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Respiratory Syncytial Virus: The rise in particular Respiratory illness but not caused by COVID-19

Respiratory Syncytial Virus

The Center for Disease Control and Prevention recently noticed an increase in people with symptoms like COVID-19. However, CDC says it’s not due to COVID-19; they believe it is Interseasonal Respiratory Syncytial Virus (RSV). Therefore, CDC is asking all the caregivers and clinicians to go for the RSV testing even after the test for SARS-CoV-2 is negative. In addition, CDC represents few statistics for the average RSV cases in the US.

  • The number of outpatient visits for children less than five years old is around 2.1 million
  • Around 58,000 children (younger than 5 years old) admitted to the hospital due to RSV disease
  • Around 177,000 people aged 65 years and older were affected with RSV and hospitalized
  • Deaths due to RSV are around 14,000 for people who are 65 and older

Respiratory Syncytial Virus

Respiratory syncytial virus (RSV) is a typical infection, which affects both the young and old. Moreover, children as young as two years old are at more risk of catching such disease. RSV is responsible for many visits in an outpatient setting, in the hospital and can lead to death. The treatment is usually an important factor. It goes without complications in most cases.

The Palivizumab is a good recommendation for preventing RSV among children and young people to reduce hospital admissions and length of stay. Patients with a weak immune system need a special type of treatment. The treatment of such patients needs a combination of vitamin (B), (C), and palivizumab. Unfortunately, there are no medical or health-related indicators, and there is no way to show a reduction in RSV-cause mortality.

Therefore, a vaccine is the best solution, but it is still under the developmental stage with the hope of decreasing this disease. Respiratory Syncytial Virus affects children as well as adults. Several recent studies indicate an annual increase in the frequency of such conditions.

The prime focus is children for the disease and the outcome. But, the research for new drugs and antibiotics focuses on the rising number of cases. In this article, we look at RSV and focus on the treatment and procedures.

Characteristics of RSV

The period of the RSV season helps with the ideal organization of prevention and clinical conclusion. RSV normally happens from November through March. Throughout the US, screening of RSV is the responsibility of the National Respiratory and Enteric Virus Surveillance System. Winter is the season when this disease reaches its peak. Although in the south of the US, the onset of the RSV disease is earlier than in other regions with a longer duration due to the weather.

On the other hand, the people of Florida are less affected. The main reason behind that is Florida has the longest season, with the spread of RSV in July, peaks up in October, and then declining in the spring. At the same time, the Midwest region of the US faces a short duration of RSV disease.

Also, a good understanding of RSV transmission helps to reduce the spread of infection. The RSV transmits through direct or close contact with an affected person through droplets. But, direct contamination is more effective than getting the infection through droplets in the air. One of the most sensitive areas of the human body is the eyes and nose. Although to prevent catching disease through eyes and nose, the best-recommended practice is to wash hands properly to reduce transmission.

Survival Rate

The survival rate for RSV on any surface is quite high. For example, it can survive on the surface of the hand for 30min; on a non-porous surface, it persists for 12 hours, whereas on a stethoscope, it persists for 6 hours. The hatching period is 3 to 5 days, and viral shedding usually occurs within 3 to 8 days. Therefore, if a child acquires it, shedding lasts for three weeks or longer. The same is the case for those who are immunocompromised. However, shedding in adults is very short, depending on the age and medical condition.

Pathogenesis

Lymphocytic peribronchiolar and respiratory tract infiltration are where the Respiratory Syncytial Virus is confined. Replication of RSV typically takes place in the nasopharynx, after which it binds to the bronchiolar epithelium and destroys the cells. Hypersecretion of the mucous membrane occurs and infiltrates into round cells, causing tumors in the adjacent submucosa. Therefore, obstruction of small airways occurs. The release of Interleukins, chemokines, causes severe irritation and tissue damage during and after the illness. Thus the recovery of the epithelium begins after seven days of the disease, but the ciliated cells regenerate after a certain period.

Clinical manifestations

Children with RSV show symptoms of poor feeding, irritability, apnea, or lethargy. Around 20% of RSV-positive infant cases admit to the hospital due to apnea. RSV-positive children present with cough, sneezing, rhinorrhea, wheezing, fever, respiratory distress, or shortness of breath. The symptoms of RSV increase on day 5 of the illness and improve rapidly from days 7 to 10.

However, the patient still has coughs even after recovery for approximately four weeks. The reason behind this is the slow recovery rate for ciliated cells. Around 50% of patients face prolonged wheeze after recovering from RSV disease. But, it is still debatable whether the reason behind this is due to RSV or due to another condition.

Diagnosis and Treatment

The American Academy of Pediatrics (AAP) suggests that clinical thinking is the intelligent approach to analyzing the RSV. Diagnostic tests can be useful but on rare occasions. For example, nasopharyngeal washes or tracheal secretion is preferred for collecting RSV samples compared to nasal swabs taken from the patient. However, the nasal swabs method is preferred as this is the simplest and easiest method. Furthermore, the specificity of E.I.A. ranges from 90% to 95%, and the test’s sensitivity ranges from 50% to 90%.

Thus, the negative result should not be ruled out in RSV disease when there is a clear indication of symptoms. Besides, other methods for the detection of disease are available such as direct or indirect Immunofluorescence assays. The only drawback is that it takes several hours to produce results. Another diagnostic test for the detection of RSV disease is RSV culture. This technique is not helpful due to the cost, time, and high level of skills required to perform it, and results take up to 4 days to 2 weeks. By the time results come from this technique, the child is improving or recovering from the infection.

Supportive Care

Constant attention is the foundation of RSV bronchiolitis treatment. Monitoring of most children at home is possible. However, only those patients admitted to the hospital with serious illness show symptoms like dehydration, have poor feeding, require supplemental oxygen, or develop respiratory distress. The usual time of stay in an emergency is 3 to 7 days. 

The course of treatment provides hydration, nasal wash with nasal bulb suction, saline nose drops, or deep suctioning. Furthermore, there is a need to encourage oral feeding. In rare cases, temporary feeding tubes are very helpful. Oxygen is a requirement for patients who develop serious conditions and cannot maintain their oxygen saturation level greater than 90%. 

Antibiotics

RSV is a viral infection which is why antibiotics are of no use. Moreover, bacterial infections are rare. Thus antibiotics are prescribed after a certain diagnosis.

Ribavirin

For the treatment of RSV, the only drug which got approval from the US Food and Drug Administration (FDA) is Ribavirin. The function of the drug is to inhibit the transcription and translational process of the virus. Moreover, there are many factors that this agent is not in use as multiple studies show no decrease in mechanical ventilation after utilizing the medicine for a certain time. 

Prevention

Non-pharmacological strategies for forestalling the spread of RSV are significant. Doctors, guardians, and those in close contact with a child with RSV should rehearse great handwashing strategies and redundant hand washing. Besides, things like Isolation of patients with RSV positive in hospital, cleaning of toys, and infection control measures help control the transmission of such diseases. Right now, there are two products recommended for those patients at high risk. These two products are palivizumab and RSV immune globulin intravenous. Currently, in the US, palivizumab is available in the market.

Vaccines

There is currently no vaccine available to prevent RSV Past adaptations, for example, a formalin-inactivated antibody, just prompted more serious infections in those with natural diseases. An intravenous live antibody did not exhibit viability, and a lessened immunization showed no reaction. At present times cold adaptive live vaccine is under evaluation along with the recombinant adenovirus-based vaccine. 

Conclusion

To sum up, RSV is a serious illness, which attracts many children each year. Powerful attention is required, including clearing nasal secretions, hydration, nutrition, and oxygen, if necessary, which is still the main treatment for the patient. For every individual, best practices for hand hygiene and contact isolation should prevent RSV transmission.

Monitoring of those patients who are at high risk with palivizumab to prevent RSV infection. Palivizumab and Ribavirin are currently in use for the treatment of patients with a weak immune system. Whereas currently, vaccines are under developmental process, which is going to take some time.

Written by HealthRadar360

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