According to a Decision Support in Medicine article published in Pediatric News, reinfections with RSV occur throughout life but generally are limited to the upper airway in healthy individuals.
The younger the child in whom RSV infection occurs, the more likely the disease will be severe, requiring hospitalization or intensive care. In a 2009 study, Hall et al., noted that 1.7% of infants less than 6 months of age in the United States were hospitalized for RSV infection, with considerable variation among communities throughout the country. Despite this high hospitalization rate, only approximately 40 children in the United States die each year from complications of bronchiolitis. Bronchiolitis tends to be more severe when associated with RSV than with other viral causes, such as influenza, parainfluenza, human metapneumovirus, and rhinovirus. Although many older children and young adults are infected with RSV, those infections tend to occur primarily in the upper respiratory tract. RSV becomes a problem again in old age: it is estimated that some 14,000 elderly Americans die of RSV-associated infections each year.
Lance Chilton, MD, FAAP
Professor of Pediatrics
University of New Mexico
In children with bronchiolitis, the duration of symptoms has been estimated at 2-3 weeks.
Explanation
According to a Decision Support in Medicine article published in Pediatric News, “[r]ecovery from bronchiolitis can require weeks; the median duration of symptoms has been estimated at 12 days, but up to 20% of children continued to have intermittent cough at 3 weeks after onset of illness. A long-term association with increased risk for asthma in later childhood has been demonstrated for infants with severe bronchiolitis requiring hospitalization, although it is unclear if this is a complication of bronchiolitis or an underlying characteristic of the child.”
Knowing the prolonged course of RSV infection is helpful to those caring for young children who have suffered the disease in helping everyone understand the persistence of symptoms and the likelihood of eventual recovery from them. Counseling on the expected course and the lack of available therapy to avoid or treat prolonged cough, increased nasal secretions, and respiratory distress will avoid impossibly optimistic predictions of quick relief. Those caring for children—parents and health care providers alike—should be aware that cough medications have severely limited effectiveness; codeine-containing preparations should be avoided in children.
Lance Chilton, MD, FAAP
Professor of Pediatrics
University of New Mexico
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RSV spreads by large droplet transmission directly from patient to patient or by contact with viral particles on surfaces, which remain infectious for several hours
The clinical course of human metapneumovirus (HMPV) and RSV appear to be similar. HMPV is “another paramyxovirus that has infectious characteristics similar to those of RSV in regard to seasonal characteristics and mode of infection. HMPV was relatively recently described, but studies of banked specimens show it consistently has accounted for 3% to 19% of bronchiolitis cases,” according to a Decision Support in Medicine article published in Pediatric News. Rhinovirus is a common coinfecting agent with RSV or human metapneumovirus.
Rhinovirus, a cause of the common cold, is a common coinfecting agent with RSV or human metapneumovirus. “Rhinovirus has an emerging role as a cause of bronchiolitis and is more common in children older than 6 months of age. Rhinovirus is known as a common trigger of wheezing in older children with chronic lung disease and asthma,” according to a Decision Support in Medicine article published in Pediatric News.
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