Respiratory Infections

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Respiratory Infections

Respiratory Syncytial Virus - RSV

Causative Agent

Respiratory syncytial virus (RSV) is a single stranded RNA paramyxovirus, which is the same family as para-influenza, measles and rubella.

Clinical Description

Although in most case symptoms resemble the common cold, RSV can cause a severe or life threatening disease, especially in younger infants. Infection does not confer immunity however and continual re-infection throughout life is common. RSV is also increasingly recognised as a major contributor to excess winter mortality in the elderly in temperate climates, such as the UK. RSV outbreaks occur on a yearly basis (in the UK with a striking seasonality at the turn of the year).

Transmission

Highly contagious, RSV transmission occurs by contact with infectious secretions via hand contamination and self-inoculation of the eyes, nose or mouth or contact with large droplets or aerosols or fomites.

Surveillance in Scotland

Surveillance information is based on the numbers of laboratory reports to HPS, which come for the most part from hospitalised patients.

Trends in Scotland (1995-2000)

RSV outbreaks have occurred repeatedly at the turn of the year in all recent winter seasons. The numbers of cases reported normally rise sharply to over 600 in the first 4 weeks of the new year and fall just as quickly thereafter. The 1999/2000 season was a particularly severe outbreak with over 800 cases per month at its peak.

Incidence and Risk

As the most common respiratory pathogen in infants and young children, RSV affects virtually all children by the age of 2 years. Most at risk of complications are very young infants, those with predisposing conditions and the elderly. Nosocomial outbreaks in paediatric areas or nurseries can be a major problem.

Prevention

Of the two available protective agents, Synagis (a monoclonal antibody) is the most effective and is hospital administered monthly, by intramuscular (IM) injections. With treatment with this drug being extremely expensive, prevention is recommended only for very young infants and children at high risk from the disease.

Graph of RSV laboratory reports to SCIEH midyear to midyear