RSV

Respiratory syncytial virus (RSV) is a common and highly contagious respiratory virus that affects the lungs and airways, causing respiratory tract infections.

In New Zealand, the RSV season typically runs from April to October. Cases usually start increasing during the autumn months and reach their highest peaks in winter and spring.

In healthy adults and older children, symptoms are typically similar to that of a cold, however in babies, young children and older adults, and in those with chronic (long-term) medical conditions, RSV can be very serious and lead to hospitalisation.

Most children will have been exposed to RSV by the age of 2 years, however reinfection is common. For adults, RSV is a major cause of upper respiratory tract infections.

RSV is the most frequent cause of hospitalisation for pre-schoolers under the age of 2 years with lower respiratory tract infections. For children of Māori or Pacific ethnicity, there is an increased risk of RSV-associated hospitalisation.

RSV is easily spread from person to person through droplets in the air from coughing, sneezing, talking, direct contact with an infected person, and contact with surfaces that have the RSV virus on them (e.g. tables, toys, hands, tissues).

While any person of any age can be infected with RSV, most healthy people will experience mild to moderate cold-like symptoms and get better in 7-14 days.

However, RSV can cause complications and make the following groups of people seriously unwell:

• premature babies and very young children
• older people
• people of any age with a heart or lung condition
• people of any age with compromised immune systems (immunocompromised)
• infants exposed to tobacco smoke, crowded living conditions, or attending childcare facilities.

Symptoms generally appear within 4 to 6 days of being infected with RSV and include:

• runny nose
• sneezing or coughing
• fever
• sore throat
• fatigue (severe tiredness)

In babies and younger children, irritability or decreased activity could be the only signs that they are unwell.

In more serious cases of RSV, a person could have:

• wheezing and difficulty breathing
• loss of appetite or difficulty feeding (in babies)
• more severe symptoms, if they have asthma, COPD (chronic obstructive pulmonary disease), or cardiovascular (heart) disease
• confusion (in older adults)

Note: Shortness of breath or rapid breathing could be a sign of bronchiolitis (particularly in infants and young children) or pneumonia (which can affect people of any age, particularly older adults, or those with weakened immune systems). This requires immediate medical attention from your healthcare provider, after-hours medical centre of hospital emergency department.”

Diagnosis of RSV is usually based on symptoms, whether the person has had close contact with someone who has similar symptoms, and how long they have been sick.

A healthcare practitioner will also do a physical examination and listen to the person’s lungs for signs and symptoms of RSV. They may also do a nose/throat swab.

For most people, RSV infections will resolve on their own in 7 to 14 days.

There is no specific treatment for RSV and most cases can be managed at home with rest, fluids (to prevent dehydration), and over-the-counter medicines from your pharmacy for pain and fever.

It is important to check with your pharmacist before buying any cough and cold medication if you are currently taking other prescription or over-the counter medicines, or if you have other health conditions – especially if this is for children.

As RSV is a viral infection, it cannot be treated with antibiotics.

For people with severe symptoms, hospital management may be necessary, including giving oxygen to support breathing and intra-venous fluids to prevent dehydration.

Shortness of breath or rapid breathing could be a sign of pneumonia or bronchiolitis and requires immediate medical attention.

Call Healthline on 0800 611 116 or see a health professional if you think your child has RSV.

See a health professional urgently if you are worried or your baby or young child:

• is under 3 months old
• is having trouble breathing
• is having less than half their normal feeds
• has fewer wet nappies than usual
• looks unwell
• is vomiting

Call 111 and ask for an ambulance if your baby, child or any other person:

• has blue lips and tongue
• has severe difficulty breathing
• is becoming very sleepy and is not easy to wake up
• is very pale
• is floppy
• has breathing that is not regular, or pauses in their breathing

As RSV is highly contagious, the best prevention is to ensure that anyone with symptoms stays away from babies and toddlers until they are well and symptom-free.

Likewise, babies and young children attending daycare/kindergarten/playcentre should be kept at home until symptom-free. People are usually infectious for up to 10 days after symptoms begin.

Commonsense health precautions will help prevent the spread of the virus:

• regular hand washing and drying hands
• coughing and sneezing into your elbow
• not sharing eating or drinking utensils
• washing any toys or surfaces with warm water and detergent if they have been sneezed on or chewed

There is no RSV vaccination available for children in New Zealand, but a medicine called palivizumab (that can help to prevent RSV) is funded for some infants and children who are at high risk of severe illness meeting specific Pharmac Special Authority criteria.

Palivizumab is given by monthly injection during the RSV season.

Infants at highest risk of complications from getting RSV are those under the age of 2 years born prematurely or with underlying respiratory, heart and neurological condition.

Infants under the age of 6 months are at highest risk, especially those born in areas of high deprivation and those of Māori and Pacific ethnicity. Talk to your healthcare provider to find out if your child is eligible.

Most children have an RSV infection by their second birthday and will develop some immunity. However, immunity to RSV wanes over time and is never fully complete, so adults are still susceptible to getting RSV later in life.

In New Zealand, there is an approved, single-dose vaccine (brand name: Arvexy) available for adults, used to protect against RSV. It is primarily administered to adults aged 60 years and older, as well as those aged 50 to 59 years who are at higher risk of severe disease.

This is currently not funded in New Zealand, meaning that patients need to pay for the vaccine.