protection within a few days against RSV and lasts at least 5 months.

Useful links