rsv

human respiratory syncytial virus / human orthopneumovirus (HRSV)

Introduction

  • now renamed to human orthopneumovirus
  • it is a negative-sense, single-stranded RNA virus of the family Pneumoviridae.
  • HRSV is the most common cause of lower respiratory tract infections in children, and nearly all children will have been infected with the virus by 2–3 years of age and 2-3% will develop bronchiolitis for which it is the most common cause
  • natural immunity following infection wanes over time resulting in the possibility of multiple infections
  • young adults can be re-infected every five to seven years, with symptoms looking like a sinus infection or a common cold (although infections can also be asymptomatic)
  • severe infections have increasingly been found among elderly patients

Clinical features

  • incubation period is usually 4-5 days but may be 2-8 days
  • spread is by direct contact - virus remains viable on hands up to 30 minutes or so, and on bench tops for up to 5hrs
  • it tends to spread rapidly in childcare centres
  • it can be spread to or from other primates
  • illness lasts 2-8 days but symptoms can last 3 weeks
  • may present as:
    • asymptomatic or common cold-like illness in healthy adults
    • bronchiolitis in infants
    • severe pneumonitis, particularly in neonates, the elderly or the immunocompromised
  • it may precipitate asthma and otitis media

Diagnosis

  • nasal swab for PCR or antigen detection tests (less reliable in adults than in children)

Treatment

  • supportive care
  • CXR and basic blood tests if indicated
  • supplemental oxygen as needed
  • IV fluids as needed
  • non-invasive ventilation as needed
  • Rx bronchiolitis as needed eg. nebulized 3% saline
  • Rx asthma as needed

Prevention

  • a person is usually infectious for up to 10 days after symptoms begin

  • isolation and mask for infected cases who should avoid contact with infants, child care centres, the elderly or immunocompromised, but can usually go to kindergarten or school if well enough
  • hand hygiene
  • don't share drinks or cups
  • clean any fomites such as toys with warm water and detergent
  • no vaccine currently available
  • palivizumab for preterm or high risk infants
    • monthly injections, which are begun just prior to the RSV season and are usually continued for five months
rsv.txt · Last modified: 2019/02/11 22:04 by gary1