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 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): Length (nm):90-10,000 Structural components: NucleocapsidNucleocapsid, envelope with transmembrane viral spikes Buoyant densityBuoyant density (g/mL): Lipid composition: Envelope lipids are derived from plasma membrane of host cell Additional information: Surface glycoprotein spikes are nm long; dense internal nucleocapsid; infectivity unstableinfectivity FAMILYSUBFAMILY

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 Accessed July 14, rsv.html  History of RSV. Center for Disease Control and Prevention. January 14, Accessed July 15,  SpringerReference. Pneumovirus Accessed July 14, tml  Stanford edu Accessed July 15,  Center for Disease Control and Prevention. January 14, Accessed July 15,