Teaching Parents About RSV

Human Respiratory Syncytial Virus (RSV)² is the center of a lot of media attention right now. The fuss, we nurses know, is long overdue. So, any other nurses with a sense of "well yes...this is what we have been trying to tell you, forever!"? Well, the hype is on, so let's take advantage and get some accurate information out there while we have their attention!

What is RSV?

Respiratory Syncytial Virus is a single-stranded, negative-strand RNA virus-A¹. For a healthy adult or child, it comes with mild cold-like symptoms, including cough, runny nose, headache, and the like. We often think of it as a virus mainly affecting children. Still, it can make a temporary home in any of our respiratory tracks. We may get a swab that tells us COVID-19 does not cause our symptoms, but we may never know that RSV was the culprit.

When RSV is More Than a Cold

The term "cold virus" is typically associated with upper respiratory symptoms. However, RSV can quickly become more serious, involving upper and lower respiratory tracks. We worry primarily about the babies, but also at risk of severe disease are older adults, anyone with immunocompromise, and anyone with heart and lung disease¹.

Infants are most at risk of significant RSV disease, especially premature infants with genetic differences (such as Trisomy 21), congenital heart disease, or neuromuscular disorders. These patients are most at risk of needing hospital admission and respiratory support, including mechanical ventilation. The mortality rate overall is low at an estimated 1%. Still, infants with risk factors make up most of that statistic¹.

When the RSV virus causes more clinically significant infection, it can lead to:

• Fever
• Bronchiolitis
• Pneumonia
• Severe, harsh-sounding cough
• Respiratory distress (tachypnea and other signs of increased work of breathing)
• Hypoxia (low oxygen saturation, even visible cyanosis)
• Lethargy
• Poor feeding

What to Teach Parents

RSV is common. It may not be possible to prevent RSV illness in infants entirely. RSV is most common in children, with an estimated 90% having been sick with RSV by age two¹.  Immunity after infection is short-lived, meaning RSV can reinfect anyone at any time. Teaching prevention and recognition of early signs and symptoms and when to seek help is essential.   Provide written information for parents to take home after giving birth. Referring parents to a reliable website² is also helpful (a simple hand-out with a QR code can work well).

RSV prevention

The principles of infection prevention and control are not unique to RSV. Thanks to COVID-19, never has the public been so aware of basic respiratory virus transmission prevention^{2, 3}:

• Droplets spread RSV from our respiratory system (virus droplets from a cough or sneeze or by touching a surface with the virus on it and then touching your face
• RSV can live on hard surfaces for many hours – B;  Surfaces should be cleaned and disinfected.
• Handwashing. It seems obvious but always worth repeating. Parents, siblings, and caregivers should wash their hands frequently when caring for an infant.
• Avoid sick people. Ask visitors with any signs of illness to delay their visit to another time.
• Avoid kissing on the face and hands (babies like to put their hands in their mouths)
• When possible, avoid high-risk settings (think lots of children)

You can't live in a bubble – when parents are sick

Everyone gets sick, including parents of young infants. Arming parents with information on what to do if they have respiratory symptoms may prevent unnecessary panic and, hopefully, undue guilt and self-blame. As we know, nobody is entirely immune. Here are some tips for parents who are experiencing respiratory symptoms:

• Handwashing (it's a repeat, but still the most important)
• If breastfeeding or pumping, keep providing breast milk if possible⁴. Antibodies from the mother and transferred into breastmilk and provide passive immunity to the baby. Reinforce to parents that breastfeeding does not need to stop if the mother is sick.
• Cough and sneeze into your sleeve and then wash your hands
• Disinfect surfaces
• Avoid kissing the baby's hands and face until feeling better.

When to seek medical attention

Parents should see medical attention if:

• A baby with risk factors of severe disease develops symptoms of a respiratory virus (premature infants or those with genetic, cardiac, or neuromuscular conditions and who are less than six months of age)
• Baby has difficulty breathing (are breathing fast or working hard to breathe)
• Baby has difficulty feeding
• Baby is lethargic

Call 911 or emergency services if:

• Baby is not responsive or difficult to wake up
• Baby appears off-color (blue or very pale)
• Baby is struggling to breathe

RSV Prophylaxis Injection (palivizumab)

Some infants may be eligible for palivizumab injections, a monthly injection that provides passive immunity during the high-risk season. However, palivizumab is costly, and guidelines for who is eligible differ between regions.   Risk factors that may qualify an infant for palivizumab include prematurity, chronic lung disease, congenital heart disease, neuromuscular disorders, and genetic differences such as Trisomy 21. Health organizations must have team members identified as responsible for screening infants for eligibility and providing parents of eligible infants with information about this option^{1, 3, 5}. 

What About Vaccination?

Parents understandably have questions about vaccination against RSV. RSV vaccinations are in the news lately, but the headlines sometimes need clarification.  RSV vaccines are in the research and development stages. No vaccination is currently available for RSV. Focus on prevention at home, prophylaxis for eligible babies, and when to seek medical help. Vaccine education can wait until it is available.

Bottom Line

RSV has long been a concern of anyone caring for patients with immunocompromise, especially those caring for at-risk infants and children.  After a brief break from the intensity of "RSV season,” thanks to the social distancing of the 2021-2022 Winter months, RSV has returned.  As we knew it would.  RSV has become a topic of conversation and media attention as it makes itself known as a virus deserving our attention.  While the interest remains high, it seems like there is no better time to hammer home our message, unchanged over decades: prevention of RSV is critical, especially for babies' first Winter. 

Parent Resources

Links to reliable web pages specific to RSV:

• Canadian Pediatric Society – Caring for Kids
• SickKids Hospital, Toronto, Canada - AboutKidsHealth
• Centers for Disease Control and Prevention
• Canadian Premature Babies Foundation
• American Academy of Pediatrics – Healthy Children.org

References

¹ Respiratory Syncytial Virus Infection - National Institutes of Health

² Respiratory Syncytial Virus Infection (RSV) - Centers for Disease Control and Prevention

³ Respiratory syncytial virus infection: Prevention in infants and children - UpToDate

⁴ Breastfeeding provides passive and likely long-lasting active immunity

⁵ Medline Plus - Palivizumab Injection