Respiratory syncytial virus (RSV) is a common respiratory pathogen that primarily affects the lower respiratory tract. It is a leading cause of respiratory infections in infants, young children, and the elderly, as well as in individuals with compromised immunity. With the emergence of a pre-epidemic period in many regions, it is essential to understand its characteristics, risks, and prevention methods.
What is VSR?
RSV is a virus belonging to the Pneumoviridae family and the Orthopneumovirus genus. It is highly contagious and spreads through:
• Respiratory droplets (coughing, sneezing);
• Direct contact with secretions;
• Contaminated surfaces.
RSV infection is seasonal, occurring mainly during autumn and winter, with pre-epidemic periods marked by a gradual increase in cases.
Pathophysiology
The virus infects the epithelial cells of the respiratory tract, causing inflammation and, in severe cases, obstruction of the airways due to the production of mucus and the formation of hyaline membranes. This obstruction is especially problematic in young children because of their narrower airways.
What are the symptoms of RSV?
Symptoms range from mild to severe, depending on the age and general health of the individual. They usually appear 4 to 6 days after exposure.
Mild cases
• Runny nose;
• Dry cough;
• Low fever;
• Sore throat;
• Fatigue.
Severe cases
• Difficulty breathing;
• Wheezing or wheezing;
• Intercostal retraction (movement of the ribs during breathing);
• Apnea (in newborns);
• Dehydration;
• Persistent high fever.
In children under 2 years of age, RSV is the leading cause of bronchiolitis and pneumonia, conditions that may require hospitalization.
Risks in children and the elderly
Children
• Premature babies are more vulnerable due to their immature immune systems and reduced lung capacity.
• Children with pre-existing conditions, such as congenital heart disease or chronic lung disease, are at greater risk of complications.
• Risk of hospitalization: Data indicate that approximately 2% of children under 1 year of age infected with RSV require hospitalization.
Elderly
• Elderly people, especially those with heart or lung disease, are at higher risk of developing pneumonia and respiratory failure.
• RSV is responsible for 177,000 hospitalizations and 14,000 deaths annually among older adults in the United States alone, according to the Centers for Disease Control and Prevention (CDC).
How to care?
Treatment of RSV is generally supportive, as there is no specific antiviral drug in widespread clinical use approved for the infection.
General care
• Hydration: Essential to prevent dehydration.
• Fever control: Use of antipyretics, such as paracetamol or ibuprofen.
• Nasal unblocking: Use of saline solution and gentle suction in babies.
• Air humidification: Reduces respiratory discomfort.
• Oxygen therapy: Necessary in severe cases with hypoxemia.
Severe cases
• Monitoring in a hospital environment;
• Use of non-invasive ventilation or intubation, if necessary;
• Intensive care for children or elderly people with respiratory failure.
What to do to prevent it?
Prevention is the best strategy to contain outbreaks, especially in pre-epidemic periods.
Preventive measures
• Hand hygiene: Wash hands frequently with soap and water.
• Avoid close contact: Especially with infected people or in places with high transmission.
• Surface cleaning: Disinfect objects and surfaces that are commonly used.
• Avoid crowds: Especially in seasons with high transmission.
• Breastfeeding: Strengthens babies’ immune systems.
Are there vaccines against RSV?
Approved vaccines
In 2023, the FDA and EMA approved the first vaccines against RSV, aimed primarily at:
• Elderly people (over 60 years of age): Vaccines based on RSV fusion proteins (e.g., Arexvy, from GSK, and Abrysvo, from Pfizer).
• Pregnant women: To protect newborns through the transfer of antibodies.
Passive immunization
The monoclonal antibody nirsevimab (brand name: Beyfortus) has been approved for use in infants. It significantly reduces hospitalizations in high-risk children.
Vaccination challenges
Despite advances, there is still no widely available vaccine for older children or healthy adults. Specific immunization should be targeted at the most vulnerable groups.
Conclusion
RSV is a significant public health challenge, especially in pre-epidemic periods. Young children, the elderly, and immunocompromised individuals are among those most affected. While supportive measures are effective for most cases, recent advances in vaccines and immunoprophylaxis offer hope for reducing the burden of this infection. Awareness of the symptoms, risks, and prevention methods is crucial to limit the spread and mitigate the impacts of this seasonal disease.
References
1. Centers for Disease Control and Prevention (CDC). Respiratory Syncytial Virus Infection (RSV). Available at: https://www.cdc.gov/
2. World Health Organization (WHO). Respiratory syncytial virus. Available at: https://www.who.int/
3. PATH. RSV Vaccine and Immunization. Available at: https://www.path.org/
