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What is respiratory syncytial virus?

• Respiratory syncytial virus (RSV) is a common virus that causes cold-like and other respiratory symptoms. It is one of the most frequent infectious diseases of early childhood, with nearly all children infected at least once with RSV by 2 years of age.

• RSV is a very common cause of hospitalization, especially in infants in the first 12 months after birth. The infection can be fatal, especially in high-risk groups (eg, weakened immune systems, preterm birth, heart abnormalities, lung disease).

• Reinfection is likely, and RSV is usually milder in older children. It can be severe in the elderly.

• Most common in winter and early spring.

What are the signs or symptoms?

• Cold-like signs or symptoms (runny nose, congestion, cough) for most children. Cough from RSV often lasts as long as 3 weeks.

• Very young infants also can exhibit

  • – Irritability

  • – Poor feeding

  • – Lethargy

  • – Fast breathing

  • – Use of chest, rib, or neck muscles to breathe

  • – Apnea (ie, brief periods of no breathing)

  • – Cyanosis (ie, skin or mucous membranes turn blue, usually when coughing)

• Respiratory problems include

  • – Bronchiolitis (ie, wheezing from narrowed airways in the lungs)

  • – Pneumonia

  • – Wheezing and/or asthma attack in children who already have asthma

• Compared with otherwise healthy children, children with weakened immune systems, preterm birth, or heart or lung problems have greater difficulty when ill with this infection. Very young infants (<6 months) have higher risk of hospitalization with RSV.

What are the incubation and contagious periods?

• Incubation period: 2 to 8 days; 4 to 6 days is most common.

• Contagious period: The virus can be shed for 11 to 14 days (3–4 weeks in young infants, usually beginning a day or so before signs or symptoms appear).

How is it spread?

• Respiratory (droplet) route: Contact with large droplets that form when a child talks, coughs, sneezes, or sings. These droplets can land on or be rubbed into the eyes, nose, or mouth. The droplets do not stay in the air; they usually travel no more than 3 feet and fall onto the ground.

• Contact with respiratory secretions or contaminated objects from children who carry RSV.

• The virus can live on surfaces for many hours and 30 minutes or more on hands.

• Before signs or symptoms appear, the infected person starts to shed virus that may infect others.

How do you control it?

• RSV prevention through immunization (see www.aap.org/immunizationschedule )

  • – Vaccination is recommended for all pregnant individuals.

  • – Infants younger than 8 months should receive immunization if their birthing parent was not vaccinated during pregnancy, or was vaccinated less than 14 days before delivery.

  • – Children ages 8 to 19 months at high risk of severe RSV diseases (eg, chronic lung disease), regardless of previous RSV vaccination status.

• Use good hand-hygiene technique at all the times listed in Chapter 2 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Prevent contact with respiratory secretions. Teach children and educators to cough or sneeze into a disposable tissue or their inner elbow/upper sleeve and to avoid covering the nose or mouth with bare hands. After coughing or sneezing, practice hand hygiene to prevent the spread of respiratory droplets. Ensure that anyone who contacts mucus or debris on their skin or surfaces washes their hands and any other contaminated skin immediately. Change or cover clothing soiled with mucus. Dispose of facial tissues that contain nasal secretions after each use.

• Clean or sanitize surfaces that are touched by hands frequently, such as toys, tables, and doorknobs, according to the Routine Schedule for Cleaning, Sanitizing, and Disinfecting in Chapter 8 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition .

• Sanitize commonly touched surfaces more frequently during the winter and early spring when outbreaks can be expected.

What are the roles of the educator and the family?

• Report the infection to the staff member designated by the early childhood education program or school for decision-making and action related to care of ill children and staff members. That person, in turn, alerts possibly exposed family and staff members to watch for symptoms.

• Practice control measures at home and in educational settings.

• Ensure parents are aware of new immunization recommendations for pregnant individuals and for children younger than 20 months to prevent RSV infection and reduce the severity of RSV in infants and young children.

• Promote breastfeeding, which helps protect infants from RSV.

• All children should be protected from exposure to tobacco smoke, and special efforts to avoid tobacco smoke (directly or indirectly [eg, clothes]) are warranted for children who are at risk (premature babies or those with lung or congenital heart disease) for serious disease from RSV.

Exclude from educational setting?

No, unless

• Child exhibits rapid or labored breathing or cyanotic (blue) episodes. Immediately refer a child with these symptoms to a health professional.

• The child is unable to participate and staff members determine they cannot care for the child without compromising their ability to care for the health and safety of the other children in the group.

• The child meets other exclusion criteria (see Conditions Requiring Temporary Exclusion in Chapter 4 of Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, 7th Edition ).

Readmit to educational setting?

Yes, when all the following criteria are met:

When exclusion criteria are resolved, the child is able to participate, and staff members determine they can care for the child without compromising their ability to care for the health and safety of the other children in the group