RSV

Breanna Fretwell

History of RSV

DISCOVERED IN 1956

ONE OF THE MOST COMMON CAUSES OF CHILDHOOD ILLNESS

A MEMBER OF THE FAMILY PARAMYXOVIRIDAE AND THE SUBFAMILY PNEUMOVIRINAE

IT IS AN ENVELOPED RNA VIRUS AND TWO STRAINS (SUBGROUPS A AND B) ARE RECOGNIZED

Case Study – Twin A

Our patient is an ex-36 wk, now 1-month old (twin A) girl with a 3-day history of cough and nasal congestion.

She presented to her PMD with decreased activity, sleepiness, cough and nasal congestion

On the day of her admission, she was seen by her doctor and noted to be hypothermic to 101.3 F, lethargic

She was admitted for further evaluation and treatment.

Because of her nasal discharge and cough, RSV and Flu-A nasal washings were sent.

Nasopharyngeal washing for RSV was positive

The team initiated racemic epinephrine and nasal suctioning

Her respiratory symptoms resolved over the course of a week

The child was discharged home

Paramyxoviridae Pneumovirinae

Morphology: Spherical or filamentous, pleomorphic

Envelope: Yes

Diameter (nm): 90-350

Length (nm): 90-10,000

Structural components:Nucleocapsid, envelope with transmembrane viral spikes

Buoyant density (g/mL): 1.18-1.20

Lipid composition:Envelope lipids are derived from plasma membrane of host cell

Additional information:Surface glycoprotein spikes are 11-20 nm long; dense internal nucleocapsid; infectivity unstable

FAMILY SUBFAMILY

Virulence

Nucleocapsid protein associates with genomic RNA

protects the RNA from nuclease digestion

Requirement for a neutral pH for fusogenic activity.

The cell attachment proteins span the viral envelope

project from the surface as spikes

bind to proteins on the surface of target cells to facilitate cell entry

Can survive on hard surfaces such as tables and crib rails for many hours

Softer surfaces like tissues and clothes for shorter period of time

What does RSV do?

Attacks: Mucous membranes of nose and throat especially

trachea, bronchi, bronchioles, and alveoli

Speed: 3-5 day incubation; progression over 1-7 days

Who does it affect? Can affect anyone of any age. The severest

infections usually occur in infants, the elderly, or people with weakened immune systems

RSV can cause: upper respiratory infections (such as colds)

lower respiratory tract infections (such as bronchiolitis and pneumonia).

In children under 1 year of age, RSV is the most important cause of bronchiolitis, an inflammation of the small airways in the lung.

Show symptoms within 4 to 6 days of infection. Most recover in 1 to 2 weeks Even after recovery, very young infants and children with weakened

immune systems can continue to spread the virus for 1 to 3 weeks.

How RSV affects human cells

How do you catch RSV?

often introduced into the home by school-aged children who have a mild upper respiratory tract infection, such as a cold.

RSV can be spread when droplets containing the virus are sneezed or coughed into the air by an infected person

direct and indirect contact with nasal or oral secretions from infected persons.

Direct contact: wiping childs nose

Indirect contact: touching door knob that the person with RSV touched and then wiping your eyes, nose or mouth

How do you know if you have it?

Nasopharyngeal washing for RSV

Dr. cultures a sample of mucous from your nose

Usually diagnosed by symptoms and by knowing whether there is an outbreak of the infection in your area

Prevention

Wash your hands often

Disinfect hard surfaces

Do not share cups or eating utensils

Isolate person with RSV

Treatment

Palivizumab

Drug for the prevention of RSV in high risk people

Does not lessen the infection if it has already been transmitted

Drug treatments are in progress, but none are available yet

Prop up your child's head to make it easier to breathe and sleep.

Suction your baby's nose if he or she can't breathe well enough

Infection will go away on its own in a week or so

Prevalence of RSV

Almost all children will have had an RSV infection by their second birthday.

When infants and children are exposed to RSV for the first time, 25% to 40% of them have signs or symptoms of bronchiolitis or pneumonia, and 0.5% to 2% will require hospitalization.

Most children hospitalized for RSV infection are under 6 months of age.

Specific number of people with this infection is unknown, but about 125,000 per year diagnosed

In temperate climates, tends to be an epidemic during winter season

In tropical climates, tends to be an epidemic during rainy season

In the United States…

In Oregon…

Why is RSV important?

RSV will affect the majority of people in their lifetimes at least once if not multiple times

Anybody of any age can get RSV

Though many cases are not serious, they are just seriously uncomfortable, some cases are very serious with the possibility or occuring of death. If death is even a possibility, it should be researched

References Case Presentation: Respiratory Synctial Virus (RSV) Infection. Sutter

Health CPMC. May 2003. Accessed July 14, 2013. http://www.cpmc.org/advanced/pediatrics/physicians/pedpage-503rsv.html

History of RSV. Center for Disease Control and Prevention. January 14, 2010. Accessed July 15, 2013. http://www.cdc.gov/rsv/research/history.html

SpringerReference. Pneumovirus. 2013. Accessed July 14, 2013 http://www.springerreference.com/docs/html/chapterdbid/311139.html

Stanford edu. 2000. Accessed July 15, 2013. http://www.stanford.edu/group/virus/rhabdo/2000/RSV.html

Center for Disease Control and Prevention. January 14, 2010. Accessed July 15, 2013. http://www.cdc.gov/rsv/about/symptoms.html