Frequently Asked Questions

What is RSV?

RSV (Respiratory Syncytial Virus) is a very common respiratory virus is children and it is related to the flu virus. It causes an infection of the airways which will make breathing more difficult. The virus is very contagious and almost all children have been infected with RSV at least once by the time they are two years old. The virus is mainly active during winter months (October-March). A mild RSV infection has symptoms of a common cold, such as a stuffy or runny nose and a cough. Nothing to worry about, you might think. However, in babies this innocent cold can quickly develop into a severe infection of the airways and require hospitalisation because of serious breathing difficulties. Even after recovery the infection can cause ongoing or recurring health problems and have a significant impact on the quality of life.

What is Bronchiolitis?

Bronchiolitis is a common lung infection that inflames the bronchioles, i.e. the small airways to the alveoli. As a result the airways narrow and you get stuffy. Bronchiolitis mainly occurs in babies and small children under two years of age. The disease can be caused by various viruses, but in children it is usually caused by RSV.

What is the difference between bronchiolitis, bronchitis and pneumonia?

Bronchitis is an inflammation of the larger airways, the so-called “bronchi”. When the smaller airways that lead to the alveoli are also inflamed, it is called bronchiolitis. In the case of pneumonia, the inflammation is deep in the lungs, in the alveoli.

How do people get infected with RSV?

The virus easily spreads from one person to another, usually via airborne droplets from sneezing or coughing. RSV can survive on hard surfaces, such as toys or furniture for many hours. Therefore, the chance of being exposed to the virus is considerable in places that are frequented by a lot of people, like doctor’s waiting rooms and nurseries.

What is the RSV burden of disease? How many people get it?

Babies are at  higher risk of a severe evolution of the infection than older children or adults, because their bodies have not yet produced enough antibodies. Research has shown that 10% of all children in Europe see a doctor because of an RSV infection. 10% Of these children are hospitalised with RSV, mostly for a few days, until they are able to feed or no longer need extra oxygen. However, those that are seriously ill (10% of hospitalised infants) need to be transferred to an intensive care unit for specialist respiratory support. Fortunately,

From a global perspective the burden of disease from RSV infection shows a different picture and is disproportionately high in low-income country settings. More than 90 percent of all RSV associated respiratory infections occur in developing countries. If 10% of these episodes need treatment in hospital, many of them may never make it to a health facility. More than 100,000 children are thought to die of RSV every year, with most deaths occurring in low- and middle-income countries (Shi T, McAllister DA, O’Brien KL, et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390:946-958).

Can RSV infect the same person more than once?

Yes, people will experience several RSV infections during their life as they do not develop permanent immunity to the virus. Subsequent infections are usually less severe. The body produces antibodies against RSV, but these do not offer lifelong protection. Most people only experience cold like symptoms.

How long does a RSV infection last?

The infection lasts about three to seven days, but health issues such as coughing and wheezing can last for several weeks after the infection itself has gone

Can RSV infection be lethal?

Yes, RSV infection can be life threatening! As there is no medicine available to treat severe RSV infection,  caring for a baby with RSV infection involves treating its effects on the respiratory system. Because ICU treatment (ventilation) is not always at hand or in time in developing countries, RSV is an important cause of mortality in young children. It is estimated to be the second most important cause of infant mortality – after malaria – worldwide.

Are some people more at risk of developing severe RSV Bronchiolitis than others?

RSV Bronchiolitis is a common lung infection in young children and infants. About 1% healthy “full term” babies end up in hospital with RSV Bronchiolitis. However, prematurely born babies (at less than 37 weeks), those born with a heart or lung condition, or another immunodeficiency condition like Down’s syndrome, are at higher risk for developing severe RSV Bronchiolitis.

What are risk factors for developing severe RSV disease?

Babies that are born before or during the RSV season are more at risk to develop a severe RSV infection. Infection rates peak in infants who are two months old, because the maternal antibodies are gone by then and they need to build their own antibodies. After the third month of life, the risk quickly decreases.

The presence of older brothers or sisters is also an important risk factor, because they can be a source of infection to the new-born child. They could have picked up the virus in school or day-care centre. These are major sources of infection.

Therefore, a healthy baby that is born in March and who do not have any siblings has a relatively small chance of ending up in hospital with RSV. For a baby born (prematurely) in September with older brothers or sisters, this risk is significantly bigger.

How can I recognise severe RSV infection?

The first symptoms of RSV infection are normal cold like symptoms, such as a runny nose, coughing and sometimes a fever. The virus causes overproduction of mucus in the lungs which makes it difficult for the child to breathe. You can tell your baby has difficulty breathing when he or she:

• is breathing rapidly or heavily (wheezing; squeaking noises while breathing, gasping for air)
• spreads out the nostrils with every breath (nasal flaring)
• is tired or quickly exhausted: e.g. is not taking the usual amount of milk;
• has retractions on the chest: skin pulling in while breathing between or under rib cage, beneath the breastbone or in the neck area
• Is irritable of lethargic; shows weak response to social cues or will awaken only with prolonged stimulation
• shows signs of dehydration, such as crying without tears or a dry nappy for more than 12 hours
• appears pale or has a bluish colour around the lips, and fingertips

As soon as you notice one or more of the above signs consult your doctor.

How is RSV treated?

There is no medicine for RSV patients. Treatment is usually not necessary and the symptoms disappear after a few days to a week. In the hospital one can only treat the consequences of the RSV infection, like treating oxygen deficiency and inflammation of the airways.

For infants considered to be at the highest risk for RSV, preventive medication is recommended. Palivizumab (or Synagis) is given as a monthly shot during the peak RSV season. Palivizumab works by giving your body antibodies to protect it against RSV infection.

Is RSV infection treated with antibiotics?

Most of the time RSV infection is not treated with antibiotics because antibiotics do not work against viruses.

Can RSV infection be prevented?

You cannot prevent RSV infection. Everyone gets it. There is no vaccine available and almost all children have had RSV at least once by the time they are 2 years old. However, you can try to limit the risk of RSV infection for your baby in its first months of life by decreasing the risk of exposure to the virus.

How can I reduce the risk of RSV Bronchiolitis for my baby?

Keep your new-born baby away from infected people or an infected environment. Unfortunately, you cannot tell if someone has RSV. That’s why it’s better to avoid contact with people who have a cold. Furthermore, make sure everyone who touches the baby washes their hands first.

Children often pass the virus to one another at school or childcare centre. Therefore, limiting the time that infants spend at childcare centres and other potentially contagious places during RSV season may help protect them from infection. Also, be aware that babies often get infected when older siblings carry the virus home and pass it to them.

Take the following measures to help protect your baby from RSV:

• Wash your hands before touching your baby and ask others to do the same
• Wash your baby’s toys, clothes, and bedding regularly
• Clean and disinfect contaminated surfaces (such as doorknobs) on a regular basis
• Keep your baby away from crowds and young children

Can a child with RSV Bronchiolitis go to nursery/child care centre?

RSV is contagious before symptoms develop and may remain contagious for days or weeks after the symptoms have abated. Therefore, staying at home does not help to prevent contamination of others. Even if you do not let your child go to nursery, somebody else could bring the virus into your home, for example an older brother or sister. Children get infections whether or not they attend child care centres.

What are typical effects of severe RSV infection in the longer term?

Bronchiolitis does not usually cause long-term breathing problems. But the more severe cases may be associated with a greater risk of recurrent wheezing in preschool-aged children, and with asthma and impaired respiratory function in school-aged children.

My child is still coughing. Is this normal?

Even though the RSV infection itself is over, the symptoms such as coughing and wheezing can persist for several weeks. This is normal. If it takes a very long time and you are concerned, consult your doctor.