RSV Prevention in Children

The respiratory syncytial virus (RSV) is a common cause of infections in people of all ages. While it often just causes symptoms similar to the common cold in older children and adults, in infants and younger children, it can cause bronchiolitis, a more serious infection, associated with inflammation in the lungs, wheezing and difficulty breathing.

RSV can also cause croup, ear infections, and pneumonia.

RSV Season

RSV infections are seasonal, and in the United States, typically run from mid-September through April, peaking from late December to mid-February.

RSV infections are so common that about two-thirds of children are infected during their first year of life and almost all children have had an RSV infection by the time they are 2 years old. Most of these are mild infections, but each year about 57,000 children under the age of 5 are hospitalized.

Children usually develop symptoms about 4 to 6 days after being exposed to someone with an RSV infection (the incubation period). These symptoms initially include just a clear runny nose, but as the virus spreads, symptoms may worsen and may include coughing, vomiting, fever (which can range from low grade to very high), rapid breathing with retractions and nasal flaring, wheezing, and poor feeding. In severe cases, children may have apnea and respiratory failure.

Treating RSV Infections

Like most viral infections, treatment of RSV infections are usually symptomatic. In children with wheezing and difficulty breathing, nebulized treatments with albuterol were once thought to be helpful but now aren't recommended.

Other treatments may include supplemental oxygen and intravenous fluids if your child is not able to eat and drink well. Treatment of bronchiolitis with steroids is controversial and is generally not thought to be helpful. Since it is a virus, treatment with antibiotics is also not usually helpful, unless your child develops a secondary bacterial infection.

Although most children with RSV infections can be safely treated at home, a few children, especially younger infants or those with a chronic medical condition, need to be hospitalized and closely monitored. Occasionally, children with severe difficulty breathing and/or apnea need to be placed on a ventilator to help them breathe. RSV can also be fatal in some children.

Preventing RSV Infections

Children most at risk for serious complications of an RSV infection include premature infants with or without chronic lung disease and term infants with chronic lung disease. Fortunately, medications are available to prevent RSV infections in these high-risk patients.

Synagis (palivizumab), a monoclonal antibody to protect against RSV, became available a in 1998.

Although it is also given monthly, Synagis is available as an intramuscular injection. Synagis is not a blood product and won't interfere with your child's immunizations.

The American Academy of Pediatrics (AAP) updated their guidelines for which children should receive RSV prophylaxis with Synagis in the 2014. While premature infants who premature infants who were born between 32-35 weeks and who are less than three months old at the start of RSV season and who have at least one risk factors could once qualify for Synagis, the latest recommendations are that Synagis is recommended for:

• Premature infants who were born at less than 29 weeks and who are less than twelve months old at the start of RSV season (typically October to March).
• Certain infants with hemodynamically significant heart disease who are less than twelve months old at the start of RSV season, especially children with acyanotic heart disease who are receiving medication to control congestive heart failure and will require cardiac surgical procedures and infants with moderate to severe pulmonary hypertension.
• Premature infants with chronic lung disease, who were born at less than 32 weeks, who are less than twelve months old at the start of RSV season, and had a requirement for > 21% oxygen for at least 28 days after birth.
• Children less than two years of age who are profoundly immunocompromised during RSV season.
• Certain children who are younger than two years with chronic lung disease who continue to require supplemental oxygen, chronic corticosteroids, or diuretic therapy, etc.
• Certain infants with pulmonary abnormalities or neuromuscular disease that impairs their ability to clear secretions from their upper airways who are less than twelve months old at the start of RSV season.

In July of 2023, the FDA approved an immunization to prevent all infants from RSV, not just those who are high-risk.

The monoclonal antibody immunization, called Beyfortus, is made by Sanofi and AstraZeneca. It's approved for infants born during RSV season or entering their first RSV season, as well as children up to 24 months who are not yet protected.

Studies show Beyfortus is 76.8% effective at reducing hospitalizations from RSV within the first five months of life.

Infants can also gain protection against RSV if their mothers are vaccinated with Pfizer’s maternal RSV vaccine, called Abrysvo, between weeks 32–36 of pregnancy.