RSV Season: Virus Will Infect Thousands of U.S. Kids This Year

A virus, called RSV, is spreading through the southern U.S. and will send thousands of kids to the hospital.

There's no vaccine. So why aren't there scary headlines? Maybe because it happens every year.

The virus is RSV — respiratory syncytial virus. Every year it puts 51,000 to 82,000 Americans in the hospital. Most of them are young children, although the virus ravages the elderly as well.

Last year, RSV season started in the South in late October. By mid-November it had spread to the Northeast and West, and to the Midwest in late December. RSV season peaked in December in the South and Northeast, in January in the West, and in February in the Midwest.

And now it's back. The CDC reports that widespread RSV infections began in the South in mid-October. Infection rates climbed through November. And preliminary data suggest that cases are rising toward the "widespread" level in the Northeast. The data appears in the Dec. 16 issue of the CDC's MMWR: Morbidity and Mortality Weekly Report.

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RSV Symptoms

If you're old enough to read this, you've almost certainly had more than one RSV infection. Most of us catch it for the first time before we're 2 years old.

You catch it by coming into contact with what the CDC delicately refers to as the "respiratory secretions" of an infected person. Usually this means close contact — for example, sharing a drinking cup — with an infected person. You probably can also get an RSV infection by touching a virus-contaminated surface and then rubbing your eye, scratching your nose, or touching your mouth.

RSV illness begins with a fever, a runny nose, a cough, and, sometimes, wheezing. Most adults experience RSV infection as a bad cold.

It's a different story for children. Among kids who catch RSV for the first time, 25 percent to 40 percent come down with symptoms of a severe lung infection: pneumonia or bronchiolitis (inflammation in the small air passageways of the lung). As many as two in 100 kids infected for the first time are hospitalized.

High-Risk Kids

The virus is particularly dangerous for some children, including:

—Kids younger than 2 years who've recently been treated for chronic lung disease.

—Kids with heart disease.

—For their first RSV season, premature infants born at less than 32 weeks' gestation.

—For their first RSV season, premature infants born at 32-35 weeks' gestation who have two of these additional risk factors: attending day care; exposure to environmental pollution; having a school-aged sibling; being born with abnormal airways; or neuromuscular disease (such as muscular dystrophy).

These high-risk kids may benefit from preventive treatment with monthly doses of an anti-RSV antibody product called Synagis.

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RSV Treatment and Prevention

Kids with mild RSV infection need nothing more than symptomatic treatment. For example, they might take acetaminophen (Tylenol is the most common brand name) to reduce fever.

Kids with severe RSV disease may need oxygen therapy and treatment with an antiviral drug called ribavirin. Sometimes mechanical ventilation is needed. Kids with immune deficiencies and severe RSV disease may be treated with intravenous anti-RSV immune globulin and ribavirin.

And it's not only kids who are at risk. Elderly people, and people with compromised immune systems also risk serious RSV disease.

For a disease this common and this serious, you'd think there would be a vaccine. But making an RSV vaccine has turned out to be a major problem. One reason is that the normal immune system may overreact to RSV. That's why a simple RSV vaccine tested in the 1960s was a disaster. It made this immune storm worse, so kids with RSV exposure actually got sicker.

The quest for a safe RSV vaccine continues. Meanwhile, there's one good way to avoid RSV infection: Wash your hands. Yes, this means frequent hand washing, with soap and warm water, gently scrubbing the hands for the time it takes to sing the alphabet song.

Unfortunately, it doesn't do any good to keep kids with colds out of school or day care if they're feeling well enough to go back. RSV spreads typically during the early stages of infection.

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By Daniel J. DeNoon, reviewed by Louise Chang, MD

SOURCES: CDC, MMWR: Morbidity and Mortality Weekly Report, Dec. 16, 2005; vol 54: pp 1259-1260. CDC web site.