Respiratory syncytial virus (RSV) infection

Respiratory syncytial virus (RSV) infection ) is a common cause of winter infections. In many cases the symptoms are similar to a cold and can be treated at home. However, some young children become seriously ill and need hospital care.

Key points about respiratory syncytial virus (RSV) infection

  1. Respiratory syncytial virus (RSV) is one of many viruses that cause infections of the respiratory tract – the parts of your body related to breathing.
  2. Almost all children will have had an RSV infection by their second birthday.
  3. If it recurs in healthy adults and older children, RSV symptoms are mild and similar to the common cold.
  4. However, in infants, the virus can cause serious illness including bronchiolitis and pneumonia (infection of your lung) and they may need hospital care.
  5. There is no vaccine against RSV, but you can help prevent its spread by covering coughs and sneezes, hand washing and other hygiene measures.

What are the symptoms of RSV infection?

The symptoms of RSV infection are typical symptoms of a cold, such as a runny nose, coughing, sneezing, fever (high temperature), wheezing and not feeling like eating. These symptoms usually appear in stages and not all at once. In very young infants with RSV, the only symptoms may be irritability, decreased activity and breathing difficulties. However, RSV can also cause serious illness, including bronchiolitis and pneumonia (infection of your lung). 

COVID-19 pandemic

Both RSV and COVID-19 are respiratory conditions. If you have any respiratory symptoms such as a cough, sore throat, shortness of breath, head cold or loss of smell, with or without fever, stay at home and call your GP or Healthline's dedicated COVID-19 number 0800 358 5453 to check whether you need to be tested for COVID-19.

When should I seek help for my child with RSV infection?

You should see your family doctor or go to an after-hours medical centre urgently if your baby or young child:

  • is under 3 months old
  • is breathing fast, has noisy breathing and is having to use extra effort to breathe
  • looks pale and unwell
  • is taking less than half of their normal feeds
  • is vomiting
  • has not had a wet nappy for more than 6 hours

You should also see a doctor if you are worried about your baby or young child. Even if you've already seen your doctor, if your child's breathing gets worse or you are worried, take your child back to the doctor. Read more about how to tell if your child is struggling to breathe.

Is RSV infection common in Aotearoa New Zealand?

In New Zealand, RSV is the most common cause of hospitalisation for lower respiratory tract infections for under 2-year-olds. Admissions for the flu occur much less often. RSV infections in Aotearoa New Zealand generally occur during winter and spring.

How is RSV infection spread?

RSV can spread when an infected person coughs or sneezes, as the virus droplets get in your eyes, nose or mouth. You can also get it from direct contact with the virus, eg, from kissing the face of a child with RSV. If you touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands, you can also get the virus.

Children are often exposed to and infected with RSV outside their home, such as in school or childcare centers. RSV can survive for many hours on hard surfaces such as tables and cot rails. It usually lives on soft surfaces, such as tissues and hands, for less time.

Who is most at risk of RSV infection?

People of any age can get another RSV infection, but infections later in life are generally less serious. People at highest risk for severe symptoms include:

  • premature babies
  • young children with congenital (from birth) heart or chronic lung disease
  • young children with compromised (weakened) immune systems due to a medical condition or medical treatment
  • adults with compromised immune systems
  • older adults, especially those with underlying heart or lung disease.

How is RSV infection diagnosed?

Your doctor will ask about your child’s symptoms, whether other close contacts have similar symptoms, your home environment and how long they have been sick. They will also do a clinical examination and, possibly, a throat swab or other tests. 

How is RSV infection treated?

Most RSV infections go away on their own in 1 to 2 weeks. There is no specific treatment for RSV infection. Care involves relieving symptoms, such as to:

  • manage fever and pain with paracetamol
  • drink enough fluids to prevent dehydration (loss of body fluids).

Talk to your healthcare provider before giving your child cold and cough medicines. Some medicines contain ingredients that are not good for children.

A medicine called palivizumab (pah-lih-VIH-zu-mahb) is available by injection to prevent severe RSV illness in infants and children who are at high risk of severe illness, such as babies born prematurely or with congenital heart disease or chronic lung disease. The medicine can help prevent serious RSV disease, but it cannot help cure or treat children already suffering from serious RSV, and it cannot prevent infection with RSV. It must be given regularly to be effective.

Is there a vaccine against RSV infection?

There is currently no vaccine readily available for RSV. Immunity to RSV develops over the first couple of years of life, but it is never fully complete, and tends to decline again with age. This means older adults can also be seriously affected with the virus.

How can I reduce the chance of my child getting RSV infection?

Take steps to make your child at less risk of catching RSV.

Breastfeeding – Breastfeeding your baby protects them from getting RSV infection by boosting their infection-fighting (immune) system. Breastfeeding beyond 4 months of age offers the best protection.

Smoke-free environment – Make sure your child's environment is smoke-free. If you want to give up smoking:

  • call the free Quitline Me Mutu on 0800 778 778 or text 4006
  • check out the website Quitline
  • ask your health professional

Vaccinations – Make sure your child is up to date with all their vaccinations. There is currently no vaccine for RSV but vaccination can prevent bacterial infections following RSV infection.

A warm house – Keeping the house warm and well-insulated will also decrease your baby's risk of developing RSV infection.

Stay away from people with coughs and colds – It is sensible to keep young babies away from people who have colds and coughs.

Parents of children at high risk for developing severe RSV disease should help their child, when possible, do the following:

  • Avoid close contact with sick people.
  • Wash their hands often with soap and water for at least 20 seconds.
  • Avoid touching their face with unwashed hands.
  • Avoid their sharing drink containers and toothbrushes.
  • Limit the time they spend in childcare centres or other potentially contagious settings, especially during autumn, winter and spring. This may help prevent infection and spread of the virus during the RSV season.

How can I prevent the spread of RSV infection?

Diagram of how to prevent the spread of RSVIf you have cold-like symptoms you should:

  • cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
  • wash your hands often with soap and water for at least 20 seconds
  • avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
  • clean frequently touched surfaces such as doorknobs and mobile devices
  • wash solid toys and consider getting rid of soft ones.

Ideally, people with cold-like symptoms should not interact with children at high risk for severe RSV disease, including premature babies, children younger than 2 years of age with chronic lung or heart conditions, and children with weakened immune systems.

If this is not possible, you should carefully follow the prevention steps mentioned above and wash your hands before interacting with such children. You should also not kiss high-risk children while they have cold-like symptoms.

Learn more

Respiratory syncytial virus (RSV) infection KidsHealth, NZ
Respiratory syncytial virus (RSV) Ministry of Health, NZ

References

  1. Respiratory syncytial virus infection (RSV) Centers for Disease Control and Prevention (CDC), US
  2. Understanding respiratory syncytial virus Asthma and Respiratory Foundation, NZ

Reviewed by

After 45 years of GP experience, and 8 years as an examiner and practice assessor, Dr Bryan Frost has completed a Diploma in Editing and is pursuing a new career. He also has a Diploma in Health Administration, with honours in management, and has also completed a paper in Health Care Law.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Bryan Frost, FRNZCGP, Morrinsville Last reviewed: 06 Jul 2021