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Respiratory Syncytial virus (RSV): symptoms and therapy

by Josephine Andrews
Published: Last Updated on 241 views

The RS virus (respiratory syncytial virus, RSV) causes respiratory diseases. Small children are particularly affected, but sometimes adults are also affected. Symptoms can be harmless and resemble a common cold. However, severe courses are also possible, which can even be fatal. In most cases, however, the disease heals on its own within a few days. Read everything you need to know about the RS virus here.

ICD codes for this disease: J21 | J12 | J20 | B97

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

quick overview

  • What is RS virus? Respiratory syncytial virus (RSV) is the causative agent of seasonal acute respiratory infections that particularly affect young children. There are two virus subgroups: RSV A and RSV B. RSV A is dominant most years.
  • Symptoms : runny nose, dry cough, sneezing, sore throat; if the lower respiratory tract is involved: fever, rapid breathing , rales when breathing, wheezing, coughing up phlegm, dry, cold and pale skin , sunken fontanel (children under 18 months).
  • Risk factors for a severe course : including premature birth , children under six months, being male, children with previous lung diseases or heart defects, chromosomal abnormalities (such as trisomy 21), disease- or therapy-related immune deficiency, smoking household, malnutrition .
  • Diagnosis : Taking the medical history, physical examination including listening to the lungs, laboratory examination (smear test).
  • Treatment : only possible symptomatically; Sufficient fluid intake, nasal rinsing, inhalation, if necessary calf wraps against fever and fever-reducing medication, decongestant nasal sprays, bronchodilators, if necessary ventilation.
  • Prognosis : In adults, RSV infection is usually uncomplicated. In children, there are sometimes severe courses involving the lower respiratory tract (bronchiolitis); fatal of course possible.
  • Prevention : Hygiene measures (washing hands, sneezing and coughing in the crook of your arm, regular and thorough cleaning of children’s toys), vaccination for children at risk

Respiratory syncytial virus(RS virus): description

The term RS virus (or RSV) stands for the English term “respiratory syncytial virus”. It is a virus that causes cells to fuse (syncytia) in the respiratory tract.

The pathogen is similar to the flu virus and occurs worldwide. It causes seasonal outbreaks of disease: In Europe, most people contract the RS virus between November and April, most frequently in January and February.

RS virus: Babies and toddlers are often affected

In principle, people of any age can become ill from the RS virus. However, small children are particularly often affected:

Within the first year of life, 50 to 70 percent of all children become infected with the RS virus. After the end of the second year of life almost all children have already gone through an RS virus infection.

Infection with the RS virus is also the most common reason when infants and young children have to be treated in hospital for a respiratory disease. RSV disease can be particularly severe in premature and other babies. In premature babies with lung damage and children with heart defects, a Respiratory syncytial virus infection is even fatal in one in 100 cases.

Girls and boys are equally affected by an RS infection. However, boys tend to have a severe course of the disease much more often.

RS virus in adults

In most adults, the RS virus causes an uncomplicated infection of the upper respiratory tract with a runny nose, fatigue and cough. Many infected people show no symptoms at all, which is why the infection goes undetected. RSV infections occur equally in women and men.

RS virus in pregnancy

If a pregnant woman becomes infected with the RS virus, the pathogen could be transmitted to the unborn child – at least that was shown in animal experiments as part of a study. From the mother’s respiratory tract, the virus entered the fetus’ organism via the placenta . The effects of transmission on the unborn child have not yet been adequately researched. However, an influence on the development of the child cannot be ruled out.

RS virus: symptoms

Symptoms of RS virus infection can vary greatly from patient to patient. Adults who are otherwise healthy often have no symptoms at all. Then doctors speak of an asymptomatic or clinically silent Respiratory syncytial virus infection. In other cases, an often mild RS virus disease develops – those affected have cold-like symptoms such as:

  • sniffle
  • dry cough
  • snow
  • Sore Throat

RSV bronchiolitis in babies and young children

Especially in small children, an RSV infection can affect not only the upper airways (nose, mouth, throat) but also the lower airways (bronchi and lungs) – more precisely, the small branches of the bronchial tree. This is then referred to as RSV bronchiolitis. Then the infection with the RS virus triggers other symptoms in babies and toddlers, which become noticeable one to three days after the onset of the disease:

  • fever
  • accelerated breathing
  • Audible crackles and wheezing when breathing
  • cough with sputum
  • heavy breathing with use of the auxiliary respiratory muscles (supporting the arms, retractions of the skin on the chest)
  • shortness of breath
  • dry, cold and pale skin
  • Blue discoloration of the skin and/or mucous membranes (cyanosis) due to lack of oxygen
  • sunken fontanel in children under 18 months

In addition, there are general signs of illness such as weakness, feeling sick, lack of appetite and refusal to drink. Overall, the clinical picture of RSV bronchiolitis is reminiscent of whooping cough .

You can find out more about this topic in the article Bronchiolitis .

The symptoms of RSV infection can become severely worse within a few hours. Breathing arrests (apneas) can occur repeatedly in premature babies.

RS virus: prevention

The most effective measure for RSV prophylaxis is careful hygiene – within the family and in public life. This can counteract the spread of the pathogen:

  • Make sure you wash your hands properly on a regular basis.
  • Sneeze and cough into the crook of your arm, not your hands.
  • Clean children’s toys regularly.
  • Sick people should not visit community facilities (daycare, school, etc.).
  • Refrain from smoking – especially around children.

Breastfeeding is also advantageous for infants: breastfed children suffer less often from respiratory diseases than bottle-fed children.

RSV: vaccination for children at risk

There is no active RSV vaccination . For children with risk factors (see below), however, there is a passive vaccination against the RS virus. It contains artificially produced, so-called monoclonal antibodies against the RS virus (called palivizumab) and is injected into a muscle once a month during the RSV season. A total of five vaccine doses are planned, which will be administered at four-week intervals from November. It is best to always immunize on the same day of the week.

Specifically, doctors recommend passive RS virus vaccination for:

  • Premature babies born before 35 weeks gestation
  • Premature babies with the lung disease bronchopulmonary dysplasia (BPD)
  • Children under the age of two with congenital heart defects

According to experts, passive vaccination against RSV could reduce the risk of long-term effects of RSV infection.

RS virus: causes and risk factors

The RS virus consists of a protein envelope and the genetic information enclosed therein (in the form of RNA). It multiplies in the surface cells of the mucous membranes lining the airways (epithelial cells). A special protein is anchored in the virus envelope: the fusion (F) protein. It causes the affected mucosal cells to fuse (syncytia formation). These syncytia and the migrating defense cells of the immune system damage the mucous membranes – cells die and then block the airways.

RS virus: transmission

The RS virus is considered highly infectious . Anyone who has been infected with the virus can infect other people just one day later – ie before they show symptoms (see below: RS virus: incubation period).

Infected people are usually contagious for three to eight days. However, premature babies, newborns and people with a weakened immune system can also shed the RS virus for several weeks, in some cases even for several months, and can therefore be contagious to other people for a long time.

RSV: ways of infection

The RS virus can be transmitted via infectious secretion droplets or contaminated surfaces:

  • Droplet infection : When coughing, sneezing or speaking, infected people release tiny droplets of saliva containing the virus into those around them. If these get on the conjunctiva or nasal mucosa of a healthy person, they can also become ill.
  • Smear infection : A smear infection, for example via contaminated toys or clothing, is also possible. Experts believe that the Respiratory syncytial virus can survive for about 20 minutes on hands, 45 minutes on towels, and even several hours on plastic surfaces.

RS virus: incubation period

The time between infection and the onset of an infectious disease is called the incubation period. With the RS virus, it is two to eight days. On average, patients develop the first symptoms five days after infection.

RS virus: risk factors

The risk of RS virus infection becoming severe is particularly high in:

  • premature babies
  • Children with chronic lung diseases, eg bronchopulmonary dysplasia, cystic fibrosis, congenital airway abnormalities
  • Children with neurological and muscular disorders that limit lung ventilation
  • children with congenital heart defects
  • severe immune deficiencies
  • immunosuppressive therapy (therapy that suppresses the immune system, eg after organ transplantation)
  • Chromosomal abnormalities (such as trisomy 21 = ” Down syndrome “)

Other risk factors for severe Respiratory syncytial virus disease are:

  • age under six months
  • multiple births
  • male gender
  • siblings in infancy
  • nursery visit
  • smoking household
  • malnutrition
  • Cases of atopic diseases (such as hay fever , neurodermatitis) or asthma in the family
  • Low social and educational status of the parents (often associated with poor/narrow wealth, many siblings, increased exposure to smoke, etc.)
  • tight domestic conditions

RS virus: investigations and diagnosis

If your child has flu-like symptoms, shortness of breath and/or a high fever, take them to the pediatrician. Distinguishing RS virus disease from other respiratory viral diseases is not easy. In addition to the clinical examination, the doctor is helped by a precise description of the symptoms and the age of the patient.


He will first ask you in detail about your medical history (anamnesis). He will ask you the following questions, among others:

  • How long have the complaints existed?
  • Does your child have a fever?
  • Has your child had shortness of breath since becoming ill?
  • Does your child drink and eat enough?
  • Does your child suffer from an underlying disease such as a heart defect or cystic fibrosis?

Physical examination

The doctor then examines his patient thoroughly. He shines a lamp into the mouth and ears to detect possible reddening of the throat or ears. He feels the lymph nodes in the neck for possible enlargements and listens to the lungs with a stethoscope.

Respiratory syncytial virus bronchiolitis may be audible in the stethoscope as crackles and wheezes.

The doctor also checks whether the little patient’s fingernails or lips are bluish (cyanosis) – a sign of too little oxygen in the blood (hypoxemia).

laboratory tests

The RS viruses can be detected in the laboratory in a smear from the nasopharynx secretion of infected people. An antibody detection in the blood is only rarely possible, since the body produces only a few antibodies against the RS virus.

RS virus: treatment

There is no causal (causal) therapy for RSV infection. Thus, only the symptoms can be treated (symptomatic therapy).

General measures and home remedies

  • adequate hydration : This will liquefy the mucus that is stuck in the airways and makes it easier to cough it up.
  • Elevate your torso : Elevating your torso higher than the rest of your body, such as using a pillow, can help breathe easier.
  • Nasal rinsing or nose drops with saline : A nasal douche with saline solution rinses the nasal cavity thoroughly and frees it of germs, mucus and other secretions. Nasal drops with saline also keep the nasal cavity clear.
  • Inhalations : Inhaling helps against symptoms such as coughs and colds. The easiest way is to hold your head over a pot of hot water and breathe in the rising steam. However, this is not recommended for babies and small children – to be on the safe side, only one inhaler should be used here for inhalation. Seek advice from your doctor or pharmacist!
  • Calf wraps : If an RS virus infection is accompanied by fever, it can be lowered from a certain height with cool, damp calf wraps. Here you can find out how to proceed, when you can use this proven home remedy and in which cases it is not recommended .

Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse despite treatment, you should always consult a doctor.

Medication for RSV

If the fever is high, the doctor treating you may prescribe antipyretics such as paracetamol or ibuprofen .

decongestant nasal spray can make breathing easier if you have a bad cold.

Bronchodilators , such as salbutamol , widen the airways, making it easier to breathe. They are supplied via an inhaler, so they reach their destination directly. In severe cases, adrenaline may be given via the inhaler to expand the bronchi. It also has an anti-inflammatory effect.

Antibiotics are not effective against RS virus because they only help against bacteria and not viruses. However, the doctor treating you can prescribe them if a bacterial infection (secondary infection) is present in addition to the RS virus infection.

Sometimes cortisone (glucocorticoids, steroids) is also given for an RSV infection : administered systemically – ie as a tablet – it can help to alleviate the acute symptoms and shorten their duration. In contrast, cortisone administered as an inhalation is not effective.

Until a few years ago, severe RS virus infection in children was treated with the antiviral agent (antiviral) ribavirin. However, studies have shown that it is not effective.


If the oxygen level in the patient’s blood drops dangerously, ventilation is necessary. At the doctor’s or in the hospital, for example, the person concerned is supplied with oxygen via a breathing mask. Ventilation via a so-called CPAP mask (continuous positive airway pressure) or a tube may also be necessary. The latter is a flexible “tube” that is inserted into the airway and connected to a ventilator.

If an infection with the RS virus leads to respiratory arrest (apnea) in infants, the little ones must be monitored in hospital.

RS virus: disease course and prognosis

Usually the prognosis is good. But how long does an RS virus infection last?

The duration and severity of the disease are generally short and mild in otherwise healthy patients. RS virus disease often heals on its own within a few days (RS virus disease usually lasts three to twelve days). However, symptoms such as coughing can last longer than four weeks.

Severe courses mainly affect small children. Premature babies in particular have a high risk of developing a severe RSV infection in the first six months of life. How long babies with severe RS virus infection have to stay in the hospital always depends on the severity of the disease and the general condition of the child.

In about one percent of cases, an RSV infection is fatal despite intensive medical care.

RS virus: complications and late effects

Complications of an RSV infection occur particularly in people with the risk factors mentioned above.

Co-infection with other viruses that also affect the respiratory tract often occurs. In contrast, an additional infection with bacteria is rather rare with an RSV infection.

A fairly common complication is inflammation of the middle ear (acute otitis media). About three quarters of a percent of all middle ear infections in children under the age of three are caused by RS viruses (alone or together with other pathogens).

RSV-related pneumonia is another possible complication. Patients whose immune system is weakened due to illness or therapy are particularly at risk.

Pre-existing asthma or other pre-existing conditions (eg, heart) may be aggravated by acute RSV infection. On the other hand, such an infection can also lead to a persistent hypersensitivity (hyperreactivity) of the respiratory tract, on the basis of which, as a further consequence, early childhood asthma may develop.

In addition, an infection with the RS virus is associated with late effects of a neurological nature in previously ill children: as laboratory experiments with mice have shown, the viruses can get into the brain during the infection . One month after a previous infection, the animals showed neurological abnormalities such as seizures, perception and coordination disorders. Learning disabilities also occurred.

The spread of the RS virus from the airways to the central nervous system can be prevented by RSV vaccination.

RS virus: Re-infection possible

The infection that has gone through does not provide long-term protection against RS virus. Reinfection (reinfection) is possible at any age. This lack of immunity can be explained by the fact that the body hardly produces any antibodies against the RS virus. Reinfections are therefore frequent.

In children, they are often less severe than the initial infection. In adults, reinfection with the RS virus often manifests itself without any symptoms or only as an uncomplicated infection of the upper respiratory tract. A more pronounced clinical picture with flu-like symptoms is mainly observed in adults who have been in close contact with infected small children.

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