Overview
Introduction
Respiratory syncytial virus (RSV) is a highly contagious and common virus that can cause respiratory tract infections, particularly in the autumn and winter months. Most children will have been exposed to RSV by the age of 2 years, but reinfection is common.
RSV is a major cause of upper respiratory tract infection (URTI) in adults. By adulthood, individuals are unlikely to be immunologically naïve to RSV, with repeat exposures occurring throughout our lifetimes. Most infected adults experience mild to moderate clinical disease. RSV-associated hospitalisation rates increase exponentially from the age of 60 years. For those with immunocompromise and older age, RSV infection can result in hospitalisation for severe respiratory tract infections, viral pneumonia and exacerbation of underlying comorbidities.
Transmission
RSV is a respiratory virus that spreads through coughs, sneezes, infected surfaces, and close contact. Infants, young children and older adults are at increased risk of severe RSV. While most people recover within a week or two, RSV can be serious for high-risk groups.
The virus is most common in autumn and winter.
RSV can survive for many hours on hard surfaces such as tables and cot rails. It typically lives on soft surfaces such as tissues and hands for shorter amounts of time.
A person with RSV is usually infectious for up to 10 days after symptoms begin.
Symptoms
People infected with RSV usually show symptoms within 4 to 6 days after being infected. Symptoms of RSV infection usually include:
• Runny nose
• Decrease in appetite
• Coughing
• Sneezing
• Fever
• Wheezing and difficulty breathing
These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity, and breathing difficulties.
Treatment
RSV infections will resolve on their own for most in 1-2 weeks and there is no specific treatment. Management of symptoms will generally occur at home with supportive treatments and over-the-counter medicines to manage pain and fever.
For those whose symptoms are more severe, management in hospital may be necessary. Oxygen may be used to support breathing and extra fluids given if dehydrated.
Risks
RSV infection can cause serious health problems. Severe infections may result - for example bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lung).
Those with certain chronic medical conditions such as asthma, chronic obstructive pulmonary disease and congestive heart failure who contract RSV can be at increased risk of exacerbation of their underlying condition, as well as being at risk of more severe lower respiratory tract infection - either or both of which can lead to hospitalisation.
Those adults more at risk of infection include:
• Older adults
• Adults with chronic heart or lung disease
• Adults with weakened immune systems
• Adults with certain other underlying medical conditions
• Adults living in nursing homes or long-term care facilities
Other people who are more at risk include:
• Pregnant women
• Infants and some young children
Prevention
A single dose of an RSV vaccine can help protect adults aged 60 years and older from getting very sick from RSV. Click here to learn about Arexvy, the available RSV vaccine in New Zealand for older adults.
Although Arexvy is targeted at those aged 60 years and over, infants are at the greatest risk of RSV.
At highest risk in the under 2s are those born prematurely, with underlying respiratory, heart and neurological conditions. Infants aged under 6 months are at highest risk, particularly those born in areas of high deprivation and those of Māori and Pacific ethnicity. A preventative RSV antibody, Palivizumab (Synagis) is available for high-risk infants and some young tamariki, however this is not currently funded in New Zealand.
