About RSV
Respiratory syncytial virus (RSV) is a common virus that infects the airways and lungs. It is highly contagious and spreads easily. The main treatment for RSV infection is rest and plenty of fluids. Regular hand washing and good personal hygiene can stop RSV from spreading[1]
1. Australian Government Department of Health and Aged Care. Respiratory Syncytial Virus (RSV) infection; last updated 14 June 2022
Cause & Transmission
RSV generally causes a mild, cold-like illness but it can cause breathing problems and lung problems like bronchiolitis and pneumonia.
RSV is the most common cause of bronchiolitis. Viruses (including RSV) are the most common causes of Community Acquired Pneumonia (CAP) in young children.
An infected person can transmit RSV by:[2]
- Sneezing or coughing
- Touching a hard surface or a soft surface like the hands or a tissue
RSV can be picked up from an infected person by:
- Getting the particles from a cough or sneeze into the eyes and mouth
- Touching a surface with virus on it and then touching the face
- Having direct contact with someone with the virus by kissing their face
People with RSV are generally contagious for three to eight days. Some infants and people with impaired immune systems may be contagious up to four weeks after symptoms subside.
Most people recover from the infection within ten days.[3]
2. Centers for Disease Control and Prevention: RSV transmission page last reviewed 18 Dec 2020
3. Government of South Australia SA Health. Respiratory syncytial virus (RSV) infection – including symptoms, treatment, and prevention. Last updated 02 April 2022
How is RSV Treated
Most cases of RSV are mild and can be treated at home with rest and hydration.
Bronchiolitis[4]
Most children presenting to the general practitioner with bronchiolitis have mild acute bronchiolitis and can be managed in the community.
Recommended management
For all children with acute bronchiolitis:
- reassure carers
- educate carers about minimal handling
- provide carer information sheet [NB1] which is available from Royal Children’s Hospital website
- advise carers to give patients small, frequent feeds.
For children with moderate to severe acute bronchiolitis, provide symptomatic care in hospital, including supplemental oxygen and nasogastric feeds or intravenous fluids.
For children with severe bronchiolitis, non-invasive ventilation (e.g. CPAP), high-flow nasal cannula therapy or invasive ventilation may be required.
Community Acquired Pneumonia (CAP)[4]
If a viral cause is suspected, treat symptoms with:
- paracetamol or ibuprofen for fever or pain
- fluids to achieve and maintain adequate hydration.
4. Therapeutic Guidelines [digital]. Melbourne: Therapeutic Guidelines Limited; 2021 Mar. https://www.tg.org.au
RSV Prevention
Advise patients/carers that RSV can be prevented by various hygiene measures:
- washing hands with soap and water for at least 20 seconds
- keeping infected people away from others, especially babies and older people
- not sharing drinks, or cutlery with people who have colds
- covering the nose and mouth when sneezing or coughing
- throwing out tissues as soon as they’ve used them
There is currently one RSV vaccine, Arexvy, approved for use in Australia. Arexvy is a recombinant respiratory syncytial virus pre-fusion F protein (adjuvanted) vaccine. It is indicated for the active immunisation of individuals 60 years and older for the prevention of lower respiratory tract disease caused by RSV. The vaccine is administered as a single dose of 0.5 mL for intramuscular injection only, preferably in the deltoid muscle. The need for revaccination has not been established. [5]
Palivizumab is a recombinant monoclonal antibody directed against a protein in the RSV. It has been developed as one approach to preventing serious infections in high-risk infants. For patients who have been admitted to hospital for RSV infection, the incidence of an ICU admission related to RSV infection is decreased in patients receiving 4 weekly Palivizumab.[6]
5. Therapeutic Goods Administration (TGA). (2024, January 22). Arexvy | Australian Prescription Medicine Decision Summary . https://www.tga.gov.au/resources/auspmd/arexvy
6. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated August 2021
RSV in Young Children
RSV is a very infectious virus, and most children will get it at least once before they turn two years of age.[7]
During 2006–2015, there were 63,814 hospitalisations with an RSV-specific principal diagnostic code; 60,551 (94.9%) were of children under 5 years of age.[8]
Children under three are at highest risk of serious illness.[9]
RSV is associated with increased morbidity amongst preterm infants and babies born with chronic health conditions such as respiratory and/or cardiac complications.[10]
7. Emergency department, Queensland Children’s Hospital. Respiratory Syncytial Virus (RSV) Reviewed February 2022
8. Saravanos G L Respiratory syncytial virus‐associated hospitalisations in Australia, 2006–2015; Med J Aust 2019; 210 (10): 447-453. || doi: 10.5694/mja2.50159
9. Emergency department, Queensland Children’s Hospital. Respiratory Synctial Virus (RSV) Reviewed February 2022
10. The Royal Children’s Hospital Melbourne. Clinical Guidelines (Nursing); Palivizumab for at-risk patients; Updated August 2021
RSV in Adults
RSV symptoms in adults and older healthy children are generally mild and mimic the common cold.
Older adults (especially those over 65 years of age), people with heart and lung disease, or people with weakened immune systems are at higher risk of complications and hospitalisation. They may develop pneumonia, more severe symptoms of asthma or COPD and congestive heart failure.