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Frequently asked questions on respiratory syncytial virus (RSV)

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Respiratory syncytial virus (RSV)

What is respiratory syncytial virus?

Respiratory syncytial virus (RSV) is one of the common viruses that cause coughs and colds in the winter period.
The virus is an enveloped RNA virus, in the same family as the human parainfluenza viruses and mumps and measles viruses.

 

How is RSV transmitted?

The respiratory virus is transmitted by large droplets and by secretions, so you may catch it if you touch an infected person and then touch your own eyes, nose or mouth. The virus can survive on surfaces or objects for about 4-7 hours. Transmission can be prevented through standard infection control practices such as hand washing. The incubation period - the delay between infection and the appearance of symptoms - is short at about three to five days.

 

When does RSV circulate?

In temperate climates such as the United Kingdom, RSV occurs regularly each year. Epidemics generally start in November or December and last for four to five months, peaking over the Christmas and New Year period. The sharp winter peak varies little in timing or magnitude, in contrast to influenza virus infection which is much less predictable in its timing.

 

Who is at particular risk from RSV infection?

For most people, RSV infection causes a respiratory illness that is generally mild. For a small number of people who are at risk of more severe respiratory disease, RSV infection might cause pneumonia or even death. RSV is best known for causing bronchiolitis in infants. Bronchiolitis occurs when the tiny airways leading to the lungs, called bronchioles, become inflamed and fill with mucus, making it difficult for a child to breathe. Over 60% of children have been infected by their first birthday, and over 80% by two years of age. The antibodies that develop following early childhood infection do not prevent further RSV infections throughout life. The full extent to which adults are affected by RSV remains unknown.

 

Who is at most risk of developing severe illness from RSV infection?

The very young (under 1 year of age) and the elderly are at the greatest risk. While most RSV infections usually cause mild illness, infants aged less than 6 months frequently develop the most severe disease (bronchiolitis and pneumonia), which may result in hospitalisation. Children born prematurely, or with underlying chronic lung disease, and the elderly with chronic disease are also at increased risk of developing severe disease.

 

Why do we know so little about the number of adults infected with RSV?

Only a minority of adult infections are diagnosed, as RSV is not widely recognised as a cause of respiratory infections in this age group. Elderly patients are frequently not investigated microbiologically, as there are fewer viruses present in their respiratory secretions compared with children. This results in the number of adult infections being underestimated.

 

Symptoms and advice

What are the symptoms of RSV infection?

RSV infection causes symptoms similar to a cold, including rhinitis (runny nose, sneezing or nasal congestion), cough, and sometimes fever. Ear infections and croup (a barking cough caused by inflammation of the upper airways) can also occur in children.

How is RSV infection diagnosed?

A doctor may diagnose a probable case of RSV infection based on typical symptoms of rhinitis, cough and fever. During the RSV season a laboratory diagnosis is not always necessary as patients can be managed without it. Specific lab tests to confirm RSV require a sample to be taken from the nose and throat.

How frequently does RSV infection occur?

In England, 28 per 1000 hospital admissions in children aged under 1 year were attributed to RSV each year, while in children aged 1 to 4 years, the figure was 1 per 1000 hospital each year. RSV infections in elderly people probably contribute to the number of admissions to hospital, but the overall impact of RSV infections in the elderly on health care services in the UK has not been fully determined.

Vaccination

Can I get vaccinated against RSV infection?

There are no vaccines against RSV available at the moment. Some pharmaceutical companies are testing vaccines for infants, older children with underlying chronic lung disease, and the elderly, but it is likely to be some time before these become available.

 

Interventions against RSV

What treatments are available for RSV infection?

No specific treatment is suitable for general use, and treatment is therefore aimed at supporting the patient and alleviating symptoms. Ribavirin is an anti-viral drug licensed for treatment of RSV infection which is sometimes used in the management of severe illness. Its effectiveness is not established, and it may be associated with toxicity.

 

Are there any drugs available to prevent RSV infection?

Palivizumab, a monclonal antibody therapy, is licensed in the UK for the prevention of serious lower respiratory tract infection caused by RSV in infants at high risk of infection.

HPA activity

What RSV information does the HPA make available?

Information about levels of RSV activity in the UK is included in the weekly Influenza Report posted onto the HPA web site throughout the winter period. Information also appears in the CDR Weekly during the RSV season.

Human metapneumovirus

What is Human metapneumovirus?

Human metapneumovirus (hMPV) is a respiratory pathogen closely related to Respiratory Syncytial Virus (RSV). It is associated with a range of illnesses from mild infection to severe bronchiolitis and pneumonia. Symptoms may include a runny nose, cough, temperature, sore throat, and wheezing. Like RSV, hMPV is thought to be a seasonal virus occurring mostly during the winter months. However, the number of people which suffer from hMPV each year is still to be determined.

 

Who is at risk from this infection?

HMPV infection occurs in infants and young children with studies suggesting that nearly everyone has had hMPV infection by the age of 5 years old. However, hMPV has also been found in older children and adults suggesting re-infection may occur later on in life.

 

When was hMPV discovered?

HMPV was first discovered in the Netherlands 2001 followed by Australia, North America and the UK indicating this virus is found in the population world wide. Despite only recently being identified studies carried out in the Netherlands on old blood samples suggest this virus has been in the human population for at least the past 50 years. HMPV however, remained unidentified as techniques routinely used for virus growth and identification did not allow for the slow growth of this virus or the inability of antibodies used to identify related viruses to recognise hMPV.


Last reviewed: 22 September 2008