Every year during cold and flu season, patients flock to pharmacies looking for advice to treat their symptoms. While many are experiencing common colds, others are afflicted by something more serious. Respiratory syncytial virus (RSV) and influenza are both highly contagious respiratory infections common throughout the fall and winter months.

Though symptoms are similar, RSV and the flu are not the same. RSV is a leading cause of hospitalization in infants. When recommending treatment options, it’s important for pharmacists to understand the symptoms in order to recommend the best course of action to effectively treat patients and help stop the spread.

What Is RSV? 

RSV is also called respiratory syncytial virus. The virus causes respiratory infections, which can range from mild to life-threatening. It is spread through respiratory droplets and is highly contagious. The virus doesn’t produce long-lasting immunity, so reinfection is possible. 

RSV is considered a seasonal virus. In North America, it is most prevalent from late fall until early spring. 

Symptoms of RSV

Symptoms of RSV usually appear within 2 to 8 days of exposure. In toddlers, children, and adults, the most common symptoms include the following:

  • Congestion
  • Cough
  • Headache
  • Fatigue
  • Fever
  • Sore throat
  • Runny nose

In babies, RSV may cause fussiness, decreased appetite, and changes to breathing patterns. 

In most cases, RSV remains mild, and symptoms resolve within 7 to 14 days. RSV can progress to bronchiolitis, which is a lower respiratory tract infection with small airway obstruction. In rare cases, it can develop into pneumonia. Severe cases of RSV can result in respiratory failure, apnea, or death. 

Signs of severe illness include:

  • Noisy breathing
  • Flaring of nostrils with every breath
  • Blue or grey tinge around lips, mouth, and fingernails
  • Laboured breathing or belly breathing
  • Short, shallow, slow, or rapid breathing
  • Pauses while breathing

What Population Is at Risk for RSV? 

Everyone is susceptible to RSV. Older children and adults can have multiple infections due to a lack of long-term immunity to the virus. The virus is mild or asymptomatic in the vast majority of cases among adults and children 12 months and older.

People with certain risk factors are at greater risk of RSV progressing to a more serious lower respiratory infection. Babies younger than six months are the most likely to develop severe infection. Other high-risk groups include:

  • Infants with heart or lung conditions
  • Premature infants
  • Children who have difficulty swallowing or clearing mucus
  • Immunocompromised children and adults
  • Adults over age 65
  • Adults with congestive heart failure, chronic obstructive pulmonary disease, or asthma

How Prevalent Is RSV?

RSV is extremely common. There are an estimated 64 million worldwide infections annually. RSV results in 3.4 million hospitalizations and an estimated 10,000 deaths worldwide per year. 

What Is the Difference Between Flu and RSV? 

Influenza, or flu, is also a viral illness that causes respiratory infection. It has many of the same symptoms as RSV, including coughing, runny nose, fever, and headaches. Flu is more likely to have a sudden onset of symptoms. Flu is also more likely to cause significant fatigue and body aches than RSV.

How To Treat RSV

Patients who present with mild RSV symptoms can be treated with home care. Children and adults may benefit from over-the-counter medication such as acetaminophen or ibuprofen to control fever. Pharmacists can recommend rest, fluids, adequate nutrition, and a cool mist humidifier to help ease symptoms and encourage recovery. 

If RSV progresses to a more serious condition, medical attention is required. Patients may need hospitalization, IV fluids, and oxygen support. 

There is one anti-viral medication – ribavirin – approved for the treatment of RSV infection in infants and, in combination with interferon α2b, hepatitis C. It is typically only recommended for patients with underlying conditions that compromise immune function. It is not indicated for patients receiving ventilation. 

How To Prevent RSV

Standard hygiene and infection control practices can reduce the risk of contracting RSV. Providers can advise patients to protect themselves through:

  • Frequent hand washing using soap and water
  • Cleaning and sanitizing frequently touched surfaces, objects, and toys
  • Keeping children home from school or daycare when they are ill
  • Avoiding contact with people who are ill
  • Limiting time in large group settings

People at high risk of complications due to RSV may be candidates for the prophylactic drug Palivizumab. This medication can reduce the risk of severe illness from RSV. Paliviumad is administered as a monthly injection during the RSV season.

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