Not Just for Kids
Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and pneumonia among infants and children under 1 year of age.1 According to the Centers for Disease Control and Prevention, almost all children are affected by the infection at least once before they are 2 years old. The disease is highly contagious and can live for several hours on a surface such as a countertop or table, or on unwashed hands.2
For most children with mild disease, no specific treatment is necessary other than the treatment of symptoms, eg, acetaminophen to reduce fever. Children with severe disease may require oxygen therapy and, sometimes, mechanical ventilation.1 Particularly at risk are infants born more than 4 weeks prematurely or those who have gone home after staying in the neonatal intensive care unit because of some type of chronic lung disease. Children who fall within the American Academy of Pediatrics guidelines for RSV immunization are eligible for prophylactic medication.2
Although many think of RSV as an infection of infants only, it often affects the elderly as much as does influenza, according to a study by Falsey et al, University of Rochester Medical Center.3 Although pediatricians are familiar with RSV, the authors write, many internists are not and do not consider RSV in adult patients, who may present with hoarseness. This despite the fact that RSV infections are responsible for an estimated 14,000 deaths of elderly and high-risk adults annually and account for more than 177,500 hospitalizations of adults each year at a cost of more than $1 billion.3 Additionally, adults may serve as an important reservoir in the community, infecting more vulnerable infants.2
The study followed 1,388 hospitalized patients, 608 healthy individuals over the age of 65, and 540 high-risk adults (congestive heart failure or COPD). The impact of RSV infection on both the healthy elderly and the high-risk group was significant, accounting for 10.6% of hospitalizations for pneumonia during winter months, 11.4% for COPD, 5.4% for CHF, and 7.2% for asthma.
There is no vaccine for RSV, although the World Health Organization has designated RSV as a high-priority target for vaccine development, and the study by Falsey et al, according to the article, provides an impetus to renew research on the treatment and prevention of RSV infection.3
If there is no vaccine, how do we prevent RSV? Frequent hand washing and not sharing items such as cups, glasses, and utensils should decrease the spread of the virus. In a hospital setting, RSV transmission can be prevented by strict attention to contact precautions, such as hand washing and wearing gowns and gloves.
The virus appears to be the most active from October to April, so we are in a high-risk time right now. What can RTs do to help prevent the spread of RSV among the elderly? Educate your high-risk patients, such as those with COPD, about the virus; in the hospital, wash your hands frequently and urge your patients to do the same. Urge your home care patients to wash their hands frequently; keep surfaces such as countertops, tables, and bathroom fixtures clean; and report flu-like symptoms to their physicians.
1. Centers for Disease Control and Prevention. Respiratory syncytial virus. Available at: www.cdec.gov/ncidod/dvrd/revb/respiratory/rsv.htm. Accessed January 9, 2006.
2. Many parents unaware of RSV: tips on this winter-borne virus. Available at: www.medicalnewstoday.com/medicalnews.php?newsid=35896. Accessed January 9, 2006.
3. Respiratory syncytial virus poses a significant threat to elderly. Available at: www.eurkalert.org/pub_releases/2005-04/wormrsv042605.php. Accessed January 9, 2006.