RSV: Myths vs. Facts

Article by  Dr. Matthew Barcellona
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Respiratory Syncytial Virus, or RSV,  is a common childhood illness. The spread of RSV peaks seasonally typically during winter months, and by age 2 years most people have suffered an infection from RSV.

Many people have heard of RSV, but most families have questions if they suspect their child is infected with RSV. Here are a few common questions about RSV in a fun way: Myth or Fact?

For further questions about RSV infections please visit the CDC website.

Myth or Fact: RSV only infects infants and young children.

Myth! It is a common belief that RSV is a disease specific to premature babies, infants, and small children. It turns out RSV infects people of all ages, and if your child had RSV chances are you got sick too.

What is true however is the disease process of RSV in infants and young children is especially recognizable; this process is called bronchiolitis. In bronchiolitis, the smallest airways of the lungs become swollen, inflamed, and produce much mucus. This inflammation leads to a classic hacking chest cough, wheezy breathing, and profuse amounts of mucus secretions. The process typically peaks around day 4 or 5 and resolves over another 1-2 weeks.

Myth or Fact: RSV causes common cold symptoms, but can become life threatening.

Fact! Most people, especially healthy older kids and adults, suffer mild common-cold type symptoms that resolve without complications. However in high risk children (i.e. children less than 1 year, chronic lung disease, congenital heart disease, or immunodeficiency) and the elderly it can be downright deadly.

Thankfully pediatric death is relatively uncommon from RSV, but it does happen. So for any infant or child suffering from RSV or another respiratory infection, it is most important to know the warning signs and symptoms of when to seek immediate medical attention. If you see any of the following signs or symptoms, seek medical help IMMEDIATELY:

• Increased work of breathing: Infants and children will begin to use “accessory” muscles to help breathe when they are struggling. This extra effort with each breath may cause deep belly breathing movements, visible rib movements with each breath (retractions), head bobbing, nostril flaring, and making a grunting sound after each breath.
• Increased respiratory rate: In addition to working harder to breathe, sick children will increase their respiratory rate. A loose guideline for breathing that is too fast for infants is > 60 breaths per minute and for children over 1 year > 40 breaths per minute. Of note, infants and children with fever typically have faster breathing rates, so if your child otherwise seems okay, first get the fever down then assess the respiratory rate.
• Cyanosis: Pale or bluish color to lips, face, chest, or nail beds

Myth or Fact: RSV requires antibiotics to get better.

Myth! RSV is a viral infection that does not respond to antibiotic therapy. The body’s own immune system needs to fight the infection. Supportive measures may help your child improve more quickly such as adequate rest and hydration. Infants may benefit from breathing humidified air, suctioning of the secretions from their nasal cavity, and application of saline in the nose to reduce mucus.

What is true however is that RSV can lead to secondary bacterial infections, such as ear infections, sinus infections, and pneumonia that may require an antibiotic. If you are concerned your child may have a secondary bacterial infection, we recommend an office visit to evaluate your child.

Myth or Fact: Once you get RSV, you cannot get it a second time.

Myth! In any given year, several strains of RSV are circulating in the community. Unfortunately, some people are unlucky to get RSV more than once, even in the same year!

Myth or Fact: The best way to prevent RSV is to get an “RSV shot”.

Myth! The best way to prevent RSV is by taking the following precautions:

• Good hand washing with soap and water for 20 seconds.
• Covering coughs and sneezing with a tissue or upper shirt sleeve.
• Avoid touching your face, eyes, nose, and mouth with unwashed hands.
• Avoid close contact (i.e. kissing, sharing cups, talking closely) with sick individuals.
• Clean and disinfect contaminated surfaces such as counters and door knobs.

Unfortunately a universal RSV vaccination is not yet available. There is an injectable preventative medicine, palivizumab, reserved for high risk children who meet the qualification criteria. This monthly shot reduces the severity of RSV infections for those most vulnerable to having a severe outcome.

Myth or Fact: Contracting RSV increases your risk of developing asthma.

Unknown! This is a hotly debated topic. What seems to be true is that those who experience clear wheezing during an RSV infection have a slightly higher risk of developing asthma later in life. However it is unclear if the development of asthma is caused by the RSV infection or if wheezing with an RSV infection is a predictor of people already at risk.