By:Dr. Kathryn Beattie
Most parents have not heard of respiratory syncytial virus (RSV). This viral infection sends more than 90,000 babies to the hospital each year in the United States.
A recent study in the Journal of the American Medical Association suggests that more and more families, particularly with babies born prematurely or those with chronic lung or heart problems, will face a bout with RSV.
Epidemiologists at the Centers for Disease Control and Prevention in Atlanta conducted an RSV study that spanned 16 years, from 1980 to 1996. They found that the rate of infants aged 6 months and younger who were hospitalized with RSV jumped a staggering 239 percent.
The study team noted that over the course of the years, 1.65 million preschoolers were hospitalized because the virus caused trouble breathing. Of those hospitalized, 81 percent were children younger than one year.
It is clear that the numbers are rising and at a disturbing pace. One possible theory for the rise in RSV infections is the increase in the number of children placed in day care. Infants and toddlers have poorly developed immune systems and are highly susceptible to all kinds of infections, RSV being one of them. As the number of cases increase, doctors continue to learn more and more about the virus.
RSV thrives during the fall, winter and early spring months and shares symptoms with those of the common cold. However, with this viral infection, the body produces much more respiratory mucous than typically accompanies a cold. So much, in fact, that infants who develop it have a difficult time breathing, swallowing and eating.
What begins as a cold progresses over a few days into a lower respiratory infection. At this point, the child can develop bronchiolitis, an inflammation of the small bronchi, and begin wheezing. Once breathing becomes labored, the child may become hypoxic, which means he or she has low oxygen levels and must be taken to the hospital.
A quick test is available to confirm the diagnosis of RSV from collected nasal secretions. While at the hospital, the infant will be given fluids, medications to open the lungs and the airways, and any other necessary treatments. These supportive therapies help the infant survive while the virus runs its course, which can take as little as one week or as long as one month.
The frustrating thing about this virus is how tenacious it is. The virus spreads easily when an infected person coughs or sneezes. Babies and toddlers are not able to control how their mucous comes into contact with others, so the job falls to their parents and day-care providers.
Be vigilant about handwashing and avoid direct or close contact with secretions. When caring for a sick child, change bibs and shirts often and be careful not to share toys with others.
Remember that very young children may not seem terribly ill until they suddenly have trouble breathing. Call your doctor if you notice that your child’s breathing is labored of if he or she has any of the following symptoms: signs of dehydration such as dry diapers or an inability to shed tears; a fever or coughing in an infant younger than 2 months old; a bluish-gray color around the lips, on the fingertips, or the skin; difficulty feeding because of a stuffy nose.
RSV can be contracted by anyone of any age and those who have had it once can get it again. Although the virus does not present a significant threat to the average healthy adult or child over the age of 3, it can spread to babies in the family or at the day care center.
RSV stays on inanimate surfaces, such as toys, for hours and lasts on the hands for half an hour after exposure. The viral shedding involved with a person infected with RSV lasts from three to eight days, averaging about one week. When you combine how easily the virus spreads, how long it lives on objects and hands, and how many days the infected person can be spreading it, it adds up to a problem with epidemic proportions.
Because the virus affects the lungs, premature babies under 32 weeks with chronic lung or heart problems run the highest risk for the first two years of their lives. Babies born under 35 weeks are at moderate risk for the first year. Because it can pose such a serious risk to these babies, preventative treatment is recommended.
Synagis, an intramuscular injection that became available in 1999, uses a monoclonal antibody to help protect the infant from RSV.
There are many studies that suggest that young children who have had RSV run the risk of developing asthma. Some researchers offer that this may be a valid link because an RSV infection can scar a youngster’s air tubes and this scarring can lead to narrower airways and wheezing.
Other researchers claim that children who suffer from RSV may have had differences in lung development that make them prone to asthma as well. Whatever the reason, no one can dispute that preventing exposure in the first place is the best course to take.
Being aware of RSV and how it progresses is the first step parents can take to help keep their little ones healthy. Educate other parents by talking about RSV in play groups, at day care centers, and at nursery schools. Let caretakers know about RSV and its warning signs. Keep babies, especially preemies, away from crowds and do not let people smoke around them.?
Dr. Kathryn Beattie is a pediatrician on staff at The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Packet and is contributed by The Medical Center at Princeton.
