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Respiratory syncytial virus: More than a pediatric infection

Schweon, Steven J. MPH, MSN, RN, CIC, HEMC

doi: 10.1097/01.NURSE.0000463675.37089.95
Department: COMBATING INFECTION
Free

Respiratory syncytial virus: Not just for kids

Steven J. Schweon is an infection prevention consultant in Saylorsburg, Pa.

The author has disclosed that he has no financial relationships related to this article.

RESPIRATORY SYNCYTIAL VIRUS (RSV) is a pathogen that infects the respiratory tract. In infants and children, it affects the lower respiratory tract and is the most common cause of bronchiolitis and pneumonia in children under age 1.1 RSV can also infect the upper respiratory tract in adults, resulting in a mild, cold-like illness. Although RSV is most often seen in infants and children, it's becoming a significant cause of respiratory illness in older adults.1

RSV has been identified as a cause of approximately 10% of winter hospital admissions for older adults.2 RSV outbreaks have been reported on adult medical units, medical and surgical ICUs, oncology units, bone marrow transplant units, and in long-term care facilities.3 Healthcare workers have been implicated in RSV transmission within healthcare facilities.4 RSV is the second most common viral cause of pneumonia in adults.5 This virus is responsible for 177,000 hospitalizations and 14,000 deaths among adults over age 65.6

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How RSV is transmitted

RSV is transmitted by large respiratory droplets spread by person-to-person contact. The droplets can be inhaled or enter the body through contact with the eyes, nose, or mouth.7 Someone can also become infected by touching contaminated objects in the environment. RSV can survive for 3 to 30 hours on nonporous surfaces at room temperature.8 An effective environmental hygiene program will reduce the viral bioburden in the environment.

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Recognizing RSV infection

RSV infection has an average incubation period of 2 to 8 days. Illness begins 4 to 6 days after exposure, usually starting with rhinorrhea and anorexia. Coughing, sneezing, and fever develop 1 to 3 days later, and wheezing may occur in children and adults.9 Signs and symptoms of infection can range from mild cold symptoms to severe respiratory distress. The clinical presentation may resemble other respiratory viral conditions, hampering the clinician's ability to diagnose RSV infection. In adults, RSV may not be suspected as a source of infection and go unrecognized as the infecting agent.

Most individuals have been infected with RSV by age 3, and previous infection doesn't provide complete protection against reinfection.8 RSV can occur at any age, with subsequent infections being less severe.10 Although the infection is usually self-limiting, older adults, adults with chronic heart or lung disease, and immunocompromised patients may experience respiratory failure.11,12

Diagnostic testing is done to distinguish RSV from similar infections and may include a rapid assay that detects RSV antigens, but this test is less useful in adults than children due to decreased viral shedding.11,13 Reverse transcriptase-polymerase chain reaction testing detects viral RNA and is very sensitive in confirming the diagnosis. Serology testing is also available and can be used for epidemiologic studies but can't assist with making a timely RSV diagnosis.

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Treatment and prevention

No antiviral medication is available to treat RSV infection. Supportive care may include fluid administration to prevent dehydration and supplemental oxygen to prevent hypoxia.

Contact precautions are indicated for immunocompromised adults, infants, and young children with RSV infection. A mask is worn according to standard precautions.14

Prevention of RSV infection and transmission depends on effective hand hygiene, adherence to contact precautions, and respiratory hygiene/cough etiquette.14 To protect vulnerable patients, healthcare personnel shouldn't come to work when ill.

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REFERENCES

1. Centers for Disease Control and Prevention. Respiratory syncytial virus infection. 2014. http://www.cdc.gov/rsv/about/index.html.
2. Sundaram ME, Meece JK, Sifakis F, Gasser RA Jr, Belongia E. Medically attended respiratory syncytial virus infections in adults aged ≥ 50 years: clinical characteristics and outcomes. Clin Infect Dis. 2014;58(3):342–349.
3. Falsey AR, Walsh EE. Respiratory syncytial virus infection in adults. Clin Microbiol Rev. 2000;13(3):371–384.
4. Mathur U, Bentley DW, Hall CB. Concurrent respiratory syncytial virus and influenza A infections in the institutionalized elderly and chronically ill. Ann Intern Med. 1980;93(1):49–52.
6. Centers for Disease Control and Prevention. Respiratory syncytial virus infection (RSV): trends and surveillance. 2014. http://www.cdc.gov/rsv/research/us-surveillance.html.
7. Centers for Disease Control and Prevention. Respiratory syncytial virus infection (RSV): frequently asked questions. 2014. http://www.cdc.gov/rsv/about/index.html.
8. Public Health Agency of Canada. Respiratory syncytial virus infection. http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/pneumovirus-eng.php.
9. Centers for Disease Control and Prevention. Respiratory syncytial virus: symptoms and care. 2014. http://www.cdc.gov/rsv/about/symptoms.html.
10. New York State Department of Health. Respiratory syncytial virus infection (RSV). 2011. http://www.health.ny.gov/diseases/communicable/respiratory_syncytial_virus/fact_sheet.htm.
11. Barr FE, Graham BS.Respiratory syncytial virus infection: clinical features and diagnosis. UpToDate. 2014. http://www.uptodate.com.
12. Centers for Disease Control and Prevention. Respiratory syncytial virus infection (RSV): infection and incidence. 2014. http://www.cdc.gov/rsv/about/infection.html.
13. Centers for Disease Control and Prevention. Respiratory syncytial virus infection (RSV): laboratory testing. 2014. http://www.cdc.gov/rsv/clinical/labtesting.html.
14. Siegel JD, Rhinehart E, Jackson M, Chiarello Lthe Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. 2007. http://www.cdc.gov/hicpac/2007IP/2007isolationPrecautions.html.
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