RSV--Bad Boy Respiratory Virus

RSV episode

WE ARE DOING THIS EPISODE AT THE START OF COLD AND FLU SEASON.  WE THOUGHT IT WOULD BE TIMELY TO TALK ABOUT RSV.

What is RSV?

Why does it have such a bad reputation compared to other colds?

RSV isn’t just a disease for children but we mostly hear about it in children. 

Should we be testing for this more in adults?

What are the symptoms of RSV in children? 

How can parents differentiate between a regular cold and a potential RSV infection?

When should parents worry?

What makes RSV so hard for kids, especially under the age of 2?

And this is where the term “bronchiolitis” comes into play in connection with RSV.   Why does RSV cause bronchiolitis?

How does RSV impact children differently across various age groups?

What symptoms do adults have?

People often say they are worried their child’s cold will “turn into RSV”—do you get that from your patients?  

When should you see your doctor?

Are there specific groups of children more vulnerable to severe RSV complications?  Which kids are at higher risk?

What is the significance of early detection and timely medical intervention?  Is it helpful to come in early

What care can parents give for RSV at home?

What are the treatment options for RSV?

What are the potential complications from RSV?

What preventive measures can parents take to reduce the risk of RSV in their children?

There are two types of immunizations for RSV—one for mothers and one for babies.

AND IF THE MOTHER DOESN’T RECEIVE THE IMMUNIZATION THERE IS ANOTHER OPPORTUNITY FOR THE CHILD

Are there any misconceptions about RSV that you'd like to address?

DO YOU HAVE A FAVORITE RSV STORY?

AND YOU OFTEN SAY YOU ARE TOO THRIFTY TO BUY SALINE DROPS.  WHAT IS THE RECIPE FOR MAKING SALINE AT HOME?

• It is 1/2 teaspoon of salt in 1 cup of warm water

Transcript

RSV episode

WE ARE DOING THIS EPISODE AT THE START OF COLD AND FLU SEASON.  WE THOUGHT IT WOULD BE TIMELY TO TALK ABOUT RSV.

What is RSV?

• RSV is Respiratory Syncytial Virus. 
• And the name tells you why it is such a challenging virus. 
• Syncytium refers to the lining of the respiratory tract—
• so the entire respiratory tract is affected by this virus from your nose to your lungs, 
• and that is what makes it worse than most respiratory viruses.
• It is also one of our croup-causing viruses

Why does it have such a bad reputation compared to other colds?

• Because it affects the entire respiratory tract, it hits kids harder than other respiratory viruses that might just cause a runny nose or a cough.
• With RSV 2% get hospitalized which is much higher than other respiratory viruses.  
• 2% isn’t a huge number, but when it is 2% of everybody, that is a lot of kids in the hospital.

RSV isn’t just a disease for children but we mostly hear about it in children. 

• Everyone has RSV by age 2-3.  The key is—how old are you when you first get infected.  The younger you are, the harder it hits you.
• Anyone can get it any year.  
• I think because we test a lot more in children we identify this virus in them a lot more. 
• If more adults were tested for RSV we would better appreciate how widespread this virus is during winter time.

Should we be testing for this more in adults?

• I think we should.  
• Knowledge is power and having better data drives better decisions.  
• I think a lot less adults would get antibiotics for respiratory infections if they knew it was RSV and not something else

What are the symptoms of RSV in children? 

• Initially RSV appears as a cold with a profuse runny nose, loose hacking cough, and lower grade fevers in the 100-102 degree range.  
• But then by about 48 hours of illness the disease progresses to more severe respiratory symptoms.

How can parents differentiate between a regular cold and a potential RSV infection?

• It is the worsening respiratory symptoms including faster and labored breathing and wheezing that comes on at about 48 hours that characterizes these more severe RSV infection

When should parents worry?

• Labored and noisy breathing is what drives parents to come in.
• there is a Fast breathing rate
• there is Wheezing
• and there are Retractions—where skin sucks in around collar bones or ribs

What makes RSV so hard for kids, especially under the age of 2?

• It is as simple as the fact that smaller children have smaller airways that are more seriously affected by the mucus that blocks their smaller airways.  
• Larger kids have larger airways that are not impacted as much as smaller kids with smaller airways

And this is where the term “bronchiolitis” comes into play in connection with RSV.   Why does RSV cause bronchiolitis?

• “-itis”refers to inflammation.
• Bronchioles are the medium-size airways that become inflamed and obstructed with RSV and so it causes bronchiol-itis
• smaller children have smaller bronchioles and when these 
• Airways become inflamed and obstructed, wheezing occurs

How does RSV impact children differently across various age groups?

• RSV occurs in any age group every year.  
• Cycles of high and low amounts of RSV every other year.
• In older children it is a particularly bad cold but they don’t often end up in the hospital unless they have underlying medical problems like asthma
• It is interesting that Every virus, Every germ, has it’s particular symptoms—fever, cough, runny nose symptoms in various degrees
• RSV is always a particularly bad cold with more cough and runny nose symptoms and less fever in older kids but doesn’t appear as severe because they have seen it before AND they are simply larger—RSV affects small bodies in a worse way
• Exacerbates Asthma
• I have had some pretty sick older kids where RSV flared up their asthma.

What symptoms do adults have?

• severe cold symptoms
• Often times incorrectly diagnosed with bacterial bronchitis and given antibiotics.
• As a croup-causing virus it causes laryngitis in adult

People often say they are worried their child’s cold will “turn into RSV”—do you get that from your patients?  

• Misconception that any cold will turn into RSV.  Either you have RSV or you don’t.  

When should you see your doctor?

• Early if it is RSV season or known exposure and you want them tested early in the disease course.
• Any concerns about how they are doing—breathing, hydration, etc

Are there specific groups of children more vulnerable to severe RSV complications?  Which kids are at higher risk?

• History of asthma or eczema
• Premature
• Especially those who are on oxygen
• Any underlying medical conditions such as heart problems

What is the significance of early detection and timely medical intervention?  Is it helpful to come in early

• The earlier we can identify RSV the better.
• About 48 hours out the symptoms get the worst
• Early identification prepares us for what to expect from RSV rather than another cold-causing virus.
• There is a predictable course for the severity of symptoms and duration of symptoms
• Early testing gives us the ability to be more aggressive early on to prevent complications that may require hospitalization—low oxygen, dehydration

What care can parents give for RSV at home?

• Mainstay: frequent nasal saline and suctioning with a bulb syringe, nose freeda or electric suctioning device
• I have had children admitted to the hospital from the ER when all they really needed was excellent nose suctioning
• also, good hydration and feeding to prevent dehydration
• AND YOU OFTEN SAY YOU ARE TOO THRIFTY TO BUY SALINE DROPS.  WHAT IS THE RECIPE FOR MAKING SALINE AT HOME?
• It is 1/2 teaspoon of salt in 1 cup of warm water
• Can use this irrigate their nose and to clean out the bulb syringe after use as well

What are the treatment options for RSV?

• Treatment in office—machine suctioning, and for those who who have eczema or asthma we can use albuterol, steroids
• Education for treatment at home
• Hospital resources: Respiratory outpatient clinic 24/7, inexpensive and very helpful
• Hospital if needed for low oxygen or dehydration

What are the potential complications from RSV?

• Higher rate of secondary infections like bacterial sinus and ear infections are common
• Potential for pneumonia

What preventive measures can parents take to reduce the risk of RSV in their children?

• Avoidance of older kids when they are sick
• quarantine the baby away from the sick kids running around the house.
• Airborne disease so sharing the same air space with sick kids put the babies at risk

There are two types of immunizations for RSV—one for mothers and one for babies.

• There is an Immunization given to mother at later stage of pregnancy and she passes antibodies on to the child before they are born

AND IF THE MOTHER DOESN’T RECEIVE THE IMMUNIZATION THERE IS ANOTHER OPPORTUNITY FOR THE CHILD

• Neonates and infants born during or entering their first RSV season are eligible
• Children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season
• Passive immunization by giving RSV antibodies that last the duration of the RSV season.

Are there any misconceptions about RSV that you'd like to address?

• Does RSV cause asthma OR does it damage lungs? No
• Kids with a worse presentation from RSV probably because a child had an underlying predisposition to wheezing—already had eczema and asthma history in self or family and not because RSV damaged their lungs and caused asthma

DO YOU HAVE A FAVORITE RSV STORY?

• New in practice 22 years ago and had a new family that moved from California, worried about their baby in the middle of a stormy night—met them at the ER at Davis hospital and he was not doing well with RSV and was too sick for our pediatric floor at Davis and needed to be transported to Primary Children’s
• Storm was too bad for life flight but we found an ambulance that could transport a very sick baby to drive him through the storm to Salt Lake
• He is back now from a church mission for the Church of Jesus Christ of Latter-day Saints and winding up college