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RSV InfectionI. Epidemiology RSV infection is most common during infancy and early childhood, but may also occur in adults. Infection usually causes mild or moderately severe upper respiratory illness. However, life-threatening pneumonia or bronchiolitis (constriction of the small airways) has been reported in children with chronic cardiac and pulmonary disease, immunocompromised patients, and the elderly. Recent surveillance of 10 U.S. hospital laboratories performing cultures for RSV suggests that community outbreaks occur yearly between December and March, last from 3-5 months, and are associated with increased hospitalization and deaths among infants and young children. During community outbreaks of RSV, children admitted to the hospital with respiratory symptoms often serve as reservoirs for RSV. II. Diagnosis The clinical characteristics of RSV infection, especially in neonates, are often indistinguishable from those of other viral respiratory tract infections. Culture of RSV from respiratory secretions remains the "gold standard" for diagnosis. Although rapid detection kits are available and can provide results within hours. The benefit of using these tests to identify infected patients depends on the accuracy of the test. The reported accuracy of RSV enzyme immunoassays vary between 80% and 95%, and may even be lower in actual practice. In general, once laboratory-confirmed cases of RSV infection are identified in a hospital, a presumptive diagnosis of RSV infection in subsequent cases with manifestations suggestive of RSV infection may be acceptable for infection control purposes. III. Modes of Transmission RSV is present in large numbers in the respiratory secretions of symptomatic persons infected with the virus and can be transmitted directly via large droplets during close contact with such persons, or indirectly via RSV-contaminated hands or fomites. The site of entry is usually the conjunctiva or the nasal mucosa. Inoculation by RSV-contaminated hands is the usual way of depositing the virus onto the eyes or nose. Hands can become contaminated through handling of infected persons' respiratory secretions or contaminated fomites. In Hospital RSV outbreaks in which the viral isolates were typed, more than one strain of RSV has often been identified, suggesting multiple sources of the virus. Potential sources include patients, hospital staff, and visitors. Because infected infants shed large amounts of virus in their respiratory secretions (snot) and easily contaminate their immediate surroundings, they are a major reservoir for RSV. Hospital staff may become infected after exposure in the community or in the hospital, and in turn, infect patients, other health-care workers, or hospital visitors. IV. Control Measures Various combinations of control measures ranging from the simple to the complex have been effective, to some degree or other, in preventing and controlling hospital aquired RSV infection. Successful programs have had two elements in common: implementation of contact-isolation precautions, and compliance with these precautions by healthcare personnel. In theory, strict handwashing should prevent most RSV infections. However, health-care workers' handwashing practices have often been poor. Thus, other preventive measures are usually relied upon to prevent RSV infection. The basic precautions that have been associated with decreased incidence of RSV infections are gloving and gowning. Gloving has helped decrease transmission probably because gloves remind patient-care personnel to comply with handwashing and other precautions, and deter persons from touching their eyes or noses. The benefits from gloving, however, are offset if gloves are not changed between patients or after contact with contaminated fomites, and if hands are not adequately washed after glove removal. Gowning, in combination with gloving, during contact with RSV-infected infants or their immediate environment has been used successfully to prevent infection. In addition, the use of eye-nose goggles rather than masks has protected healthcare workers from infection; however, eye-nose goggles are not widely available and are inconvenient to wear.
What You Should Know About... Respiratory Syncytial Virus (RSV) in the Child Care Setting RSV causes infections of the upper respiratory tract (like a cold) and the lower respiratory tract (like pneumonia). It is the most frequent cause of lower respiratory infections, including pneumonia, in infants and children under 2 years of age. Almost 100 percent of children in child care get RSV in the first year of their life, usually during outbreaks in the winter months. In most children, symptoms appear similar to a mild cold. About half of the infections result in lower respiratory tract infections and otitis media. An RSV infection can range from very mild to life-threatening or even fatal. Children with heart or lung disease and weak immune systems are at increased risk of developing severe infection and complications. RSV causes repeated symptomatic infections throughout life. RSV is spread through direct contact with infectious secretions such as by breathing them in after an infected person has coughed or by touching a surface an infected person has contaminated by touching it or coughing on it. A young child with RSV may be infectious for 1 to 3 weeks after symptoms subside. The most effective preventive measure against the spread of RSV and other respiratory viral infections is careful and frequent handwashing. Once one child in a group is infected with RSV, spread to others is rapid. Frequently, a child is infectious before symptoms appear. Therefore, an infected child does not need to be excluded from child care unless he or she is not well enough to participate in usual activities. If a child or adult in the child care facility develops an illness caused by RSV infection: · Make sure that procedures regarding handwashing, hygiene, disposal of tissues used to clean nasal secretions, and cleaning and disinfection of toys are followed.
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