Of interest is the fact that RSV is also a frequent and unrecognized cause of lower respiratory tract infection in adults and is a significant problem for the elderly and immunocompromised patients. RSV infection in adults may be responsible for as much as 25% of excess mortality which was thought to be due to influenza. In a study done in Rochester, NY, RSV developed in three to seven percent of healthy elderly adults and four to 10 percent of high-risk adults. The mortality was eight percent for RSV infected adults and seven percent for influenza-infected adults.

Risk factors for infants and children:
1. Infants – newborns to age six months
2. Premature infants – less than 35 weeks gestation
3. Infants with congenital heart disease
4. Infants exposed to cigarette smoke
5. Infants with chronic lung disease secondary to respiratory distress syndrome, usually seen in premature infants in the neonatal period.

How is RSV transmitted? An infected person, infant, child or adult can spray out droplets when coughing. These can enter the body through the eye, (conjunctiva) or nose, (nasopharyngeal). Droplets from coughing or on hands can remain infectious for several hours. Direct contact is the most common route of transmission. Your hand touches some object which has the virus on it and then one, by chance touches his nose or eye, and there you go. After contact, the incubation period is four to six days. A person is contagious from about three to eight days. Once infected and recovery has taken place, immunity is not complete and reinfection is possible even when antibody levels are detectable. Infants born with antibody levels for RSV do tend to have milder disease.

What happens to the lungs in infants? The virus damages the cells lining the small airway in the lung, and this causes swelling and decreased diameter of the airway, making it harder to move air in and out of the lungs. This effort can cause a decrease in oxygen saturation and may require hospitalization for an infant in order to provide supplementary oxygen via nasal tubes, etc. Infants are also hospitalized in order to monitor their breathing rate. After an infant has recovered from RSV, wheezing can occur in up to 50-80% of affected individuals.

In children and adults, reinfection may look like a common cold characterized by cough, runny nose, red eyes, and secondary ear and sinus infections. RSV is diagnosed by a nasal swab test which takes about 15 minutes to complete. Often, the diagnosis is clinically apparent when the characteristic cough is heard in affected infants.

Prevention: There is no vaccine for RSV, but premature infants and infants with other risk factors can be given Synagis, which is a monoclonal antibody used to prevent growth of RSV. It is not a treatment for an infant with an active case of RAS, bronchiolitis. Keeping susceptible infants away from anyone with a cold, cough, runny nose, etc., is highly recommended. In a household with other children who are infected, this is usually not possible.

The following statement is directed towards the prevention or decreased risk of acquiring all respiratory infectious disease. Wash your hands and keep your hands away from your face, (nose, eyes and mouth) when your hands have come in to contact with infected persons, public areas, shopping carts, doorknobs, etc. Also, use a handkerchief when coughing or sneezing, or cough into your elbow or with folded arm. As always, infants who are coughing, having difficulty breathing, and are febrile, should be seen by a physician for diagnosis and appropriate therapy.