B’More Healthy – January 2016

By Suzanne Pollak

With winter comes sledding, snowmen, and—much less joyously—the inevitable runny nose and cough. But for the very youngest of our children, the typical cold symptoms can turn into more than just an inconvenience and are definitely nothing to play with.

Almost all children have had a respiratory syncytial virus (RSV) by their second birthday. RSV affects the lower respiratory tract where the lungs and windpipe are, making it difficult to breathe. The virus occurs most frequently from November to April and is so common that “most of us, meaning babies, meaning children, meaning adults, have encountered some form of RSV in our lives,” says Dr. Ashanti Woods, a pediatrician at Mercy Medical Center in Baltimore.

For most children, RSV results in nothing more than a cold. But for the very young, its effects can be much worse. “It wreaks havoc on children less than 2 years of age,” says Woods, adding that its impact can range “from mild all the way to severe.” In severe cases, the virus can cause bronchiolitis, lung failure, and pneumonia. Infected children may experience decreased urine output, and the skin on their faces or chests may appear blue due to a lack of oxygen. Premature infants, as well as those with a chronic lung disease, a weakened immune system, or certain heart diseases, are particularly susceptible to developing serious health complications from RSV.

RSV is highly contagious, spreading when an infected person coughs or sneezes and sends virus-containing droplet particles into the air. It also can be spread directly, through kissing. The virus can live for more than 90 minutes on a person’s hands and for several hours on hard surfaces like doorknobs, tables, and cribs. If an older child or adult have a cold, their sneezing can spread RSV to the youngest in the family. The virus also tends to spread quickly in crowds and day care centers. “RSV will be in your young child’s day care this fall or winter,” promises Woods.

People infected with RSV are usually contagious for three to eight days, with symptoms normally manifesting within four to six days after contact with the virus. A cough, stuffy nose, and fever are common. The goal in treating these minor symptoms in children is to make the child comfortable by reducing a fever greater than 100.4 degrees and using nasal sprays or drops to help thin the mucus. “A child who can breathe is a comfortable child,” notes Woods.

It’s also important to get fluids, including water, into a sick child, adds Woods. If the child is too sick to eat, Woods recommends having him or her drink an electrolyte-rich fluid, like Pedialyte, or milk. “Milk is that heavy meal to a baby,” he explains.

To keep a lookout for any signs of RSV, parents should monitor their babies’ breathing to make sure they aren’t wheezing or in respiratory distress. They should also check if their children’s nostrils flare or their chests visibly move—“almost like a seesaw at a playground,” says Woods—with each breath. For a baby, more than 60 breaths a minute is considered rapid; the normal rate is between 30 to 45 breaths a minute, points out Woods.

If a child’s breathing appears to be labored, he or she should be taken to a health care provider immediately. Most hospitals and clinics can test for RSV using a sample of fluid taken from the nose with a cotton swab. If RSV is detected in a young child, supplemental oxygen may be administered or mucus may be suctioned from his or her airway. Antibiotics are generally not recommended unless the child also has an ear infection. RSV typically lasts from one to two weeks, with the worst symptoms occurring during days three through five.

To help prevent RSV infection, the University of Maryland Medical Center recommends that people wash their hands with warm water and soap before touching a baby. Anyone with a cold or fever should avoid contact with babies altogether or at least wear a mask around them. Avoid sharing food or utensils as well, the center further recommends, and refrain from smoking anywhere near a baby, as exposure to tobacco smoke increases the risk of contracting RSV.

There currently is no vaccine for RSV, but researchers are working to develop one. Late this past September, Novavax Inc., a Gaithersburg company, announced that a mid-stage study of an RSV vaccine it has been working on for pregnant women in their last trimester showed that the vaccine was both safe for the mothers and, through the transfer of anti-RSV antibodies in utero, provided increased protection against the virus to their babies after birth.

A few days after Novavx’s announcement, the FDA approved the Simplexa Flu, a new test that was expected to begin detecting additional strains of RSV this flu season.

According to the Centers for Disease Control and Prevention, the drug palivizumab can prevent RSV in certain infants who are at high risk although it cannot treat or cure the virus. BC

Respiratory syncytial virus, or RSV, affects the lower respiratory tract where the lungs and windpipe are, making it difficult to breathe. For most children, the virus, which occurs most frequently from November to April, results in nothing more than a cold. But for very young kids, its effects can be severe, causing bronchiolitis, lung failure, or pneumonia in some cases.