ACHOO! According to the CDC, those sneezes could be spreading Respiratory Syncytial Virus (RSV) with nearly all children contracting RSV by their second birthday. It doesn’t end there! People can be infected with RSV at any age and multiple times throughout their lifetime. The CDC estimates between 60,000-160,000 older adults in the U.S. are hospitalized with 6,000-10,000 dying from RSV infection each year.
Annually, the RSV season starts in the Fall and peaks in the Winter months in the U.S. RSV is highly contagious with symptoms mimicking the common cold (a runny nose, sneezing, coughing, and fever.) Most people will recover in a couple of weeks but for high-risk infants and adults over 60 it can lead to severe lower respiratory tract disease (LRTD). By understanding how RSV spreads and taking precautions, we can minimize exposure and reduce the risks of RSV exposure.
Transmission
RSV spreads by direct and indirect contact. It is transmitted directly through large droplets (through uncovered coughs) during close contact with infected persons or indirectly by hands or fomites that are contaminated with RSV. The incubation period ranges from 2 to 8 days; 4 to 6 days is most common. In general, infected persons shed the virus for 3 to 8 days, but young infants may shed the virus for as long as 4 weeks.
Precautions
In infants and children, RSV is most likely to present as viral bronchiolitis. In adults, RSV typically manifests into an upper respiratory tract infection. Direct contact with infected respiratory secretions is the most important determinant of transmission. CDC recommends placing patients with suspected RSV in droplet and contact precautions. Appropriate donning and doffing procedures and hand hygiene compliance are crucial. We’re human and sometimes in haste we may need a reminder. Don’t hesitate to remind a co-worker if you notice they accidentally forget to perform hand hygiene or grab that mask.
RSV can survive for many hours on hard surfaces, e.g., tables and crib rails. Be vigilant during cleaning and disinfection practices by only using hospital approved disinfectants and allowing for contact wet-times in accordance with the manufacturer’s instructions for use.
Educate patients and families on these simple hygiene practices to reduce the spread of RSV:
- Wash hands often, using soap and water for at least 20 seconds. If you do not have access to soap and water, use alcohol-based hand sanitizer
- Avoid close contact, such as kissing, and sharing cups or eating utensils with people who have cold-like symptoms
- Cover your mouth and nose with a tissue or your upper shirt sleeve when coughing or sneezing to prevent germ droplets from landing on surfaces and objects. Throw the tissue in the trash afterward
- Clean high-touch surfaces and objects, such as toys, doorknobs, and mobile devices
- If possible, stay home from work, school, and public areas when you are sick
RSV Vaccinations
For the first time, the U.S. has vaccinations and antibodies approved for high-risk populations. In May 2023, the FDA launched approval of the first RSV vaccine, Arexvy, approved for use in individuals aged 60 or older. Within months, Abyrso was FDA-approved for vaccination of pregnant women to prevent RSV in unborn babies. Additionally, the first RSV monoclonal antibody product, Nirsevimab (Beyfortus), was approved by the FDA for babies and children up to 24 months of age.
CDC recommends either maternal RSV vaccination or infant immunization with an RSV monoclonal antibody. Only under rare circumstances would an infant need both.
- Starting during pregnancy, within 32-36 weeks, women can be vaccinated during the months of September to January by receiving one dose Abrysvo which is the only RSV vaccine recommended during pregnancy.
- For all infants 8 months and younger, who are born during or entering RSV season, it is recommended that they receive immunization with one dose of Nirsevimab if the mother did not receive RSV vaccination during pregnancy or if the infant was born within 14 days of vaccination.
- For all children between the ages of 8-19 months, CDC recommends vaccination with Nirsevimab based on certain high-risk conditions. The first high-risk condition is being American Indian or Alaskan Native which are deemed to be higher risk for contracting severe RSV; other high-risk conditions include chronic lung disease from premature birth, a severe weakened immune system, or having severe Cystic Fibrosis.
- For adults aged 60 and older, there are certain conditions that place them at high-risk for developing severe RSV. For this population, the CDC recommends one dose of Arexvy or Abrysvo. High-risk conditions include chronic heart and lung disease, weakened immune system, and resident of long-term care facilities.
Every year, infants and older adults develop severe RSV and require hospitalization. For the first time, vaccines and monoclonal antibody products are available to protect older adults, infants, and young children from severe RSV. As always, the basics of infection prevention and control can prevent the spread of RSV.
References:
- Centers for Disease Control and Prevention. (2023, November 7). Respiratory Syncytial Virus Infection (RSV). Retrieved from cdc.gov
- Centers for Disease Control and Prevention. (2023, August 30). Respiratory Syncytial Virus (RSV) Immunizations. Retrieved from cdc.gov
- Federal Drug Administration. (2023, May 03) FDA approves first Respiratory Syncytial Virus (RSV) Vaccine. Retrieved from fda.gov
- Jones JM, Fleming-Dutra KE, Prill MM, et al. Use of Nirsevimab for the Prevention of Respiratory Syncytial Virus Disease Among Infants and Young Children: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:920–925. DOI:dx.doi.org
- Kaler, J., Hussain, A., Patel, K., Hernandez, T., & Ray, S. (2023). Respiratory Syncytial Virus: A Comprehensive Review of Transmission, Pathophysiology, and Manifestation. Cureus, 15(3), e36342.doi.org
- Melgar M, Britton A, Roper LE, et al. Use of Respiratory Syncytial Virus Vaccines in Older Adults: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023. MMWR Morb Mortal Wkly Rep 2023; 72:793–801. DOI: dx.doi.org
- Siegel JD, Rhinehart E, Jackson M, Chiarello L; Health Care Infection Control Practices Advisory Committee, Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007. Retrieved from cdc.gov