Overview

Respiratory syncytial virus, or RSV, is a highly infectious virus that commonly affects children but is increasingly recognised as an important pathogen in adults.^1,2
The clinical presentation of RSV ranges from mild upper respiratory tract infection (URTI) to severe and potentially life-threatening lower respiratory tract disease (LRTD). The most common form of LRTD is bronchiolitis, but pneumonia and croup also occur.¹

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Signs and symptoms

RSV infection causes mild URTI in most people with symptoms that can include:²

• Rhinorrhoea
• Cough
• Congestion
• Low-grade fever
• Reduced appetite
• Respiratory distress

In some cases, RSV can progress to LRTD with more serious symptoms such as:

• Dry, wheezy cough^1,2
• Difficulty breathing^1,2
• Fever (uncommon)¹

Virology

RSV is a single-stranded RNA Pneumovirus that belongs to the Paramyxoviridae
family.¹ There are several different respiratory syncytial viruses, but only one serotype can be hosted by humans.¹ RSV is transmitted from person to person through droplets containing the virus when someone coughs or sneezes, or from touching contaminated objects or surfaces.²

Diagnosis

Coughs, colds, and breathing problems can be diagnosed by a doctor and RSV can be confirmed with a polymerase chain reaction (PCR) test via a nose or throat swab.²

Prevention

Some simple ways to reduce the spread of RSV include:²

• Washing hands regularly with soap and warm water or using hand sanitiser.
• Wearing a mask in crowded areas or when visiting high risk individuals.
• Regularly cleaning surfaces and items that may be contaminated, including toys shared among children.
• Staying at home when unwell.
• Covering the nose and mouth when sneezing or coughing.
• Avoiding sharing cups, glasses, or cutlery with people when unwell.
• Throwing out tissues as soon as they’ve been used.
• Avoiding contact with high-risk people such as infants, older people, and immunocompromised individuals when sick.

Immunisations and vaccines are available for pregnant women, infants and some toddlers, and adults aged 60 years and over.

Epidemiology

RSV infects almost all children by the age of 3 years.³ In Australia during 2006–2015, there were 86,687 RSV-related hospitalisations and a clear seasonal pattern during the autumn and winter months in all states and territories except the Northern Territory.⁴

Most infections are mild, with patients experiencing upper respiratory illness. However, in some cases, RSV can progress to severe LRTD, predominantly in the form of bronchiolitis, or less commonly, pneumonia and croup.¹

Risk factors for severe RSV include:⁴

• Young age (up to 5 years)
• Older age (>65 years)
• Underlying health conditions
• Weakened immune system
• Premature birth
• Low birth weight
• Being from an Indigenous community

However, RSV is unpredictable in infants and children with the majority of those admitted to hospital with RSV being otherwise healthy with no predisposing conditions.^4–7

Treatment

Mild RSV can usually be managed with bed rest, over-the-counter pain medicines such as paracetamol and ibuprofen, and staying hydrated, while the body’s natural immune response fights off infection.²

For more severe RSV symptoms, individuals may need to be hospitalised and treated with intravenous fluids and extra oxygen.² There is no specific treatment against RSV, with management generally consisting of supportive care.¹