Respiratory syncytial virus disease: update on treatment and prevention

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections in infants and young children, accounting for more than 100,000 hospitalizations per year in the USA. The majority of hospitalizations occur in infants less than 1 year of age. Worldwide, RSV is associated with an annual mortality rate of 160,000-600,000 deaths. Premature infants, and infants with congenital heart disease, neuromuscular disease, structural airway abnormalities and immunodeficiencies are at increased risk for severe RSV disease. Despite the magnitude of RSV disease, treatment remains primarily supportive. Trials of bronchodilators, corticosteroids and montelukast have not demonstrated conclusive clinical benefit. The antiviral drug ribavirin has demonstrated only marginal clinical benefit and is not routinely indicated in treatment of RSV disease. Palivizumab is beneficial in prophylaxis for infants at high-risk for severe RSV infection although optimal indications based on cost-effectiveness considerations have not been defined. Future directions in treatment and prevention of RSV infections likely include the second-generation monoclonal antibody motavizumab, more potent antiviral compounds and more unique anti-inflammatory agents. Vaccination against RSV is in development but not eminent.     

Respiratory syncytial virus (RSV): overview, treatment, and prevention strategies

Respiratory syncytial virus (RSV) is one of the most common diseases of childhood. Virtually all children have been exposed to this virus by age two. RSV causes common cold symptoms in most patients. In vulnerable children, RSV can progress to bronchiolitis and/or pneumonia with an increased chance of significant morbidity or death. The nature of the virus and mode of infection protects it from the human immune system. Treatment for RSV is largely supportive. Key elements of treatment are maintenance of hydration, and oxygenation, as well as keeping the airways clear of mucus. Prevention of RSV in vulnerable infants is important because of the increased morbidity and mortality. A modest effort spent identifying vulnerable infants, educating the parents about RSV and its prevention, and providing immunoprophylaxis to those who qualify for it, increases the chances that these vulnerable children get through the first several years of life without RSV bronchiolitis.     

Respiratory syncytial virus: a nursing perspective

Respiratory syncytial virus (RSV), a common winter illness, is most devastating in infants with underlying pulmonary and cardiovascular disease. Ribavirin aerosol is an effective treatment when used with appropriate nursing management.     

呼吸道合胞病毒及其基因检测

呼吸道合胞病毒是引起婴幼儿呼吸道疾病的重要病原体,易引起毛细支气管炎和肺炎,产生严重的感染和并发症。儿童感染后可能会表现出喂养效果差、鼻漏、呼吸暂停、喘鸣和呼吸窘迫等症状。成人急性感染也很常见,对于免疫力低下的老年人也可能引起严重肺炎,并发展为成人呼吸窘迫综合征(ARDS)。分别对呼吸道合胞病毒的分子生物学特征、流行病学、临床症状、预防和治疗、临床和试验室检测方法进行介绍,以加深对该病毒的了解。     

Respiratory syncytial virus infection in children

Respiratory syncytial virus (RSV) is an RNA virus that causes respiratory tract infections in children. In the North- ern Hemisphere, the peak infection season is November through April. By two years of age, most children will have had an RSV infection. Bronchiolitis, a lower respiratory tract infection, is often caused by RSV. An RSV infection is diagnosed based on patient history and physical examination. Children typically present with cough, coryza, and wheezing. Laboratory testing and chest radiography are not necessary to make the diagnosis. Serious concur- rent bacterial infections are rare. Treatment of an RSV infection is supportive, with particular attention to maintaining hydration and oxygenation. Children younger than 60 days and those with severe symptoms may require hospitalization. Neither antibiotics nor corticosteroids are helpful for bronchiolitis. A bronchodilator trial is appropriate for children with wheezing, but should not be continued unless there is a prompt favorable response. Frequent hand washing and contact isolation may prevent the spread of RSV infections. Children younger than two years at high risk of severe illness, including those born before 35 weeks of gestation and those with chronic lung or cardiac problems, may be candidates for palivizumab prophylaxis for RSV infection during the peak infection season. Most children recover uneventfully with supportive care.     

Respiratory syncytial virus in blood and marrow transplant recipients

Nurses caring for blood and bone marrow transplant recipients need to understand the effects that respiratory syncytial virus (RSV) infection can have on transplant recipients, family members, and healthcare providers. With knowledge about the virulence and transmission of RSV, nurses are in a position to educate patients and family, reduce nosocomial spread of the infection, and influence clinical practice. By recognizing specific risk factors for infection, nurses can act as gatekeepers who identify candidates to screen and enhance early detection of infection. Nurses need to possess knowledge of early detection, implement clinical management strategies and precautions, and optimize delivery of appropriate therapy while maintaining a safe environment for all people involved. This article reviews RSV's clinical risk factors, transmission, signs and symptoms, diagnosis, treatment options, and impact on transplant recipients and candidates.     

Respiratory syncytial virus infection and the primary care physician

Respiratory syncytial virus (RSV) infection is a common viral illness affecting almost all children within their first few years of life. In most young children, RSV results in a mild respiratory infection. It is, however, the single most important cause of bronchiolitis and pneumonitis in infancy and contributes to significant morbidity and even mortality in a subset of high-risk children. There are new developments in the diagnosis, treatment, and prevention of RSV infection in infants and children. Early recognition of young children at high risk for severe RSV infection and apnea can help to minimize the morbidity and mortality.     

Respiratory syncytial virus morbidity and mortality estimates in congenital heart disease patients: a recent experience.

OBJECTIVE: To determine recent morbidity and mortality rates from respiratory syncytial virus infection in a pediatric congenital heart disease population. DESIGN: Retrospective cohort study design. SETTING: The C. S. Mott Children's Hospital, University of Michigan Medical Center. PATIENTS: A total of 740 pediatric patients hospitalized at the University of Michigan Medical Center for symptomatic respiratory syncytial virus infection, of whom, 79 patients had clinically important congenital heart disease. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We retrospectively examined the charts of 740 patients hospitalized at our children's hospital from July 1, 1983 to June 30, 1990 with symptomatic respiratory syncytial virus infection to assess morbidity and mortality outcomes. Seventy-nine patients had congenital heart disease and 40 of these patients had pulmonary hypertension. For the entire cohort and a subset of patients with community-acquired infection, those patients with congenital heart disease had longer durations of hospitalization and greater need for, and days of, both intensive care and mechanical ventilation than patients without congenital heart disease. Mortality risk for respiratory syncytial virus community-acquired infection was not different for congenital heart disease vs. noncongenital heart disease patients (0.0% vs. 0.2%; p = 1.00). When examining only patients with congenital heart disease, those patients with pulmonary hypertension had increased hospital days and greater intensive care and mechanical ventilation durations compared with patients without this diagnosis. The overall mortality rate was low and was equally low for congenital heart disease groups with or without pulmonary hypertension (2.5 vs. 2.6). For community-acquired illness, no mortality was found in either congenital heart disease group. When the cohort of congenital heart disease patients was divided into pre- and postribavirin administration eras, no differences in mean hospital duration, ICU days, and mechanical ventilation days were noted. Of the 79 congenital heart disease patients, only two died during their hospitalization in which respiratory syncytial virus infection occurred. Both patients had nosocomial-acquired respiratory syncytial virus and both were from the postribavirin administration cohort. One of these two patients had received antiviral therapy. Neither death was secondary to respiratory syncytial virus respiratory failure (based on pathologic examination). CONCLUSIONS: We conclude that respiratory syncytial virus mortality risk in pediatric patients with congenital heart disease is less than the risk reported a decade ago. Respiratory syncytial virus infection in congenital heart disease patients with pulmonary hypertension is associated with increased morbidity but not increased mortality rates. The markedly decreased respiratory syncytial virus mortality risk in patients with congenital heart disease currently experienced is likely secondary to improvements in intensive care management and advances in the surgical correction in this population rather than antiviral therapy.     

Respiratory syncytial virus morbidity, premorbid factors, seasonality, and implications for prophylaxis

Objectives

We investigated factors associated with morbidity and pediatric intensive care unit (PICU) admission in children with respiratory syncytial virus (RSV) infection and explored seasonality and implication of prophylaxis.

Methods

A retrospective study between 2006 and 2008 of every child with a laboratory-confirmed RSV infection was included.

Results

Six hundred seventy RSV admissions were identified. Ten (1.5%) required PICU admissions. Children admitted to PICU were younger than non-PICU admissions (median [interquartile range] age, 0.3 [0.11-0.48] vs 1.18 [0.46-2.49] years; P = .001). Odds associated with PICU admissions included history of chronic lung disease (odds ratio [95% confidence interval], 18.08 [2.29-114.95]; P = .010), history of acyanotic heart disease (7.61 [1.04-42.59], P = .043), and neurodevelopmental conditions (mental retardation, cerebral palsy, or neuromuscular disease; 8.41 [1.63-38.57], P = .012). Odds of bacterial coinfections was 13.50 (1.77-81.29), P = .017. There appeared no significant PICU predilection in terms of sex, history of prematurity, cyanotic heart disease, seizure disorders, chromosomal disorders, or malignancy. Admissions associated with proven RSV infections accounted for 2.4% of PICU annual admissions. The duration of PICU stay was generally brief (median, 3 days). However, median length of hospital stay was significantly longer in the PICU category (8.5 vs 3 days, P < .001). There was no death in the study period. Only 5 (0.75%) of 665 patients were readmitted to the pediatric infectious disease isolation ward in consecutive years, and none required PICU support. Twenty (3%) of admissions involved neonates younger than 30 days. There was no definite seasonality, but incidence was lowest between October and January.

Conclusions

Most infants have mild disease and do not require PICU support. Young infants with history of chronic lung disease, congenital heart disease, and neurodevelopmental conditions appear to be at significantly increased risk for PICU support. There is no winter seasonality for RSV disease in Hong Kong. Therefore, any prophylaxis for at-risk population should provide adequate coverage for the warmer months in subtropical regions.     

Respiratory syncytial virus infection in chronic bronchitis patients

Two groups of patients with acute respiratory disease (ARD) were examined: 57 (the 1st group) had chronic bronchitis, 265 patients (the 2nd group) had no previous history of chronic bronchitis. The investigation was performed using serological and immunofluorescent methods and was repeated in the course of 12-18 months. Respiratory syncytial (RS) viral infection was diagnosed significantly more frequently in the 1st group whereas the frequency of influenza, parainfluenza and adenoviral infection in both groups was the same. Mixed RS-viral infection in these patients was more common. In 3 patients RS-viral infection was diagnosed each time in new ARD in parallel with influenza and other viral infections which was indicative of RS-virus persistence in the body.     

Respiratory syncytial virus: a pediatric nursing plan of care.

Thirty-three pediatric cases of respiratory syncytial viral (RSV) infections were treated at Providence Hospital's Pediatric Intensive Care Unit (PICU), Anchorage, AK, between September 1987 and March 1988. Our 8-bed PICU nursing and respiratory therapy staff learned effective techniques in caring for patients with RSV. Our aim in this article is to share our approach in providing comprehensive care for patients with RSV infections.     

Respiratory syncytial virus (RSV): a common health problem.

RSV infections pose a variety of considerations for emergency personnel. Nurses should be suspicious of this cause of illness during the winter months because of its prevalence, should be able to recognize and treat those who are experiencing or are at risk for acquiring lower respiratory tract complications, and should be aware of the need to reduce the spread of the virus by using isolation techniques, vigorous hand-washing protocol, and other protective measures to reduce contact with the organism. Patients who are at high risk for respiratory distress should be admitted for observation and supportive therapy.     

Respiratory syncytial virus disease mechanisms implicated by human, animal model, and in vitro data facilitate vaccine strategies and new therapeutics

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis, pneumonia, mechanical ventilation, and respiratory failure in infants in the US. No effective post-infection treatments are widely available, and currently there is no vaccine. RSV disease is the result of virus-induced airway damage and complex inflammatory processes. The outcome of infection depends on host and viral genetics. Here, we review disease mechanisms in primary RSV infection that are implicated by clinical studies, in vitro systems, and animal models. Defining RSV disease mechanisms is difficult because there is a wide range of RSV disease phenotypes in humans, and there are disparities in RSV disease phenotypes among the animal models of RSV infection. However, host factors identified by multiple lines of investigation as playing important roles in RSV pathogenesis are providing key insights. A better understanding of RSV molecular biology and RSV pathogenesis is facilitating rational vaccine design strategies and molecular targets for new therapeutics.