Why RSV is a cause for concern. 

Respiratory syncytial virus (RSV) is one of the most common causes of childhood illness. Here’s what you should know.

Respiratory syncytial virus (RSV) is a dangerous infection which could lead to severe morbidity and mortality in children under the age of two – and there’s still much to be learned about the virus. Dr Angela Colquhoun, a paediatrician at Mediclinic Kloof, explains why a close and ongoing relationship with your specialist paediatrician is a crucial part of your child’s health journey, especially when it comes to RSV.

“Respiratory syncytial virus causes bronchiolitis in children under the age of two and bronchopneumonia in older children,” she explains. “Bronchiolitis is an acute virus-induced inflammation of the bronchioles [small airways] that causes airway inflammation and acute respiratory tract infection.” Initial signs of RSV are similar to mild cold symptoms and include congestion, a runny nose, fever, cough and sore throat. Very young infants may be irritable, fatigued and have breathing difficulties.

“The illness is generally self-limiting but some babies present with hyper-inflation of the chest, lower chest wall retraction, and wheezing,” Dr Colquhoun says. “For high-risk infants and children, RSV can cause serious health problems that can result in hospitalisation – and for premature babies, RSV can be life-threatening. Other risk factors include congenital heart disease, overcrowding, vitamin deficiencies and being exposed to second-hand smoking.”

There are three viruses that cause this lung infection, Dr Colquhoun adds, but RSV is by far the most dangerous. The other two common viruses are rhinovirus and parainfluenza virus type 3.

“RSV was only identified in 1998 and we’re still discovering so much about it,” she says. “Many studies still need to be conducted but it’s definitely a virus we need to respect. According to a study published last year, it’s estimated that RSV can cause up to 76 600 deaths annually worldwide – primarily of children under the age of five and the elderly.” Dr Colquhoun makes the point that although SARS-CoV-2 (the virus that causes COVID-19) has recently been top of mind for most, children aren’t as seriously affected by the novel coronavirus as they are by RSV.

There are two types of RSV – Type A has 23 different genotypes (that cause severe illness), while Type B has six different genotypes.

“RSV has been our biggest challenge in the past year-and-a-half – especially in the past few months,” she says. “We had an outbreak in Pretoria and needed to treat a number of severely ill infants. If a baby’s oxygen saturation level is less than 91% and they’re struggling to breathe, they need to be admitted. But because of the pandemic we didn’t have enough hospital beds, which was extremely stressful. Our ICU at Mediclinic Kloof had to extend into the paediatric ward and at one point we had to send RSV patients to other cities for high-flow oxygen, as every single Pretoria hospital ICU was full. That was terrifying.”

According to a 2016 study published in the South African Medical Journal, several factors are contributing to an outbreak of RSV infection. These include geographical location (latitude and altitude) and climatic factors (temperature, barometric pressure, humidity, hours of light and precipitation). In South Africa, the peak in RSV season varies slightly by province, with onset of the epidemic usually in KwaZulu-Natal in December-January; in Gauteng in February-March; and the Western Cape in March.

Treatment of an RSV infection is supportive, with particular attention to maintaining hydration and oxygenation. While a bronchodilator trial is appropriate for infants who are wheezing, it should not be continued unless there’s a prompt positive response. “RSV is viral and cannot be treated with antibiotics,” Dr Colquhoun stresses. “Children are sometimes subject to other treatments with no benefits, such as physio, which can worsen distress, or inhalation therapy, and, generally, cortisone – even inhaled – doesn’t necessarily make a difference. The correct treatment is symptomatic but children who are having breathing difficulties need to be admitted and generally require high-flow oxygen.”

Although there’s no vaccination against RSV, Synagis is an FDA-approved prescription made up of virus-fighting antibodies that can help high-risk infants by protecting them from serious RSV disease. “However, it’s extremely expensive, and although 2015 guidelines recommend that all infants born under 34 weeks should receive it, medical funds don’t always comply,” she says.

And RSV is not just an acute problem. “One study showed 76% of RSV patients presented with long-term asthma, persistent wheezing and other chronic lung problems.” This is just one of many reasons why parents should err on the side of caution. “Parents should contact their paediatrician if they are at all concerned about their child’s symptoms,” Dr Colquhoun advises.

RSV can’t really be prevented, as it’s transmitted between young children via coughing and droplets (in the same way as SARS-CoV2), but regular check-ups with your paediatrician can help. Vaccinate your child against flu if they’re older than six months and ensure they build a healthy immune system through proper nutrition and outside play. “Don’t let their immune system be compromised more by getting unnecessary antibiotics. Rather be over-sensitive about their cough or runny nose and phone a healthcare professional. The problems occur when parents wait too long.”